Biocompatibility With Osteogenic Potential of Premixed Bioceramic Cements for Use in Apical Surgery

This study investigated the biocompatibility and osteogenic potential of premixed bioceramic cements (PBCs)-CeraPutty, EndoCEM MTA Premixed, Well-Root PT, and One-Fil PT Injectable-as alternatives to mineral trioxide aggregate for retrograde filling in endodontic microsurgery. Setting time was measured in saline and fetal bovine serum (FBS). Cytocompatibility was assessed using MTT assays on human periodontal ligament fibroblasts with serial extract dilutions at multiple time points. Osteogenic differentiation was evaluated by alkaline phosphatase (ALP) activity and Alizarin Red S staining for mineralized nodule formation. One-way ANOVA was used for biological data and two-way ANOVA for setting time analysis (p < 0.05). All PBCs demonstrated over 90% cell viability. CeraPutty showed significantly higher ALP activity, indicating enhanced early osteogenic differentiation. All materials promoted mineral deposition. Setting time varied by material and medium, generally increasing in FBS. Overall, PBCs exhibited favourable biological and setting properties, supporting their clinical use as reliable MTA alternatives.