Evaluation of the pH and Antibacterial Efficacy of Mineral Trioxide Aggregate With and Without the Incorporation of Titanium Tetrafluoride

Abstract

Introduction Microorganisms play an important role in causing inflammation in the pulp and periapical regions. Even after undergoing chemo-mechanical procedures during root canal treatment, bacteria may persist within dentinal tubules, posing a risk of disease recurrence. Mineral trioxide aggregate (MTA), introduced as a dental material, has been investigated as a potential antibacterial agent since its early use. Calcium and phosphorus are the primary ions in MTA, and their antibacterial characteristics are attributed to the release of calcium hydroxide through surface hydrolysis of calcium silicate components. Previous studies have shown that MTA has limited antimicrobial properties. Several alterations have been made to enhance the biological properties of MTA, such as incorporating nanoparticles made from silver, zinc, gold, and titanium. Therefore, in this study, titanium tetrafluoride (TiF(4)) was added to MTA in an effort to enhance its antimicrobial properties. Aim To compare and evaluate the antibacterial efficacy of MTA after the incorporation of TiF(4). Materials and methods A total of 56 samples were made by mixing MTA with different weight proportions of TiF(4) (1 wt%, 2 wt%, and 3 wt%). Out of these, 28 samples were taken to test each of the following properties: antibacterial efficacy and pH. The specimens were prepared using stainless steel molds of recommended dimensions for testing the pH. The pH was evaluated using a pH meter, and the antibacterial efficacy was assessed using the direct contact test. Data regarding the antibacterial efficacy and pH of MTA with various proportions of TiF(4) were investigated for normality using the Kolmogorov-Smirnov test and assessed for normal distribution. The antibacterial properties among the four groups were analyzed using one-way analysis of variance (ANOVA), followed by pairwise multiple comparisons using Tukey's Honest Significant Difference test. The level of statistical significance was determined at p ≤ 0.05. MTA, when incorporated with TiF(4), showed enhanced antibacterial properties. Results On day 1, the group treated with MTA containing 3% TiF(4) demonstrated the strongest antibacterial effectiveness, with a mean of 4.67 ± 0.04 colony-forming units (CFU)/mL × 10^8. However, the group treated with plain MTA had the lowest mean values, at 5.67 ± 0.25 CFU/mL × 10^8. On day 1, the MTA group with 3% TiF(4) also had the highest mean pH values (11.90 ± 0.05), while the plain MTA group had the lowest mean pH values (11.64 ± 0.78). On day 7, the MTA group with 3% TiF(4) had the highest pH value (12.85 ± 0.08), whereas the plain MTA group had the lowest pH value (11.92 ± 0.09). Conclusion The inclusion of TiF(4) resulted in an augmentation of the antibacterial efficacy of MTA against Enterococcus faecalis (E. faecalis). Hence, the integration of TiF(4) into MTA can be considered a promising development against E. faecalis during endodontic procedures.