1
|
Tez BÇ, Eliaçık BBK, Taşlı PN, Yılmaz H, Şahin F. Biocompatibility and Cytotoxicity of Pulp-Capping Materials on DPSCs, With Marker mRNA Expressions. Int Dent J 2024; 74:1064-1077. [PMID: 38692961 DOI: 10.1016/j.identj.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 05/03/2024] Open
Abstract
OBJECTIVES The present study aimed to (1) investigate biocompatibility and cytotoxicity of pulp-capping materials on viability of human dental pulp stem cells (hDPSCs); (2) determine angiogenic, odontogenic, and osteogenic marker mRNA expressions; and (3) observe changes in surface morphology of the hDPSCs using scanning electron microscopy (SEM). METHODS Impacted third molars were used to isolate the hDPSCs, which were treated with extract-release fluids of the pulp-capping materials (Harvard BioCal-Cap, NeoPUTTY MTA, TheraCal LC, and Dycal). Effects of the capping materials on cell viability were assessed using 3-(4,5-di-methyl-thiazol-2-yl)-5-(3-carboxy-methoxy-phenyl)-2-(4-sulfo-phenyl)-2H-tetrazolium (MTS) assay and the apoptotic/necrotic cell ratios and reactive oxygen species (ROS) levels from flow cytometry. Marker expressions (alkaline phosphatase [ALP], osteocalcin [OCN], collagen type I alpha 1 [Col1A], secreted protein acidic and rich in cysteine [SPARC], osteonectin [ON], and vascular endothelial growth factor [VEGF]) were determined by quantitative reverse-transcription polymerase chain reaction. Changes in surface morphology of the hDPSCs were visualised by SEM. RESULTS The MTS assay results at days 1, 3, 5, and 7 indicated that Harvard BioCal-Cap, NeoPUTTY MTA, and TheraCal LC did not adversely affect cell viability when compared with the control group. According to the MTS assay results at day 14, no significant difference was found amongst Dycal, Harvard BioCal-Cap, NeoPUTTY MTA, and TheraCal LC affecting cell viability. Dycal was the only capping material that increased ROS level. High levels of VEGF expression were observed with Harvard BioCal-Cap, TheraCal LC, and NeoPUTTY MTA. NeoPUTTY MTA, and Dycal upregulated OCN expression, whereas TheraCal LC upregulated Col1A and SPARC expression. Only Dycal increased ALP expression. HDSCs were visualized in characteristic spindle morphology on SEM when treated with TheraCal LC and Harvard BioCal-Cap. CONCLUSIONS NeoPUTTY MTA and Harvard BioCal-Cap showed suitable biocompatibility values; in particular, these pulp-capping materials were observed to support the angiogenic marker.
Collapse
Affiliation(s)
- Banu Çiçek Tez
- Department of Pediatric Dentistry, Faculty of Dentistry, Ankara Medipol University, Ankara, Türkiye
| | | | - Pakize Neslihan Taşlı
- Department of Genetics and Bioengineering, Faculty of Engineering and Architecture, Yeditepe University, Istanbul, Türkiye
| | - Hazal Yılmaz
- Department of Genetics and Bioengineering, Faculty of Engineering and Architecture, Yeditepe University, Istanbul, Türkiye
| | - Fikrettin Şahin
- Department of Genetics and Bioengineering, Faculty of Engineering and Architecture, Yeditepe University, Istanbul, Türkiye
| |
Collapse
|
2
|
Lin CY, Chen RS, Hsu SH, Chen MH. A tricalcium phosphate (TCP) and hydroxyapatite (HA) based light-cured biomaterial for vital pulp therapy. Dent Mater 2024; 40:1417-1424. [PMID: 38937202 DOI: 10.1016/j.dental.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 06/03/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVES Evaluate a new light-cured material with better properties for vital pulp therapy. METHODS Light-cured resin materials consisted of polyethylene glycol (600) diacrylate mixed with different ratios of TCP to HA. In addition to the temperature change (n = 5 for each subgroup) were tested, cell viability and Alizarin Red Staining (ARS) assay were also tested in vitro on human dental pulp cells (n = 6 for each subgroup). Lastly, the material was then compared with Biodentine and control groups in the molars of Wistar rats in vivo for histology assessment. RESULTS The temperature change for the new materials were under 5 degrees Celsius. For the in vitro assessments, there was no significant difference on day 3 and day 7 for cell viability test. ARS assay showed significantly higher mineralized nodule formation when treated without induction medium for Group D and Biodentine on day 10 compared to Group C and control. On the contrary, Biodentine and control groups treated with induction medium showed significant higher mineralization than the new materials. Histology assessments demonstrated higher mineralized content in Group D and Biodentine on week 3 and week 6. The inflammatory cells in the dental pulp complex of the Biodentine group resolved on week 6 while the inflammation resolved in Group D on week 3. SIGNIFICANCE The new material exhibits low heat production, low cytotoxicity, and good calcium ion release capability. Compared to traditional materials, it has shorter setting time and better aesthetic outcomes, making it highly suitable for use in vital pulp therapy.
Collapse
Affiliation(s)
- Chun-Yen Lin
- School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, No. 325, Section 2, Chenggong Rd., Neihu Dist., Taipei City 114202, Taiwan, ROC; Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, No. 15-2, Gongyuan Rd., Zhongzheng Dist., Taipei City 100227, Taiwan, ROC
| | - Rung-Shu Chen
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, No. 15-2, Gongyuan Rd., Zhongzheng Dist., Taipei City 100227, Taiwan, ROC
| | - Sheng-Hao Hsu
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, No. 15-2, Gongyuan Rd., Zhongzheng Dist., Taipei City 100227, Taiwan, ROC
| | - Min-Huey Chen
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, No. 15-2, Gongyuan Rd., Zhongzheng Dist., Taipei City 100227, Taiwan, ROC; Department of Dentistry, National Taiwan University Hospital, No. 15-2, Gongyuan Rd., Zhongzheng Dist., Taipei City 100227, Taiwan, ROC.
| |
Collapse
|
3
|
Nazemi Salman B, Mohebbi Rad M, Saburi E. Apoptotic effects of biodentine, calcium-enriched mixture (CEM) cement, ferric sulfate, and mineral trioxide aggregate (MTA) on human mesenchymal stem cells isolated from the human pulp of exfoliated deciduous teeth. Minerva Dent Oral Sci 2024; 73:194-199. [PMID: 38963287 DOI: 10.23736/s2724-6329.24.04826-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
BACKGROUND Preservation of primary teeth in children is highly important. Pulpotomy is a commonly performed treatment procedure for primary teeth with extensive caries. Thus, biocompatibility of pulpotomy agents is highly important. Biodentine, calcium enriched mixture (CEM) cement, ferric sulfate, and mineral trioxide aggregate (MTA) Angelus are commonly used for this purpose. Thus, this study aimed to assess the apoptotic effects of Biodentine, CEM cement, ferric sulfate, and MTA on stem cells isolated from the human pulp of exfoliated deciduous teeth. METHODS In this in-vitro, experimental study, stem cells isolated from the human pulp of exfoliated deciduous teeth were exposed to three different concentrations of Biodentine, CEM cement, ferric sulfate, and MTA for different time periods. The cytotoxicity of the materials was evaluated by flow cytometry using the annexin propidium iodide (PI) kit. Data were analyzed by ANOVA and Tukey's test at P<0.05 level of significance. RESULTS All four tested materials induced significantly greater apoptosis compared with the control group. The difference in cell apoptosis caused by the first concentration of ferric sulfate and MTA was not significant at 24 hours. In other comparisons, the cytotoxicity of ferric sulfate was significantly lower than that of other materials. Biodentine showed higher cytotoxicity than MTA at first; but this difference faded over time. The cytotoxicity of CEM cement was comparable to that of MTA. The highest cell viability was noted at 24 hours in presence of the minimum concentration of ferric sulfate. The lowest cell viability was noted at 72 hours in presence of the maximum concentration of CEM cement. CONCLUSIONS In comparison with other materials, ferric sulfate showed minimum cytotoxicity; the cytotoxicity of the three cements was comparable. It appears that the concentration of ferric sulfate and the composition of cements are responsible for different levels of cytotoxicity.
Collapse
Affiliation(s)
- Bahareh Nazemi Salman
- School of Dentistry, Department of Pediatric Dentistry, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mahshid Mohebbi Rad
- School of Dentistry, Department of Orthodontics, Hamadan University of Medical Sciences, Hamadan, Iran -
| | - Ehsan Saburi
- School of Medicine, Medical Genetics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
4
|
Koutrouli A, Machla F, Arapostathis K, Kokoti M, Bakopoulou A. "Biological responses of two calcium-silicate-based cements on a tissue-engineered 3D organotypic deciduous pulp analogue". Dent Mater 2024; 40:e14-e25. [PMID: 38431482 DOI: 10.1016/j.dental.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/14/2024] [Accepted: 02/18/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES The biological responses of MTA and Biodentine™ has been assessed on a three-dimensional, tissue-engineered organotypic deciduous pulp analogue. METHODS Human endothelial (HUVEC) and dental mesenchymal stem cells (SHED) at a ratio of 3:1, were incorporated into a collagen I/fibrin hydrogel; succeeding Biodentine™ and MTA cylindrical specimens were placed in direct contact with the pulp analogue 48 h later. Cell viability/proliferation and morphology were evaluated through live/dead staining, MTT assay and Scanning Electron Microscopy (SEM), and expression of angiogenic, odontogenic markers through real time PCR. RESULTS Viable cells dominated at day 3 after treatment presenting typical morphology, firmly attached within the hydrogel structures, as shown by live/dead staining and SEM images. MTT assay at day 1 presented a significant increase of cell proliferation in Biodentine™ group. Real-time PCR showed significant upregulation of odontogenic markers DSPP, BMP-2 (day 3,6), RUNX2, ALP (day 3) in contact with Biodentine™ compared to MTA and the control, whereas MTA promoted significant upregulation of DSPP, BMP-2, RUNX2, Osterix (day 3) and ALP (day 6) compared to the control. MSX1 presented downregulation in both experimental groups. Expression of angiogenic markers VEGFa and ANGPT-1 at day 3 was significantly upregulated in contact with Biodentine™ and MTA respectively, while the receptors VEGFR1, VEGFR2 and Tie-2, as well as PECAM-1 were downregulated. SIGNIFICANCE Both calcium silicate-based materials are biocompatible and exert positive angiogenic and odontogenic effects, although Biodentine™ during the first days of culture, seems to induce higher cell proliferation and provoke a more profound odontogenic and angiogenic response from SHED.
Collapse
Affiliation(s)
- A Koutrouli
- Department of Paediatric Dentistry, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki GR-54124, Greece
| | - F Machla
- Department of Prosthodontics, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki GR-54124, Greece
| | - K Arapostathis
- Department of Paediatric Dentistry, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki GR-54124, Greece
| | - M Kokoti
- Department of Prosthodontics, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki GR-54124, Greece
| | - A Bakopoulou
- Department of Prosthodontics, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki GR-54124, Greece.
| |
Collapse
|
5
|
Bilge K, Ataş O, Yildiz Ş, Çalik I, Dündar S, Gezer Ataş A. Histological evaluation of tissue reaction and new bone formation of different calcium silicate-based cements in rats. Aust Dent J 2024; 69:18-28. [PMID: 37715562 DOI: 10.1111/adj.12980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the local reactions and new bone formation of rat subcutaneous and bone tissue to different calcium silicate cements. METHODS In this study, 80 rats were divided into five groups as control, BIOfactor MTA (BIO), NeoMTA Plus (NEO), MTA Repair Hp (REP), Biodentine (DENT) and then into two subgroups according to sacrification times (7, 30 days; n = 8). Polyethylene tubes filled with appropriate materials (test groups); empty tubes (control group) were implanted into the dorsum of each rat subcutaneously. For intraosseous implantation, materials were placed in the cavities created in tibia of rats. Subcutaneous tissue and tibia samples were stained with haematoxylin-eosin and subjected to histopathological analysis. A score (0-3) was used to grade inflammatory reaction and new bone formation. Data were analysed by Kruskal-Wallis and Mann-Whitney U tests (P < 0.05). RESULTS Inflammatory reaction observed in subcutaneous and intraosseous tissues for 7 days decreased significantly in all groups over time (P < 0.05). It was determined that there was significant increase in new bone formation in REP, BIO, DENT groups over time (P < 0.05). CONCLUSION Four contemporary bioceramic materials induced local inflammation and tissues changes shortly after subcutaneous implantation, which were reduced over time. In ıntraosseous implantation, all materials induced new bone formation over time. REGISTRATION NUMBER ADJ-03-23-0134. © 2023 Australian Dental Association.
Collapse
Affiliation(s)
- K Bilge
- Department of Restorative Dentistry, Faculty of Dentistry Firat University, Elazıg, Turkey
| | - O Ataş
- Department of Pediatric Dentistry, Faculty of Dentistry Firat University, Elazıg, Turkey
| | - Ş Yildiz
- Department of Pediatric Dentistry, Faculty of Dentistry Firat University, Elazıg, Turkey
| | - I Çalik
- Department of Pathology, Faculty of Medicine, Firat University, Elazıg, Turkey
| | - S Dündar
- Department of Periodontology, Faculty of Dentistry, Firat University, Elazig, Turkey
| | | |
Collapse
|
6
|
Park SH, Ye JR, Asiri NM, Chae YK, Choi SC, Nam OH. Biocompatibility and Bioactivity of a Dual-Cured Resin-Based Calcium Silicate Cement: In Vitro and in vivo Evaluation. J Endod 2024; 50:235-242. [PMID: 37995904 DOI: 10.1016/j.joen.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 11/02/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION This study aimed to assess the biocompatibility and bioactivity of a dual-cured resin-based calcium silicate cement in vitro and in vivo. METHODS For in vitro analyses, standardized samples were prepared using TheraCal LC, TheraCal PT, and ProRoot MTA. The amount of residual monomer released from TheraCal LC and TheraCal PT was assessed using liquid chromatography/mass spectrometry. Calcium ion release from the materials was evaluated using inductively coupled plasma-optical emission spectroscopy. Scanning electron microscopy and energy-dispersive X-ray spectroscopy were used to determine the calcium weight volume in the materials. For in vivo analysis, a rat direct pulp capping model with TheraCal LC, TheraCal PT, and ProRoot MTA groups (n = 16 per group) was used. The rats were euthanized after 7 or 28 days, and histological and immunohistochemical analyses (CD68 and DSPP) were performed. RESULTS Bisphenol A-glycidyl methacrylate and polyethylene glycol dimethacrylate release from TheraCal PT was lower than that from TheraCal LC (P < .05). Similar results were obtained for calcium-ion release and calcium weight volume, with ProRoot MTA showing the highest values. In the in vivo evaluation, TheraCal PT showed significantly greater hard tissue formation than TheraCal LC (P < .017). TheraCal PT showed lower CD68 expression and greater DSPP expression than TheraCal LC (P < .017). There were no significant differences in the expression of CD68 or DSPP between the TheraCal PT and ProRoot MTA groups. CONCLUSIONS Within the limitations of this study, the biocompatibility and bioactivity of TheraCal PT could be comparable to those of ProRoot MTA.
Collapse
Affiliation(s)
- Seung Hwan Park
- Department of Pediatric Dentistry, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Seoul, Korea
| | - Ju Ri Ye
- Department of Pediatric Dentistry, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Seoul, Korea
| | - Naif Mohammed Asiri
- Department of Pediatric Dentistry, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Seoul, Korea
| | - Yong Kwon Chae
- Department of Pediatric Dentistry, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Seoul, Korea
| | - Sung Chul Choi
- Department of Pediatric Dentistry, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Seoul, Korea; Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Ok Hyung Nam
- Department of Pediatric Dentistry, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Seoul, Korea; Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul, Korea.
| |
Collapse
|
7
|
Kandemir Demirci G, Çöven FO, Güneri P, Karavana SY, Nalbantsoy A, Köse T, Kaval ME. The solubility, pH value, chemical structure, radiopacity, and cytotoxicity of four different root canal sealers: an in vitro study. Clin Oral Investig 2023; 27:5413-5425. [PMID: 37486382 DOI: 10.1007/s00784-023-05160-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE The aim of this study was to investigate solubility, pH value, chemical structure, radiopacity, and cytotoxicity of AH Plus BC, TotalFill BC, AH Plus, and AH Plus Jet sealers. MATERIALS AND METHODS Cytotoxicity analysis with direct and extraction tests at 3 different concentrations (1:1, 1:2, 1:4 v/v%) and time (24 h, 48 h, and 72 h) on Saos-2, PdLF, and THP-1 cell lines, chemical structure with scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX) analysis, solubility, pH, and radiopacity values of AH Plus BC, TotalFill BC, AH Plus, and AH Plus Jet were evaluated. For statistical analyses of the groups, repeated measures, factorial, and one-way ANOVA tests were used. The statistical significance level was set at p < .05. RESULTS Resin-based sealers showed higher cytotoxicity values than the bioceramic-based sealers (p < 0.05). Time and concentrations were effective on the cell viabilities for cell lines. Higher peaks of calcium were detected bioceramic-based sealers and higher amount of zirconium was detected in AH Plus BC (p < 0.05). AH Plus BC showed similar radiopacity value with AH Plus, AH Plus Jet, whereas TotalFill BC showed the lowest radiopacity (p < 0.05). Bioceramic-based sealers had higher pH values in all experiment periods, and the difference between resin- and bioceramic-based sealer groups was significant (p < 0.05). However, the solubility values of the tested root canal sealers revealed no differences (p > 0.05). CONCLUSIONS The newly produced AH Plus BC Sealer showed similar properties with TotalFill BC, and their biological properties were better than AH Plus and AH Plus Jet. CLINICAL RELEVANCE AH Plus BC could be a possible alternative to other bioceramic- or resin-based sealers.
Collapse
Affiliation(s)
| | - Furkan Ozan Çöven
- Department of Bioengineering, Faculty of Engineering, Ege University, İzmir, Turkey
| | - Pelin Güneri
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Ege University, İzmir, Turkey
| | - Sinem Yaprak Karavana
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Ege University, İzmir, Turkey
| | - Ayşe Nalbantsoy
- Department of Bioengineering, Faculty of Engineering, Ege University, İzmir, Turkey
| | - Timur Köse
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Mehmet Emin Kaval
- Department of Endodontology, School of Dentistry, Ege University, 35100, İzmir, Turkey
| |
Collapse
|
8
|
Yousefi-Koma AA, Assadian H, Mohaghegh S, Nokhbatolfoghahaei H. Comparative Biocompatibility and Odonto-/Osteogenesis Effects of Hydraulic Calcium Silicate-Based Cements in Simulated Direct and Indirect Approaches for Regenerative Endodontic Treatments: A Systematic Review. J Funct Biomater 2023; 14:446. [PMID: 37754860 PMCID: PMC10532331 DOI: 10.3390/jfb14090446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/12/2023] [Accepted: 02/17/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Regenerative dentistry is the operation of restoring dental, oral and maxillofacial tissues. Currently, there are no guidelines for the ideal cement/material in regenerative endodontic treatments (RET). Hydraulic calcium silicate-based cements (hCSCs) are currently the material of choice for RET. OBJECTIVES This systematic review was conducted to gather all of the different direct and indirect approaches of using hCSCs in RET in vitro and in vivo, and to ascertain if there are any superiorities to indirect approaches. METHODS AND MATERIALS This systematic review was conducted according to the 2020 PRISMA guidelines. The study question according to the PICO format was as follows: Comparison of the biological behavior (O) of stem cells (P) exposed to hCSCs through direct and indirect methods (I) with untreated stem cells (C). An electronic search was executed in Scopus, Google Scholar, and PubMed. RESULTS A total of 78 studies were included. Studies were published between 2010 and 2022. Twenty-eight commercially available and eighteen modified hCSCs were used. Seven exposure methods (four direct and three indirect contacts) were assessed. ProRoot MTA and Biodentine were the most used hCSCs and had the most desirable results. hCSCs were either freshly mixed or set before application. Most studies allowed hCSCs to set in incubation for 24 h before application, which resulted in the most desirable biological outcomes. Freshly mixed hCSCs had the worst outcomes. Indirect methods had significantly better viability/proliferation and odonto-/osteogenesis outcomes. CONCLUSION Biodentine and ProRoot MTA used in indirect exposure methods result in desirable biological outcomes.
Collapse
Affiliation(s)
- Amir-Ali Yousefi-Koma
- Dental Research Center, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran 1983963113, Iran
| | - Hadi Assadian
- Department of Endodontics, Tehran University of Medical Sciences, Tehran 1417614418, Iran
| | - Sadra Mohaghegh
- Dental Research Center, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran 1983963113, Iran
| | - Hanieh Nokhbatolfoghahaei
- Dental Research Center, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran 1983963113, Iran
| |
Collapse
|
9
|
Abrão SMS, Gregorio D, Azevedo MKCD, Mori GG, Poli-Frederico RC, Maia LP. Cytotoxicity and genotoxicity of Bio-C Repair, Endosequence BC Root Repair, MTA Angelus and MTA Repair HP. Braz Dent J 2023; 34:14-20. [PMID: 37194852 DOI: 10.1590/0103-6440202305047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 01/05/2023] [Indexed: 05/18/2023] Open
Abstract
The aim was to evaluate in vitro cytotoxicity and genotoxicity of Bio-C Repair (BCR), compared to Endosequence BC Root Repair (ERRM), MTA Angelus (MTA-Ang), and MTA Repair HP (MTA-HP). MC3T3 osteoblastic cells were exposed to extracts of the repairing bioceramic cements. After 1, 3, and 7 days, cytotoxicity and genotoxicity were evaluated by MTT and Micronucleus tests, respectively. Cells not exposed to biomaterials were used as a negative control. Data were compared using ANOVA two-way, followed by the Tukey Test (α=5%). MTA-Ang and MTA-HP showed no difference in relation to control regarding cytotoxicity in any experimental times. BCR and ERRM reduced cell viability after 3 and 7 days (p<0.05); however, the reduction caused by BCR was less than that caused by ERRM. Considering the micronucleus formation, all biomaterials caused an increase after 3 and 7 days (p<0.05), being greater for the BCR and ERRM groups. It can be concluded that BCR is non-cytotoxic in osteoblastic cells, as well as MTA-Ang e MTA Repair HP. BCR and ERRM showed greater genotoxicity than others tested biomaterials.
Collapse
Affiliation(s)
| | - Danielle Gregorio
- Graduate Program in Dentistry of the University Pitagoras Unopar (UNOPAR), Londrina, Paraná, Brazil
| | | | - Graziela Garrido Mori
- Graduate Program in Dentistry of the University of Western Sao Paulo (UNOESTE). Presidente Prudente, São Paulo, Brazil
| | | | - Luciana Prado Maia
- Graduate Program in Dentistry of the University Pitagoras Unopar (UNOPAR), Londrina, Paraná, Brazil
- Graduate Program in Dentistry of the University of Western Sao Paulo (UNOESTE). Presidente Prudente, São Paulo, Brazil
| |
Collapse
|
10
|
Mangal U, Kang TY, Jung JW, Kim JY, Seo JY, Cha JY, Lee KJ, Yu HS, Kim KM, Kim JM, Kwon JS, Choi SH. Polybetaine-enhanced hybrid ionomer cement shows improved total biological effect with bacterial resistance and cellular stimulation. Biomater Sci 2023; 11:554-566. [PMID: 36472228 DOI: 10.1039/d2bm01428a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Hybrid ionomer cements (HICs) are aesthetic polyelectrolyte cements that have been modified with a resin. The setting of HICs occurs by both monomer polymerization and an acid-base reaction. In addition, HICs contain a resin, which is substituted for water. Thus, the competition between the setting reactions and reduced water content inherently limits polysalt formation and, consequently the bioactive interactions. In this study, we explored the effects of polybetaine zwitterionic derivatives (mZMs) on the augmentation of the bioactive response of HICs. The polybetaines were homogenized into an HIC in different proportions (α, β, and γ) at 3% w/v. Following basic characterization, the bioactive response of human dental pulp stem cells (hDPSCs) was evaluated. The augmented release of the principal constituent ions (strontium, silica, and fluoride) from the HIC was observed with the addition of the mZMs. Modification with α-mZM elicited the most favorable bioactive response, namely, increased ion elution, in vitro calcium phosphate precipitation, and excellent biofouling resistance, which deterred the growth of the bridging species of Veillonella. Moreover, α-mZM resulted in a significant increase in the hDPSC response, as confirmed by a significant increase (p < 0.05) in alizarin red staining. The results of mRNA expression tests, performed using periodically refreshed media, showed increased and early peak expression levels for RUNX2, OCN, and OPN in the case of α-mZM. Based on the results of the in vitro experiments, it can be concluded that modification of HICs with polybetaine α-mZM can augment the overall biological response.
Collapse
Affiliation(s)
- Utkarsh Mangal
- Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
| | - Tae-Yun Kang
- Department and Research Institute of Dental Biomaterials and Bioengineering, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
| | - Ju Won Jung
- Department and Research Institute of Dental Biomaterials and Bioengineering, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea. .,Department of Oral Microbiology and Immunology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, 08826, South Korea.
| | - Ji-Yeong Kim
- Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea. .,BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Ji-Young Seo
- Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
| | - Jung-Yul Cha
- Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
| | - Kee-Joon Lee
- Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
| | - Hyung-Seog Yu
- Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
| | - Kwang-Mahn Kim
- Department and Research Institute of Dental Biomaterials and Bioengineering, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
| | - Jin-Man Kim
- Department of Oral Microbiology and Immunology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, 08826, South Korea.
| | - Jae-Sung Kwon
- Department and Research Institute of Dental Biomaterials and Bioengineering, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea. .,BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Sung-Hwan Choi
- Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea. .,BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| |
Collapse
|
11
|
Liu Y, Liu N, Na J, Li C, Yue G, Fan Y, Zheng L. Wnt/β-catenin plays a dual function in calcium hydroxide induced proliferation, migration, osteogenic differentiation and mineralization in vitro human dental pulp stem cells. Int Endod J 2023; 56:92-102. [PMID: 36229421 DOI: 10.1111/iej.13843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 12/14/2022]
Abstract
AIM Calcium hydroxide is the gold standard material for pulp capping and has been widely used in clinical dentistry. Calcium hydroxide promotes proliferation, migration and osteogenic differentiation of dental pulp stem cells (DPSCs). However, the underlying mechanism is not clear. Our study investigated the role of Wnt/β-catenin pathway in calcium hydroxide-induced proliferation, migration, osteogenic differentiation and mineralization of human DPSCs. METHODOLOGY Protein and gene expression was detected by western blot (WB), immunofluorescence staining and quantitative real-time PCR (qPCR). Cell viability was analysed using the Cell Counting Kit-8 (CCK-8) assay. Wound-healing assay was used to analyse cell migration. The expression of alkaline phosphatase (ALP) was detected using ALP staining. Mineralization was analysed by alizarin red staining. RESULTS Calcium hydroxide increased the protein expression of phosphorylated-GSK3β/GSK3β, β-catenin and the gene expression of LEF-1. Inhibition of Wnt/β-catenin abolished calcium hydroxide-induced proliferation and migration of DPSCs in 24 h. However, incubation with calcium hydroxide for 7 days and 14 days reduced Wnt/β-catenin signalling. Inhibition of Wnt/β-catenin promoted calcium hydroxide-induced osteogenic differentiation and mineralization in DPSCs. CONCLUSION Wnt/β-catenin pathway plays a dual role in calcium hydroxide-regulated DPSC behaviour. Incubation with calcium hydroxide promoted rapid proliferation and migration of DPSCs, while prolonged incubation negatively regulated osteogenic differentiation and mineralization.
Collapse
Affiliation(s)
- Yu Liu
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Nan Liu
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Jing Na
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Chiyu Li
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Gan Yue
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yubo Fan
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Lisha Zheng
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| |
Collapse
|
12
|
Comparative chemical properties, bioactivity, and cytotoxicity of resin-modified calcium silicate-based pulp capping materials on human dental pulp stem cells. Clin Oral Investig 2022; 26:6839-6853. [PMID: 36104606 DOI: 10.1007/s00784-022-04713-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/07/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study investigated the cytotoxicity, the residual monomer release, degree of conversion (DC), calcium ion (Ca2+) release, and crystal structure of TheraCal PT (ThPT) by comparison with TheraCal LC (ThLC) and mineral trioxide aggregate (MTA). MATERIALS AND METHODS The cytotoxicity of the cured materials was evaluated on human dental pulp stem cells (hDPSCs) isolated from third molars by the water-soluble tetrazolium salt (WST-1) method. The monomer release and DC of the resin-containing materials were analyzed by high-performance liquid chromatography (HPLC) and Fourier transform infrared (FTIR), respectively. The chemical composition and Ca2+ release of the materials were determined by scanning electronic microscopy-energy-dispersive spectroscopy (SEM-EDS), X-ray diffractometry (XRD), and inductively coupled plasma-optical emission spectroscopy (ICP-OES), respectively. Statistical differences were evaluated with one-way ANOVA, repeated measure ANOVA, and the Tukey test (p < 0.05). RESULTS MTA showed significantly lower cytotoxicity than either ThLC or ThPT after 1, 3, and 7 days (p < 0.05). TEGDMA release of ThPT is significantly higher than ThLC (p < 0.05). All materials showed calcium Ca2+ release, with MTA significantly higher than the others (p < 0.05). CONCLUSIONS MTA showed low cytotoxicity and high Ca2+ release compared to ThLC and ThPT. CLINICAL RELEVANCE The cytotoxicity and residual monomer release of ThLC and ThPT may raise concerns about the viability of hDPSCs. Further investigations with the use of in vivo research models are required to validate in vitro bioactivity properties and the potential adverse biological effects of ThLC and ThPT on hDPSCs.
Collapse
|
13
|
Setzer FC, Kratchman SI. Present Status and Future Directions - Surgical Endodontics. Int Endod J 2022; 55 Suppl 4:1020-1058. [PMID: 35670053 DOI: 10.1111/iej.13783] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Abstract
Endodontic surgery encompasses several procedures for the treatment of teeth with a history of failed root canal treatment, such as root-end surgery, crown- and root resections, surgical perforation repair, and intentional replantation. Endodontic microsurgery is the evolution of the traditional apicoectomy techniques and incorporates high magnification, ultrasonic root-end preparation and root-end filling with biocompatible filling materials. Modern endodontic surgery uses the dental operating microscope, incorporates cone-beam computed tomography (CBCT) for preoperative diagnosis and treatment planning, and has adopted piezoelectric approaches to osteotomy and root manipulation. Crown- and root resection techniques have benefitted from the same technological advances. This review focuses on the current state of root-end surgery by comparing the techniques and materials applied during endodontic microsurgery to the most widely used earlier methods and materials. The most recent additions to the clinical protocol and technical improvements are discussed, and an outlook on future directions is given. While non-surgical retreatment remains the first choice to address most cases with a history of endodontic failure, modern endodontic microsurgery has become a predictable and minimally invasive alternative for the retention of natural teeth.
Collapse
Affiliation(s)
- F C Setzer
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - S I Kratchman
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| |
Collapse
|
14
|
Bond Strength of Adhesive Systems to Calcium Silicate-Based Materials: A Systematic Review and Meta-Analysis of In Vitro Studies. Gels 2022; 8:gels8050311. [PMID: 35621609 PMCID: PMC9141246 DOI: 10.3390/gels8050311] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/08/2022] [Accepted: 05/16/2022] [Indexed: 12/16/2022] Open
Abstract
Since the adhesion of resin composites to calcium silicate-based cement is considered challenging. Therefore, the best adhesion strategy should be indicated. This review aimed to assess the effect of different adhesive systems on the bond strength of resin composite to calcium silicate-based cement through a systematic review and meta-analysis. The subsequent PICOS framework used was: population, calcium silicate-based cement; intervention, use of self-etch adhesive systems; control, use of total-etch adhesive systems; outcome, bond strength; study design, in vitro studies. The literature search was conducted independently by two reviewers up to 18 February 2021. Electronic databases (PubMed, ISI Web of Science, SciELO, Scopus, and Embase) were searched for applicable articles. In vitro manuscripts studying the effect of adhesive systems on the bond strength of calcium silicate-based cement were considered. The meta-analyses were performed using Review Manager Software version 5.3.5 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). Bond strength comparisons were made considering the type of calcium silicate-based cement (Mineral Trioxide Aggregate (MTA), Biodentine™, or TheraCal LC®). A p-value < 0.05 was considered statistically significant. A total of 7321 studies were retrieved in databases searched. After full-text evaluation, 37 eligible papers were assessed for qualitative analysis, leaving a total of 22 papers for the quantitative analysis. According to the meta-analysis, the bond strength values of resin composite materials to MTA and TheraCal LC® cement were favored when a total-etch adhesive system was used (p ≤ 0.02). On the other hand, the meta-analysis of the bond strength of resin-based materials to Biodentine™ calcium silicate-based cement was similar between both approaches (p = 0.12). The in vitro evidence suggests that the bond strength of resin-based materials to both MTA and TheraCal LC® cement was preferred by using the total-etch adhesive strategy. However, when bonding to Biodentine™, the use of self-etch or total-etch strategies displayed promising results. Given the lack of evidence related to the chemical interaction of self-etch adhesive materials with the bioceramics, if self-etch adhesives are used for bonding resin-based restorations to calcium silicate-based cement, a pretreatment with phosphoric acid could be recommended.
Collapse
|
15
|
Sismanoglu S, Ercal P. Effects of calcium silicate-based cements on odonto/osteogenic differentiation potential in mesenchymal stem cells. AUST ENDOD J 2022; 49:66-74. [PMID: 35229930 DOI: 10.1111/aej.12615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 02/13/2022] [Indexed: 11/30/2022]
Abstract
The objective of this study was to evaluate the biological effects and odonto/osteogenic differentiation potential of Biodentine, NeoMTA Plus and TheraCal LC in tooth germ-derived stem cells (TGSCs). TGSCs were exposed to the material extracts. Biocompatibility was tested with MTS cell proliferation assay. Odonto/osteogenic differentiation was assessed with alkaline phosphatase (ALP) activity and mRNA gene expressions (RUNX2, DSPP and DMP-1). Scanning electronic microscopy/energy-dispersive X-ray (SEM/EDX) analysis and pH analysis were also performed for the materials. Data were evaluated using the one-way ANOVA and Tukey's tests. TGSCs remained viable after 7 days of incubation with all tested materials. Biodentine and NeoMTA Plus showed high ALP activity and increased expression of RUNX2, DSPP and DMP-1 compared to that of TheraCal LC. All materials can induce odonto/osteogenic differentiation of MSCs in various levels. Biocompatibility and odonto/osteogenic differentiation potential of Biodentine and NeoMTA Plus are similar and superior to that of TheraCal LC.
Collapse
Affiliation(s)
- Soner Sismanoglu
- Department of Restorative Dentistry, Faculty of Dentistry, Altınbaş University, Istanbul, Turkey
| | - Pinar Ercal
- Centre for Oral Immunobiology and Regenerative Medicine and Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University London (QMUL), London, UK
| |
Collapse
|
16
|
Elbanna A, Atta D, Sherief D. In vitro bioactivity of newly introduced dual-cured resin-modified calcium silicate cement. Dent Res J (Isfahan) 2022; 19:1. [PMID: 35308449 PMCID: PMC8927947 DOI: 10.4103/1735-3327.336686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/21/2021] [Accepted: 07/23/2021] [Indexed: 11/21/2022] Open
Abstract
Background: This study was designed to investigate the in vitro bioactivity of a new dual cured calcium silicate cement (TheraCal PT) compared to its light cured (TheraCal LC) and chemically set (Biodentine) counterparts. Materials and Methods: The study is an in vitro original research article. Prepared cements discs were immersed in deionized water. Ca2+ release was evaluated using inductively coupled plasma-optical emission spectrometry while pH was assessed using a pH meter after 1, 14, and 28 days. Discs for surface characterization were immersed in phosphate-buffered saline (PBS) and were examined using an environmental scanning electron microscope with energy dispersive X-ray (ESEM/EDX), immediately after setting and at 1, 14, and 28 days intervals after that. Attenuated total reflectance (ATR)/Fourier transform infrared (FTIR) and Raman spectroscopy analyses were performed after setting and after 28 days storage in PBS. Statistical analysis was performed using the two-way repeated measure analysis of variance test followed by Bonferroni test for multiple comparisons (P < 0.05). Results: Biodentine exhibited the highest mean values for Ca2+ release (792,639,278 ppm) and pH (10.99, 12.7, 11.54) at all time intervals. ESEM/EDX displayed a continuous layer of calcium phosphate formed by Biodentine and TheraCal LC while TheraCal PT developed scarce interrupted precipitates after immersion in PBS. ATR/FTIR and Raman spectroscopy for the formed precipitates confirmed the presence of phosphate and Ca (OH) 2 in Biodentine, TheraCal LC and TheraCal PT. Conclusion: TheraCal PT exhibited limited in vitro bioactivity which may limit its prognosis in clinical applications for vital pulp therapy. TheraCal LC is considered a potential bioactive calcium silicate cement despite its lower Ca2+ release compared to Biodentine. Highest bioactivity was observed in Biodentine.
Collapse
|
17
|
Biocompatibility and Osteogenic Potential of Calcium Silicate-Based Cement Combined with Enamel Matrix Derivative: Effects on Human Bone Marrow-Derived Stem Cells. MATERIALS 2021; 14:ma14247750. [PMID: 34947344 PMCID: PMC8706689 DOI: 10.3390/ma14247750] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/08/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022]
Abstract
The characteristics of retrograde filling material are important factors that can affect the long-term success of apical microsurgery. Various calcium silicate-based cements (CSC) were introduced to overcome drawbacks of mineral trioxide aggregate (MTA), while Emdogain is known to be effective in the regeneration of periodontal tissues. The aim of this study is to evaluate the biocompatibility and osteogenic potential of various CSCs combined with Emdogain on human bone marrow-derived mesenchymal stem cells. Experimental groups were classified into eight groups depending on the material and the presence of Emdogain. In the cell-counting kit test, all experimental groups combined with Emdogain showed higher cell viability compared with those without Emdogain at days 1 and 2. In the wound-healing assay, cell migration increased significantly over time, with or without Emdogain. In the alkaline phosphatase assay, all groups treated with Emdogain showed higher activity compared with those without Emdogain at day 3 (p < 0.05). Using alizarin red S staining, all groups treated with Emdogain showed greater calcium nodule formation compared with those without Emdogain at days 7 and 14 (p < 0.05). In conclusion, using CSCs as retrograde filling materials and the application of additional Emdogain will increase bone regeneration and improve the prognosis of apical microsurgery.
Collapse
|
18
|
Khedmat S, Sarraf P, Seyedjafari E, Sanaei-Rad P, Noori F. Comparative evaluation of the effect of cold ceramic and MTA-Angelus on cell viability, attachment and differentiation of dental pulp stem cells and periodontal ligament fibroblasts: an in vitro study. BMC Oral Health 2021; 21:628. [PMID: 34876089 PMCID: PMC8650362 DOI: 10.1186/s12903-021-01979-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Biocompatibility and induction of mineralized tissue formation are the properties expected from a material used in vital pulp therapy and repair of perforations. Cold ceramic (SJM, Iran; CC) is a newly introduced calcium silicate-based cement for above mentioned therapeutic applications. This in-vitro study aimed to compare the effect of CC and White MTA-Angelus (MTA) on cell viability, attachment, odontogenic differentiation, and calcification potential of human dental pulp stem cells (DPSCs) and periodontal ligament fibroblasts (PDLFs). METHODS Cell viability of DPSCs and PDLFs was assessed using MTT on days 1, 3, 7, and 14 (n = 9) in contact with freshly mixed and set states of CC and MTA. Field emission scanning electron micrographs (FESEM) were taken to evaluate cell-bioceramic interaction (n = 6). Gene expression levels of osteo/odontogenic markers (Dentin sialophosphoprotein, Dentin matrix protein 1, Collagen type I alpha 1, and Alkaline phosphatase (DSPP, DMP1, COL 1A1, and ALP, respectively) (n = 8) were assessed using qrt-PCR. ALP enzymatic activity was evaluated to assess the mineralization potential. A two-way ANOVA test was applied, and p < 0.05 was considered to be statistically significant. RESULTS The effect of freshly mixed and set MTA and CC on the survival of DPSCs and PDLFs in all study groups was statistically similar and comparable to the positive control group (p > 0.05); the only exception was for the viability of PDLFs in contact with freshly mixed cements on day 1, showing a more significant cytotoxic effect compared to the control and the set state of materials (p < 0.05). PDLFs attached well on CC and MTA. The spread and pseudopodium formation of the cells increased on both samples from day 1 to day 14. Contact of MTA and CC with DPSCs similarly increased expression of all dentinogenesis markers studied on days 7 and 14 compared to the control group (p < 0.001), except for DSPP expression on day 7 (p = 0.46 and p = 0.99 for MTA and CC, respectively). CONCLUSIONS Within the limitation of this in-vitro study, cold ceramic and MTA-Angelus showed high biocompatibility and induced increased expression of osteo/dentinogenic markers. Therefore, cold ceramic can be a suitable material for vital pulp therapy and the repair of root perforations.
Collapse
Affiliation(s)
- Sedigheh Khedmat
- School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Pegah Sarraf
- School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Parisa Sanaei-Rad
- School of Dentistry, Arak University of Medical Sciences, Arak, Iran
| | - Faranak Noori
- School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
19
|
Sanz JL, Soler-Doria A, López-García S, García-Bernal D, Rodríguez-Lozano FJ, Lozano A, Llena C, Forner L, Guerrero-Gironés J, Melo M. Comparative Biological Properties and Mineralization Potential of 3 Endodontic Materials for Vital Pulp Therapy: Theracal PT, Theracal LC, and Biodentine on Human Dental Pulp Stem Cells. J Endod 2021; 47:1896-1906. [PMID: 34425148 DOI: 10.1016/j.joen.2021.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/01/2021] [Accepted: 08/03/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The aim of this study was to assess the biological properties and mineralization potential of the new Theracal PT (Bisco Inc, Schaumburg, IL) compared with its predecessor Theracal LC (Bisco Inc) and the hydraulic silicate-based cement Biodentine (Septodont, Saint-Maur-des-Fossés, France) on human dental pulp stem cells (hDPSCs) in vitro. METHODS Standardized sample discs were obtained for each material (n = 30) together with 1:1, 1:2, and 1:4 material eluates. Previously characterized hDPSCs were cultured with the different materials in standardized conditions, and the following assays were performed: a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, a wound healing assay, Annexin-V-FITC and 7-AAD staining (BD Biosciences, San Jose, CA), reactive oxygen species production analysis, cell adhesion and morphology evaluation via scanning electron microscopy and immunofluorescence, quantification of the expression of osteo/odontogenic markers via real-time quantitative reverse-transcriptase polymerase chain reaction, and alizarin red S staining. Statistical significance was established at P < .05. RESULTS All of the tested dilutions of Theracal LC exhibited a significantly higher cytotoxicity and reactive oxygen species production (P < .001) and a lower cell migration rate than the control group (hDPSCs cultured in growth medium without material extracts) at all of the measured time points (P < .001). Both 1:4 Theracal PT and Biodentine-treated hDPSCs exhibited similar levels of cytocompatibility to that of the control group, a significant up-regulation of at least 1 odontogenic marker (Biodentine: dentin sialophosphoprotein (P < .05); Theracal PT: osteonectin and runt-related transcription factor 2 [P < .001]), and a significantly higher mineralized nodule formation (P < .001). CONCLUSIONS The newly introduced TheraCal PT offers an improved in vitro cytocompatibility and mineralization potential on hDPSCs compared with its predecessor, TheraCal LC, and comparable biological properties to Biodentine.
Collapse
Affiliation(s)
- José Luis Sanz
- Department of Stomatology, Faculty of Medicine and Dentistry, Universitat de València, Valencia, Spain
| | - Anna Soler-Doria
- Department of Stomatology, Faculty of Medicine and Dentistry, Universitat de València, Valencia, Spain
| | - Sergio López-García
- Hematopoietic Transplant and Cellular Therapy Unit, Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca, IMIB Arrixaca, University of Murcia, Murcia, Spain; Department of Dermatology, Stomatology, Radiology and Physical Medicine, Morales Meseguer Hospital, Faculty of Medicine, University of Murcia, Murcia, Spain
| | - David García-Bernal
- Hematopoietic Transplant and Cellular Therapy Unit, Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca, IMIB Arrixaca, University of Murcia, Murcia, Spain
| | - Francisco J Rodríguez-Lozano
- Hematopoietic Transplant and Cellular Therapy Unit, Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca, IMIB Arrixaca, University of Murcia, Murcia, Spain; Department of Dermatology, Stomatology, Radiology and Physical Medicine, Morales Meseguer Hospital, Faculty of Medicine, University of Murcia, Murcia, Spain
| | - Adrián Lozano
- Department of Stomatology, Faculty of Medicine and Dentistry, Universitat de València, Valencia, Spain
| | - Carmen Llena
- Department of Stomatology, Faculty of Medicine and Dentistry, Universitat de València, Valencia, Spain
| | - Leopoldo Forner
- Department of Stomatology, Faculty of Medicine and Dentistry, Universitat de València, Valencia, Spain
| | - Julia Guerrero-Gironés
- Department of Dermatology, Stomatology, Radiology and Physical Medicine, Morales Meseguer Hospital, Faculty of Medicine, University of Murcia, Murcia, Spain.
| | - María Melo
- Department of Stomatology, Faculty of Medicine and Dentistry, Universitat de València, Valencia, Spain
| |
Collapse
|
20
|
Kim Y, Lee D, Kim HM, Kye M, Kim SY. Biological Characteristics and Odontogenic Differentiation Effects of Calcium Silicate-Based Pulp Capping Materials. MATERIALS 2021; 14:ma14164661. [PMID: 34443182 PMCID: PMC8399810 DOI: 10.3390/ma14164661] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 01/18/2023]
Abstract
We compared calcium silicate-based pulp capping materials to conventional calcium hydroxide in terms of their biological properties and potential effects on odontogenic differentiation in human dental pulp stem cells (hDPSCs). We cultured hDPSCs on disks (7-mm diameter, 4-mm high) of ProRoot MTA (Dentsply Tulsa Dental Specialties), Biodentine (Septodont), TheraCal LC (Bisco), or Dycal (Dentsply Tulsa Dental Specialties). Cell viability was assessed with cell counting (CCK) and scanning electron microscopy (SEM). Odontogenic activity was assessed by measuring alkaline phosphatase (ALP) activity and gene expression (quantitative real-time PCR). CCK assays showed that Dycal reduced cell viability compared to the other materials (p < 0.05). SEM showed low and absent cell attachment on TheraCal LC and Dycal disks, respectively. hDPSCs exposed to TheraCal LC and Dycal showed higher ALP activity on day 6 than the control group (p < 0.05). The day-9 Runx2 expression was higher in the ProRoot MTA and TheraCal LC groups than in the control group (p < 0.05). On day 14, the ProRoot MTA group showed the highest dentin sialophosphoprotein levels (not significant; p > 0.05). In conclusion, various pulp capping materials, except Dycal, exhibited biological properties favorable to hDPSC viability. ProRoot MTA and TheraCal LC promoted higher Runx2 expression than Biodentine. Future studies should explore the odontogenic potential of pulp capping materials.
Collapse
Affiliation(s)
- Yemi Kim
- Department of Conservative Dentistry, College of Medicine, Ewha Womans University, Seoul 07986, Korea;
| | - Donghee Lee
- College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Hye-Min Kim
- Department of Conservative Dentistry, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.-M.K.); (M.K.)
| | - Minjoo Kye
- Department of Conservative Dentistry, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.-M.K.); (M.K.)
| | - Sin-Young Kim
- Department of Conservative Dentistry, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.-M.K.); (M.K.)
- Correspondence: ; Tel.: +82-2-2258-1787
| |
Collapse
|
21
|
Song W, Li S, Tang Q, Chen L, Yuan Z. In vitro biocompatibility and bioactivity of calcium silicate‑based bioceramics in endodontics (Review). Int J Mol Med 2021; 48:128. [PMID: 34013376 PMCID: PMC8136140 DOI: 10.3892/ijmm.2021.4961] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/19/2021] [Indexed: 12/26/2022] Open
Abstract
Calcium silicate-based bioceramics have been applied in endodontics as advantageous materials for years. In addition to excellent physical and chemical properties, the biocompatibility and bioactivity of calcium silicate-based bioceramics also serve an important role in endodontics according to previous research reports. Firstly, bioceramics affect cellular behavior of cells such as stem cells, osteoblasts, osteoclasts, fibroblasts and immune cells. On the other hand, cell reaction to bioceramics determines the effect of wound healing and tissue repair following bioceramics implantation. The aim of the present review was to provide an overview of calcium silicate-based bioceramics currently applied in endodontics, including mineral trioxide aggregate, Bioaggregate, Biodentine and iRoot, focusing on their in vitro biocompatibility and bioactivity. Understanding their underlying mechanism may help to ensure these materials are applied appropriately in endodontics.
Collapse
Affiliation(s)
- Wencheng Song
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Shue Li
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Qingming Tang
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Lili Chen
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Zhenglin Yuan
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| |
Collapse
|
22
|
Pedano MS, Yoshihara K, Li X, Camargo B, Van Landuyt K, Van Meerbeek B. Experimental resin-modified calcium-silicate cement containing N-(2-hydroxyethyl) acrylamide monomer for pulp tissue engineering. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 126:112105. [PMID: 34082929 DOI: 10.1016/j.msec.2021.112105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/24/2021] [Accepted: 04/08/2021] [Indexed: 01/06/2023]
Abstract
AIM Our study aimed to measure (1) the flexural strength, (2) shear bond strength to dentin, (3) pH, and (4) calcium (Ca) release of a series of innovative resin-modified calcium-silicate pulp-capping cements (Rm-CSCs). Using an ex-vivo human vital tooth-culture model, we additionally assessed (5) their pulp-healing initiation when brought in direct contact with human dental pulp tissue. METHODOLOGY Three experimental Rm-CSCs, being referred to 'Exp_HEAA', 'Exp_GDM' and 'Exp_HEAA/GDM', contained either 20 wt% N-(2-hydroxyethyl) acrylamide (HEAA), 20 wt% glycerol dimethacrylate (GDM) or 10 wt% HEAA plus 10 wt% GDM, added to a common base composition consisting of 25 wt% urethane dimethacrylate (UDMA), 10 wt% 4-methacryloxyethyl trimellitate anhydride (4-MET), and 5 wt% N,N'-{[(2-acrylamido-2-[(3-acrylamidopropoxy)methyl] propane-1,3-diyl)bis(oxy)]bis-(propane-1,3-diyl)}diacrylamide (FAM-401). As Ca source and radiopacifier, 37 wt% tricalcium silicate powder (TCS) and 3 wt% zirconium oxide (ZrO 2) were respectively added. RESULTS All three experimental Rm-CSCs revealed a significantly higher flexural strength and shear bond strength to dentin (p < 0.05) than the commercial reference Rm-CSC TheraCal LC (Bisco). Exp_HEAA presented with a significantly higher Ca release and pH at 24 h compared with the other Rm-CSCs (p < 0.05). At 1 week, the Ca release and pH of Exp_HEAA and Exp_HEAA/GDM was significantly higher than those of Exp_GDM and TheraCal LC (p < 0.05). Using the ex-vivo human vital tooth culture model, Exp_HEAA revealed pulp-healing initiation capacity as documented by nestin and collagen-I expression. CONCLUSIONS Depending on the formulation, the innovative Rm-CSCs performed favorably for primary properties of relevance regarding pulp capping, this more specifically in terms of flexural strength, bond strength to dentin, as well as alkaline pH and Ca release. However, only Exp_HEAA revealed pulp-healing initiation in direct contact with human dental pulp tissue in the ex-vivo human vital tooth-culture model. This promising outcome for Exp_HEAA should be attributed to the combined use of (1) a novel hydrophilic acrylamide monomer, enabling sufficient polymerization while maintaining adequate hydrophilicity, with (2) the functional monomer 4-MET, possessing chemical bonding potential to dentin, and (3) tricalcium silicate powder to achieve an alkaline pH and to release Ca in a sufficient and controlled way.
Collapse
Affiliation(s)
- Mariano S Pedano
- KU Leuven (University of Leuven), Department of Oral Health Sciences, BIOMAT - Biomaterials Research group & UZ Leuven (University Hospitals Leuven), Dentistry, Leuven, Belgium.
| | - Kumiko Yoshihara
- National Institute of Advanced Industrial Science and Technology (AIST), Health Research Institute, 2217-14 Hayashi-Cho, Takamaysu, Kagawa 761-0395, Japan; Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Department of Pathology & Experimental Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Xin Li
- KU Leuven (University of Leuven), Department of Oral Health Sciences, BIOMAT - Biomaterials Research group & UZ Leuven (University Hospitals Leuven), Dentistry, Leuven, Belgium
| | - Bernardo Camargo
- KU Leuven (University of Leuven), Department of Oral Health Sciences, BIOMAT - Biomaterials Research group & UZ Leuven (University Hospitals Leuven), Dentistry, Leuven, Belgium
| | - Kirsten Van Landuyt
- KU Leuven (University of Leuven), Department of Oral Health Sciences, BIOMAT - Biomaterials Research group & UZ Leuven (University Hospitals Leuven), Dentistry, Leuven, Belgium
| | - Bart Van Meerbeek
- KU Leuven (University of Leuven), Department of Oral Health Sciences, BIOMAT - Biomaterials Research group & UZ Leuven (University Hospitals Leuven), Dentistry, Leuven, Belgium
| |
Collapse
|
23
|
Rodríguez-Lozano FJ, López-García S, García-Bernal D, Sanz JL, Lozano A, Pecci-Lloret MP, Melo M, López-Ginés C, Forner L. Cytocompatibility and bioactive properties of the new dual-curing resin-modified calcium silicate-based material for vital pulp therapy. Clin Oral Investig 2021; 25:5009-5024. [PMID: 33638052 DOI: 10.1007/s00784-021-03811-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/22/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of the present study was to evaluate the in vitro biocompatibility of Theracal PT, Theracal LC, and MTA Angelus, considered as bioactive materials used for vital pulp treatment, on human dental pulp stem cells (hDPSCs). MATERIALS AND METHODS Human dental pulp stem cells (hDPSCs) were isolated from third molars, and material eluates were prepared (undiluted, 1:2, and 1:4 ratios). The hDPSC cytotoxicity, adhesion, morphology, viability, and cell migration were assessed. The mineralization nodule formation was determined by Alizarin red S staining (ARS). The odonto/osteogenic differentiation potential was assessed by osteo/odontogenic marker expression real-time qPCR. The chemical composition and ion release of the vital pulp materials were determined by energy dispersive X-ray (EDX) and inductively coupled plasma-mass spectrometry (ICP-MS), respectively. Statistical differences were assessed by ANOVA and Tukey's test (p < 0.05). RESULTS The three vital pulp materials showed variable levels of calcium, tungsten, silicon, and zirconium release and in their chemical composition. Cytocompatibility assays revealed higher hDPSC viability and migration rates when treated with Theracal PT than with Theracal LC. The lowest cell adhesion and spreading were observed in all Theracal LC-treated groups, whereas the highest were observed when treated with MTA. Theracal PT and MTA promoted the upregulation of DSPP and RUNX2 gene expression (p < 0.05). After 21 days, both MTA Angelus and Theracal PT-treated cells exhibited a significantly higher mineralized nodule formation than the negative control (p < 0.05). CONCLUSIONS This study demonstrates the favorable in vitro cytocompatibility and bioactive properties of the recently introduced Theracal PT and the well-established MTA Angelus on hDPSCs, as opposed to Theracal LC. More studies, including in vivo animal testing are suggested before these new formulations might be used in the clinical setting. CLINICAL RELEVANCE Theracal PT is a new material that could be clinically suitable for vital pulp therapy. Further studies considering its biocompatibility and bioactivity are necessary.
Collapse
Affiliation(s)
- Francisco Javier Rodríguez-Lozano
- Cellular Therapy and Hematopoietic Transplant Research Group, Biomedical Research Institute, Virgen de la Arrixaca Clinical University Hospital, IMIB-Arrixaca, University of Murcia, 30120, Murcia, Spain.
- Department of Dermatology, Stomatology, Radiology and Physical Medicine, Morales Meseguer Hospital, Faculty of Medicine, University of Murcia, 30100, Murcia, Spain.
- School of Dentistry, Hospital Morales Meseguer 2 pl., University of Murcia, Av. Marqués de los Vélez, s/n, 30008, Murcia, Spain.
| | - S López-García
- Cellular Therapy and Hematopoietic Transplant Research Group, Biomedical Research Institute, Virgen de la Arrixaca Clinical University Hospital, IMIB-Arrixaca, University of Murcia, 30120, Murcia, Spain
- Department of Dermatology, Stomatology, Radiology and Physical Medicine, Morales Meseguer Hospital, Faculty of Medicine, University of Murcia, 30100, Murcia, Spain
| | - D García-Bernal
- Cellular Therapy and Hematopoietic Transplant Research Group, Biomedical Research Institute, Virgen de la Arrixaca Clinical University Hospital, IMIB-Arrixaca, University of Murcia, 30120, Murcia, Spain
| | - J L Sanz
- Department of Stomatology, Faculty of Medicine and Dentistry, Universitat de València, 46010, Valencia, Spain
| | - A Lozano
- Department of Stomatology, Faculty of Medicine and Dentistry, Universitat de València, 46010, Valencia, Spain
| | - M P Pecci-Lloret
- Department of Dermatology, Stomatology, Radiology and Physical Medicine, Morales Meseguer Hospital, Faculty of Medicine, University of Murcia, 30100, Murcia, Spain
| | - M Melo
- Department of Stomatology, Faculty of Medicine and Dentistry, Universitat de València, 46010, Valencia, Spain
| | - C López-Ginés
- Department of Pathology, Faculty of Medicine and Dentistry, Universitat de València, 46010, Valencia, Spain
| | - L Forner
- Cellular Therapy and Hematopoietic Transplant Research Group, Biomedical Research Institute, Virgen de la Arrixaca Clinical University Hospital, IMIB-Arrixaca, University of Murcia, 30120, Murcia, Spain
| |
Collapse
|
24
|
Sanz JL, Rodríguez-Lozano FJ, Lopez-Gines C, Monleon D, Llena C, Forner L. Dental stem cell signaling pathway activation in response to hydraulic calcium silicate-based endodontic cements: A systematic review of in vitro studies. Dent Mater 2021; 37:e256-e268. [PMID: 33573840 DOI: 10.1016/j.dental.2021.01.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/16/2020] [Accepted: 01/20/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To present a qualitative synthesis of in vitro studies which analyzed human dental stem cell (DSC) molecular signaling pathway activation in response to hydraulic calcium silicate-based cements (HCSCs). METHODS A systematic electronic search was performed in Medline, Scopus, Embase, Web of Science and SciELO databases on January 20 and last updated on March 20, 2020. In vitro studies assessing the implication of signaling pathways in activity related marker (gene/protein) expression and mineralization induced by HCSCs in contact with human DSCs were included. RESULTS The search identified 277 preliminary results. After discarding duplicates, and screening of titles, abstracts, and full texts, 13 articles were considered eligible. All of the materials assessed by the included studies showed positive results in cytocompatibility and/or bioactivity assays. ProRoot MTA and Biodentine were the modal HCSCs studied, hDPSCs were the modal cell variant used, and the most studied signaling pathway was MAPK. In vitro assays measuring the expression of activity-related markers and mineralized nodule formation evidenced the involvement of MAPK (and its subfamilies ERK, JNK and P38), NF-κB, Wnt/β-catenin, BMP/Smad and CAMKII pathways in the biological response of DSCs to HCSCs. SIGNIFICANCE HCSCs considered in the present review elicited a favorable biological response from a variety of DSCs in vitro, thus supporting their use in biologically-based endodontic procedures. MAPK, NF-κβ, Wnt/β-catenin, BMP/Smad and CAMKII signaling pathways have been proposed as potential mediators in the biological interaction between DSCs and HCSCs. Understanding the signaling processes involved in tissue repair could lead to the development of new biomaterial compositions targeted at enhancing these mechanisms through biologically-based procedures.
Collapse
Affiliation(s)
- José Luis Sanz
- Department of Stomatology, Faculty of Medicine and Dentistry, Universitat de València, 46010 Valencia, Spain
| | - Francisco Javier Rodríguez-Lozano
- Department of Dermatology, Stomatology, Radiology and Physical Medicine, Morales Meseguer Hospital, Faculty of Medicine, University of Murcia, 30100 Murcia, Spain
| | - Concha Lopez-Gines
- Department of Pathology, Faculty of Medicine and Dentistry, Universitat de València, 46010 Valencia, Spain
| | - Daniel Monleon
- Department of Pathology, Faculty of Medicine and Dentistry, Universitat de València, 46010 Valencia, Spain
| | - Carmen Llena
- Department of Stomatology, Faculty of Medicine and Dentistry, Universitat de València, 46010 Valencia, Spain
| | - Leopoldo Forner
- Department of Stomatology, Faculty of Medicine and Dentistry, Universitat de València, 46010 Valencia, Spain.
| |
Collapse
|
25
|
Rathinam E, Govindarajan S, Rajasekharan S, Declercq H, Elewaut D, De Coster P, Martens L, Leybaert L. The calcium dynamics of human dental pulp stem cells stimulated with tricalcium silicate-based cements determine their differentiation and mineralization outcome. Sci Rep 2021; 11:645. [PMID: 33436827 PMCID: PMC7804324 DOI: 10.1038/s41598-020-80096-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 12/03/2020] [Indexed: 12/19/2022] Open
Abstract
Calcium (Ca2+) signalling plays an indispensable role in dental pulp and dentin regeneration, but the Ca2+ responses of human dental pulp stem cells (hDPSCs) stimulated with tricalcium silicate-based (TCS-based) dental biomaterials remains largely unexplored. The objective of the present study was to identify and correlate extracellular Ca2+ concentration, intracellular Ca2+ dynamics, pH, cytotoxicity, gene expression and mineralization ability of human dental pulp stem cells (hDPSCs) stimulated with two different TCS-based biomaterials: Biodentine and ProRoot white MTA. The hDPSCs were exposed to the biomaterials, brought in contact with the overlaying medium, with subsequent measurements of extracellular Ca2+ and pH, and intracellular Ca2+ changes. Messenger RNA expression (BGLAP, TGF-β, MMP1 and BMP2), cytotoxicity (MTT and TUNEL) and mineralization potential (Alizarin red and Von Kossa staining) were then evaluated. Biodentine released significantly more Ca2+ in the α-MEM medium than ProRoot WMTA but this had no cytotoxic impact on hDPSCs. The larger Biodentine-linked Ca2+ release resulted in altered intracellular Ca2+ dynamics, which attained a higher maximum amplitude, faster rise time and increased area under the curve of the Ca2+ changes compared to ProRoot WMTA. Experiments with intracellular Ca2+ chelation, demonstrated that the biomaterial-triggered Ca2+ dynamics affected stem cell-related gene expression, cellular differentiation and mineralization potential. In conclusion, biomaterial-specific Ca2+ dynamics in hDPSCs determine differentiation and mineralization outcomes, with increased Ca2+ dynamics enhancing mineralization.
Collapse
Affiliation(s)
- Elanagai Rathinam
- Department of Paediatric Dentistry and Special Care, PAECOMEDIS Research Cluster, Ghent University, Ghent University Hospital, 9000, Ghent, Belgium.
| | - Srinath Govindarajan
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent University Hospital, 9000, Ghent, Belgium.,Unit for Molecular Immunology and Inflammation, VIB-Center for Inflammation Research, Technologiepark 71, 9052, Zwijnaarde, Ghent, Belgium
| | - Sivaprakash Rajasekharan
- Department of Paediatric Dentistry and Special Care, PAECOMEDIS Research Cluster, Ghent University, Ghent University Hospital, 9000, Ghent, Belgium
| | - Heidi Declercq
- Tissue Engineering and Biomaterials Group, Department of Human Structure and Repair, Ghent University, Ghent University Hospital, 9000, Ghent, Belgium.,Tissue Engineering Lab, Department of Development and Regeneration, KU Leuven, 8500, Kortrijk, Belgium
| | - Dirk Elewaut
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent University Hospital, 9000, Ghent, Belgium.,Unit for Molecular Immunology and Inflammation, VIB-Center for Inflammation Research, Technologiepark 71, 9052, Zwijnaarde, Ghent, Belgium
| | - Peter De Coster
- Department of Reconstructive Dentistry and Oral Biology, Dental School, Ghent University, Ghent University Hospital, 9000, Ghent, Belgium
| | - Luc Martens
- Department of Paediatric Dentistry and Special Care, PAECOMEDIS Research Cluster, Ghent University, Ghent University Hospital, 9000, Ghent, Belgium
| | - Luc Leybaert
- Department of Basic And Applied Medical Sciences - Physiology Group, Ghent University, Ghent, Belgium
| |
Collapse
|
26
|
Babaki D, Yaghoubi S, Matin MM. The effects of mineral trioxide aggregate on osteo/odontogenic potential of mesenchymal stem cells: a comprehensive and systematic literature review. Biomater Investig Dent 2020; 7:175-185. [PMID: 33313519 PMCID: PMC7717865 DOI: 10.1080/26415275.2020.1848432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/07/2020] [Indexed: 12/12/2022] Open
Abstract
The significance of dental materials in dentin-pulp complex tissue engineering is undeniable. The mechanical properties and bioactivity of mineral trioxide aggregate (MTA) make it a promising biomaterial for future stem cell-based endodontic therapies. There are numerous in vitro studies suggesting the low cytotoxicity of MTA towards various types of cells. Moreover, it has been shown that MTA can enhance mesenchymal stem cells' (MSCs) osteo/odontogenic ability. According to the preferred reporting items for systematic reviews and meta-analyses (PRISMA), a literature review was conducted in the Medline, PubMed, and Scopus databases. Among the identified records, the cytotoxicity and osteo/odontoblastic potential of MTA or its extract on stem cells were investigated. Previous studies have discovered the differentiation-inducing potential of MTA on MSCs, providing a background for dentin-pulp complex cell therapies using the MTA, however, animal trials are needed before moving into clinical trials. In conclusion, MTA can be a promising candidate dental biomaterial for futuristic stem cell-based endodontic therapies.
Collapse
Affiliation(s)
- Danial Babaki
- Department of Biomedical Engineering, Tagliatela College of Engineering, University of New Haven, West Haven, CT, USA
| | - Sanam Yaghoubi
- Visiting Scholar at Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Maryam M. Matin
- Department of Biology, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran
- Novel Diagnostics and Therapeutics Research Group, Institute of Biotechnology, Ferdowsi University of Mashhad, Mashhad, Iran
| |
Collapse
|
27
|
Alazrag MA, Abu-Seida AM, El-Batouty KM, El Ashry SH. Marginal adaptation, solubility and biocompatibility of TheraCal LC compared with MTA-angelus and biodentine as a furcation perforation repair material. BMC Oral Health 2020; 20:298. [PMID: 33121465 PMCID: PMC7599098 DOI: 10.1186/s12903-020-01289-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 10/21/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This study evaluated the marginal adaptation, solubility and biocompatibility of TheraCal LC compared with mineral trioxide aggregate (MTA-Angelus) and Biodentine when used as a furcation perforation repair material. METHODS The marginal adaptation was assessed by scanning electronic microscope and presence of any gap between the dentin surface and filling material in each quadrant of the sample was analyzed at 1000 X magnification. The solubility was measured after one week by the ISO standard method. Biocompatibility was evaluated by the inflammatory response and radiography after one month and three months of repair of experimental furcation perforations in dog's teeth. RESULTS There were significant differences in the marginal adaptation, solubility and biocompatibility of the tested materials (P < 0.05). TheraCal LC showed the highest frequency distribution of gap presence that was followed by the MTA-Angelus then Biodentine. The least soluble material after one week was TheraCal LC that was followed by the MTA-Angelus and Biodentine. After one month and three months, TheraCal LC showed the highest inflammatory response and highest frequency distribution of radiolucency that was followed by the Biodentine then MTA-Angelus. CONCLUSION Unlike Biodentine, TheraCal LC is incapable of alternating the MTA in furcation perforation repair due to its poor biocompatibility and poor marginal adaptation.
Collapse
Affiliation(s)
- M A Alazrag
- Department of Endodontic, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - A M Abu-Seida
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Cairo University, Giza - Giza Square, 12211, Egypt.
| | - K M El-Batouty
- Department of Endodontic, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - S H El Ashry
- Department of Endodontic, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| |
Collapse
|
28
|
Efficacy of different calcium silicate materials as pulp-capping agents: Randomized clinical trial. J Dent Sci 2020; 16:723-731. [PMID: 33854725 PMCID: PMC8025185 DOI: 10.1016/j.jds.2020.08.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/28/2020] [Indexed: 01/11/2023] Open
Abstract
Background/purpose Calcium hydroxide-based materials were the gold standard in vital pulp therapies for decades' despite of several shortcomings. However, calcium silicates have been discussed as an alternative to overcome these drawbacks. It was aimed to investigate the in-vivo effectiveness of different calcium silicates based materials in pulp capping in this study. Materials and methods A parallel-design, randomized controlled trial with 213 patients who has deep dentin caries, vital pulps and without spontaneous pain or history of swelling was designed. 525 M teeth were randomized, blinded and allocated to one of the five groups for pulp capping treatment (n = 105). All teeth were followed up clinically and radiographically (after 1st, 6th, 12th and 36th months) by blinded investigators. The clinical and radiographic success, and the effect of the pulp exposure to the success rate analyzed with Wald chi-square and Z tests. Results Clinical and radiographic success of MTA+ (86.3%, 85.4%) and Biodentine (79.4%, 80.1%) were found the highest. Although results of Theracal LC group (72.1%, 73.6%) were better than Dycal group (69.4%, 70.2%), the difference was nonsignificant (p > 0.05). Only in light-cured groups, (TheraCal LC & LC Calcihyd) pulpal exposure size effected the success of the materials (p < 0.05). MTA+ and Biodentine resulted better scores, when compared with TheraCal LC in large pulpal exposures (p < 0.05). Conclusion After 36-month follow-up, both MTA+ and Biodentine were found to be the appropriate material for direct pulp capping in permanent teeth. The filler ingredient of the Theracal-LC eases the usage of calcium silicates but decreases the success rate.
Collapse
|
29
|
Biocompatibility and Bioactivity of Set Direct Pulp Capping Materials on Human Dental Pulp Stem Cells. MATERIALS 2020; 13:ma13183925. [PMID: 32899877 PMCID: PMC7558537 DOI: 10.3390/ma13183925] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 12/15/2022]
Abstract
In this study, we assessed the biocompatibility and bioactivity of various pulp capping materials—ProRoot MTA (Dentsply Tulsa Dental Specialties), Biodentine (Septodont), TheraCal LC (Bisco), and Dycal (Dentsply Caulk)—on human dental pulp stem cells (hDPSCs). Experimental disks (diameter, 7 mm; height, 4 mm) were stored in a humified incubator at 37 °C for 48 h. Then, the pulp capping materials were tested for cytotoxic effects by methyl-thiazoldiphenyl-tetrazolium and scratch wound healing assays, and for mineralization potential by Alizarin red S (ARS) staining assay and alkaline phosphatase enzyme (ALP) activity. Cell viability and cell migration did not significantly differ between ProRoot MTA, Biodentine, and control (p > 0.05). TheraCal LC exhibited slower cell migration on days 2–4 compared to control (p < 0.05), and Dycal showed no cell migration. ALP activity was highest with Biodentine on days 10 and 14, and was lowered with TheraCal LC and Dycal (p < 0.05). In the ARS assay, hDPSCs grown in ProRoot MTA and TheraCal LC eluates showed significantly increased mineralized nodule formation on day 21 compared to Biodentine, Dycal, and control (p < 0.05). These findings indicate that ProRoot MTA, Biodentine, and TheraCal LC exhibit better biocompatibility and bioactivity than Dycal.
Collapse
|
30
|
Eraković M, Duka M, Bekić M, Tomić S, Ismaili B, Vučević D, Čolić M. Anti‐inflammatory and immunomodulatory effects of Biodentine on human periapical lesion cells in culture. Int Endod J 2020; 53:1398-1412. [DOI: 10.1111/iej.13351] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 12/19/2022]
Affiliation(s)
- M. Eraković
- Clinic for Stomatology Military Medical Academy BelgradeSerbia
| | - M. Duka
- Clinic for Stomatology Military Medical Academy BelgradeSerbia
| | - M. Bekić
- Institute for the Application of Nuclear Energy Zemun Serbia
| | - S. Tomić
- Institute for the Application of Nuclear Energy Zemun Serbia
| | - B. Ismaili
- Polyclinic, Ismaili Gostivar North Macedonia
| | - D. Vučević
- Medical Faculty of the Military Medical Academy University of Defense Belgrade Serbia
| | - M. Čolić
- Institute for the Application of Nuclear Energy Zemun Serbia
- Medical Faculty of the Military Medical Academy University of Defense Belgrade Serbia
- Medical Faculty Foča University of East Sarajevo R.Srpska Bosnia and Herzegovina
| |
Collapse
|
31
|
Gasperi TL, Silveira JDACD, Schmidt TF, Teixeira CDS, Garcia LDFR, Bortoluzzi EA. Physical-Mechanical Properties of a Resin-Modified Calcium Silicate Material for Pulp Capping. Braz Dent J 2020; 31:252-256. [PMID: 32667514 DOI: 10.1590/0103-6440202003079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 01/23/2020] [Indexed: 03/21/2023] Open
Abstract
The purpose of this study was to investigate and to compare the physical-mechanical properties of a resin-modified calcium silicate material (TheraCal LC), used for pulp-capping, to MTA (Angelus) and a calcium hydroxide cement (Dycal). Specimens of each material (n=12) were prepared in Teflon molds (3.58 mm x 3 mm) and measured before and after immersion in distilled water for 24 h and 30 days to evaluate the dimensional change. The same specimens were submitted to compressive strength test on a Universal Testing Machine (Instron) (1 mm/min). Root canals were filled with the cements (n=8), and after 24 h, the bond strength (push-out test) to dentin was also assessed on a Universal Testing Machine (1 mm/min). Eight additional specimens of TheraCal LC were prepared to evaluate the bond strength immediately after light curing. Data were analyzed using One-Way ANOVA, and Tukey or Bonferroni post hoc tests (p<0.05). Percentage expansion of TheraCal LC was above the Specification No. 57 of ANSI/ADA, in both periods. The dimensional change for TheraCal LC was higher than MTA in 24 h and 30 days; and Dycal in 30 days (p<0.05). TheraCal LC had higher compressive and bond strength to dentin in comparison with MTA and Dycal (p<0.05). Although TheraCal LC expanded more than the ANSI/ADA recommendation, its compressive and push-out bond strength to dentin were satisfactory and superior to MTA and Dycal.
Collapse
Affiliation(s)
- Taynnara Licéski Gasperi
- Department of Dentistry, Endodontics Division, Health Sciences Center, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | | | - Tamer Ferreira Schmidt
- Department of Dentistry, Endodontics Division, Health Sciences Center, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Cleonice da Silveira Teixeira
- Department of Dentistry, Endodontics Division, Health Sciences Center, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Lucas da Fonseca Roberti Garcia
- Department of Dentistry, Endodontics Division, Health Sciences Center, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Eduardo Antunes Bortoluzzi
- Department of Dentistry, Endodontics Division, Health Sciences Center, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| |
Collapse
|
32
|
Çelik N, Işcan Yapar M, Taghizadehghalehjoughi A, Nalcı KA. Influence of resveratrol application with pulp-capping materials on the genetic expression levels of stem cells. Int Endod J 2020; 53:1253-1263. [PMID: 32515014 DOI: 10.1111/iej.13345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 11/30/2022]
Abstract
AIM To evaluate in a laboratory setting the response of human mesenchymal stem cells (MSCs) to pulp-capping materials with and without resveratrol (RSV). METHODOLOGY Five materials, Calcimol LC, Life, TheraCal LC, ProRoot MTA and Biodentine, were prepared according to the manufacturers' instructions. Human MSCs were then exposed to these materials, with and without RSV, for 24 h (n = 8). Cell viability was evaluated using the MTT assay, and total cell death was quantified by annexin V-FITC staining with flow cytometry. The expression levels of the IL-8, IL-10, HBD-2 and BCL-2 genes were investigated using real-time polymerase chain reaction (RT-PCR). Data obtained from MTT test were analysed using one-way anova, and Tukey's multiple-comparison test. The paired Student t test was employed to compare the effects of materials on gene expression (significance level of 5%). RESULTS The group cell viabilities were Calcimol LC 53%, Life 43%, TheraCal LC 78%, ProRoot MTA 75% and Biodentine 78%. Calcimol LC and Life exhibited significant differences compared with the control groups (P < 0.05). The percentages of necrotic/late apoptotic cells associated with Calcimol LC and TheraCal LC were greater than in the other materials. However, when RSV was added to wells containing materials, cell viability increased to Calcimol LC 63%, Life 52%, TheraCal LC 82%, ProRoot MTA 91% and Biodentine 96%, and the percentages of early apoptotic and late apoptotic/necrotic cells decreased. Calcimol LC + RSV and Life + RSV differed significantly from the control group (P < 0.05). The expression of IL-8 gene was high for all materials, ProRoot MTA caused significant overexpression, and the addition of RSV reduced the expression of IL-8 in the Calcimol LC, TheraCal LC and ProRoot MTA groups and led to increased expression of IL-10 in the Calcimol LC, Life and Biodentine groups. HBD-2 and BCL-2 exhibited increased expression in ProRoot MTA with RSV (P < 0.05). CONCLUSIONS The addition of RSV exerted a protective effect on MSCs and regulated the inflammatory process by altering the expression levels of pro- and anti-inflammatory genes.
Collapse
Affiliation(s)
- N Çelik
- Department of Restorative Dentistry, Faculty of Dentistry, Atatürk University, Erzurum, Turkey
| | - M Işcan Yapar
- Department of Restorative Dentistry, Faculty of Dentistry, Atatürk University, Erzurum, Turkey
| | - A Taghizadehghalehjoughi
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Atatürk University, Erzurum, Turkey
| | - K A Nalcı
- Department of Medical Pharmacology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| |
Collapse
|
33
|
Pedano MS, Li X, Yoshihara K, Landuyt KV, Van Meerbeek B. Cytotoxicity and Bioactivity of Dental Pulp-Capping Agents towards Human Tooth-Pulp Cells: A Systematic Review of In-Vitro Studies and Meta-Analysis of Randomized and Controlled Clinical Trials. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E2670. [PMID: 32545425 PMCID: PMC7345102 DOI: 10.3390/ma13122670] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/06/2020] [Accepted: 06/08/2020] [Indexed: 12/12/2022]
Abstract
Background. In the era of biology-driven endodontics, vital pulp therapies are regaining popularity as a valid clinical option to postpone root-canal treatment. In this sense, many different materials are available in the market for pulp-capping purposes. Objectives. The main aim of this systematic review and meta-analysis was to examine literature regarding cytotoxicity and bioactivity of pulp-capping agents by exposure of human dental pulp cells of primary origin to these materials. A secondary objective was to evaluate the inflammatory reaction and reparative dentin-bridge formation induced by the different pulp-capping agents on human pulp tissue. Data sources. A literature search strategy was carried out on PubMed, EMBASE and the Web of Science databases. The last search was done on 1 May 2020. No filters or language restrictions were initially applied. Two researchers independently selected the studies and extracted the data. Study selection included eligibility criteria, participants and interventions, study appraisal and synthesis methods. In vitro studies were included when human dental pulp cells of primary origin were (in)directly exposed to pulp-capping agents. Parallel or split-mouth randomized or controlled clinical trials (RCT or CCT) were selected to investigate the effects of different pulp-capping agents on the inflammation and reparative bridge-formation capacity of human pulp tissue. Data were synthesized via odds ratios (95% confidence interval) with fixed or random effects models, depending on the homogeneity of the studies. The relative risks (95% confidence interval) were presented for the sake of interpretation. Results. In total, 26 in vitro and 30 in vivo studies were included in the systematic review and meta-analysis, respectively. The qualitative analysis of in vitro data suggested that resin-free hydraulic calcium-silicate cements promote cell viability and bioactivity towards human dental pulp cells better than resin-based calcium-silicate cements, glass ionomers and calcium-hydroxide cements. The meta-analysis of the in vivo studies indicated that calcium-hydroxide powder/saline promotes reparative bridge formation better than the popular commercial resin-free calcium-silicate cement Pro-Root MTA (Dentsply-Sirona), although the difference was borderline non-significant (p = 0.06), and better than calcium-hydroxide cements (p < 0.0001). Moreover, resin-free pulp-capping agents fostered the formation of a complete reparative bridge better than resin-based materials (p < 0.001). On the other hand, no difference was found among the different materials tested regarding the inflammatory effect provoked at human pulp tissue. Conclusions. Calcium-hydroxide (CH) powder and Pro-Root MTA (Dentsply-Sirona) have shown excellent biocompatibility in vitro and in vivo when tested on human cells and teeth. Their use after many years of research and clinical experience seems safe and proven for vital pulp therapy in healthy individuals, given that an aseptic environment (rubber dam isolation) is provided. Although in vitro evidence suggests that most modern hydraulic calcium-silicate cements promote bioactivity when exposed to human dental pulp cells, care should be taken when these new materials are clinically applied in patients, as small changes in their composition might have big consequences on their clinical efficacy. Key findings (clinical significance). Pure calcium-hydroxide powder/saline and the commercial resin-free hydraulic calcium-silicate cement Pro-Root MTA (Dentsply-Sirona) are the best options to provide a complete reparative bridge upon vital pulp therapy. Systematic review registration number. PROSPERO registration number: CRD42020164374.
Collapse
Affiliation(s)
- Mariano S. Pedano
- Department of Oral Health Sciences, KU Leuven (University of Leuven), BIOMAT—Biomaterials Research Group & UZ Leuven, University Hospitals Leuven, 3000 Leuven, Belgium; (M.S.P.); (X.L.); (K.V.L.)
| | - Xin Li
- Department of Oral Health Sciences, KU Leuven (University of Leuven), BIOMAT—Biomaterials Research Group & UZ Leuven, University Hospitals Leuven, 3000 Leuven, Belgium; (M.S.P.); (X.L.); (K.V.L.)
| | - Kumiko Yoshihara
- National Institute of Advanced Industrial Science and Technology (AIST), Health Research Institute, 2217-14 Hayashi-Cho, Takamaysu, Kagawa 761-0395, Japan;
- Department of Pathology & Experimental Medicine, Dentistry and Pharmaceutical Sciences, Graduate School of Medicine, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Kirsten Van Landuyt
- Department of Oral Health Sciences, KU Leuven (University of Leuven), BIOMAT—Biomaterials Research Group & UZ Leuven, University Hospitals Leuven, 3000 Leuven, Belgium; (M.S.P.); (X.L.); (K.V.L.)
| | - Bart Van Meerbeek
- Department of Oral Health Sciences, KU Leuven (University of Leuven), BIOMAT—Biomaterials Research Group & UZ Leuven, University Hospitals Leuven, 3000 Leuven, Belgium; (M.S.P.); (X.L.); (K.V.L.)
| |
Collapse
|
34
|
Li X, Pedano MS, Li S, Sun Z, Jeanneau C, About I, Hauben E, Chen Z, Van Landuyt K, Van Meerbeek B. Preclinical effectiveness of an experimental tricalcium silicate cement on pulpal repair. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 116:111167. [PMID: 32806325 DOI: 10.1016/j.msec.2020.111167] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/18/2020] [Accepted: 06/05/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To investigate the pulpal repair potential of an experimental zirconium-oxide containing tricalcium-silicate cement, referred to as 'TCS 50'. MATERIALS AND METHODS The effect of TCS 50 on viability, proliferation, migration, and odontoblastic differentiation of human dental pulp cells (HDPCs) was assessed using XTT assay, in-vitro wound healing assay and RT-PCR, respectively. Additionally, the pulp-capping potential was evaluated using a vital human tooth model. Statistical analysis was performed using non-parametric Kruskal-Wallis test and post-hoc test (Mann-Whitney U test). The tests were performed at a significance level of α = 0.05. RESULTS The effect of TCS 50 towards HDPCs was dose dependent. Undiluted TCS 50 extract showed no immediate adverse impact on cell viability (p > .05); however, it significantly inhibited proliferation and migration of HDPCs (p < .05). A 25% diluted TCS 50 extract showed no significant effect on cell viability, proliferation or migration (p > .05), and it significantly enhanced odontoblastic differentiation of HDPCs (p < .05). In pulps capped with TCS 50 for both 2 and 4 weeks, H&E staining revealed a normal morphology of pulp tissue; mineralized foci with cellular components entrapped in the matrix were formed underneath the exposure site. Collagen I expression was weak within the matrix of mineralized foci, while the expression of nestin was positive for entrapped cellular components within the mineralized foci, indicating that the formed mineralized foci corresponded to an initial form of reparative dentin formation. CONCLUSION TCS 50 is capable of generating an early pulp-healing reaction and therefore could serve as a promising pulp-capping agent.
Collapse
Affiliation(s)
- Xin Li
- KU Leuven (University of Leuven), Department of Oral Health Sciences, BIOMAT & UZ Leuven (University Hospitals Leuven), Dentistry, Leuven, Belgium
| | - Mariano Simón Pedano
- KU Leuven (University of Leuven), Department of Oral Health Sciences, BIOMAT & UZ Leuven (University Hospitals Leuven), Dentistry, Leuven, Belgium
| | - Shuchen Li
- Wuhan University, School and Hospital of Stomatology, The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine of Ministry of Education, Wuhan, PR China
| | - Zheyi Sun
- Wuhan University, School and Hospital of Stomatology, The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine of Ministry of Education, Wuhan, PR China
| | - Charlotte Jeanneau
- Wuhan University, School and Hospital of Stomatology, The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine of Ministry of Education, Wuhan, PR China
| | - Imad About
- Aix Marseille Univ, CNRS, ISM, Inst Movement Sci, Marseille, France
| | - Esther Hauben
- Laboratory for Pathology, UZ Leuven & Department of Imaging and Pathology, Translational Cell and Tissue Research, KU, Leuven, Belgium
| | - Zhi Chen
- Wuhan University, School and Hospital of Stomatology, The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine of Ministry of Education, Wuhan, PR China
| | - Kirsten Van Landuyt
- KU Leuven (University of Leuven), Department of Oral Health Sciences, BIOMAT & UZ Leuven (University Hospitals Leuven), Dentistry, Leuven, Belgium
| | - Bart Van Meerbeek
- KU Leuven (University of Leuven), Department of Oral Health Sciences, BIOMAT & UZ Leuven (University Hospitals Leuven), Dentistry, Leuven, Belgium.
| |
Collapse
|
35
|
Comparative Surface Morphology, Chemical Composition, and Cytocompatibility of Bio-C Repair, Biodentine, and ProRoot MTA on hDPCs. MATERIALS 2020; 13:ma13092189. [PMID: 32397585 PMCID: PMC7254305 DOI: 10.3390/ma13092189] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 12/31/2022]
Abstract
Biocompatibility is an essential property for any vital pulp material that may interact with the dental pulp tissues. Accordingly, this study aimed to compare the chemical composition and ultrastructural morphology of Biodentine (Septodont, Saint Maur-des-Fosses, France), ProRoot MTA (Dentsply Tulsa Dental Specialties, Johnson City, TN, USA), and Bio-C Repair (Angelus, Londrina, PR, Brazil), as well as their biological effects on human dental pulp cells. Chemical element characterization of the materials was undertaken using scanning electron microscopy and energy dispersive X-ray analysis (SEM-EDX). The cytotoxicity was assessed by analyzing the cell viability (MTT assay), cell morphology (immunofluorescence assay), and cell attachment (flow cytometry assay). The results were statistically analyzed using ANOVA and Tukey’s test (p < 0.05). EDX revealed that ProRoot MTA and Biodentine were mostly composed of calcium, carbon, and oxygen (among others), whereas Bio-C Repair evidenced a low concentration of calcium and the highest concentration of zirconium. SEM showed adequate attachment of human dental pulp cells (hDPCS) to vital pulp materials and cytoskeletal alterations were not observed in the presence of material eluates. Remarkably, the undiluted Biodentine group showed higher viability than the control group cells (without eluates) at 24 h, 48 h, and 72 h (p < 0.001). Based on the evidence derived from an in vitro cellular study, it was concluded that Bio-C Repair showed excellent cytocompatibility that was similar to Biodentine and ProRoot MTA.
Collapse
|
36
|
Sanz JL, Forner L, Almudéver A, Guerrero-Gironés J, Llena C. Viability and Stimulation of Human Stem Cells from the Apical Papilla (hSCAPs) Induced by Silicate-Based Materials for Their Potential Use in Regenerative Endodontics: A Systematic Review. MATERIALS 2020; 13:ma13040974. [PMID: 32098171 PMCID: PMC7078727 DOI: 10.3390/ma13040974] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/13/2020] [Accepted: 02/20/2020] [Indexed: 12/12/2022]
Abstract
Blood clot formation in the apical third of the root canal system has been shown to promote further root development and reinforcement of dentinal walls by the deposition of mineralized tissue, resulting in an advancement from traditional apexification procedures to a regenerative endodontic treatment (RET) for non-vital immature permanent teeth. Silicate-based hydraulic biomaterials, categorized as bioactive endodontic cements, emerged as bright candidates for their use in RET as coronal barriers, sealing the previously induced blood clot scaffold. Human stem cells from the apical papilla (hSCAPs) surviving the infection may induce or at least be partially responsible for the regeneration or repair shown in RET. The aim of this study is to present a qualitative synthesis of available literature consisting of in vitro assays which analyzed the viability and stimulation of hSCAPs induced by silicate-based hydraulic biomaterials. A systematic electronic search was carried out in Medline, Scopus, Embase, Web of Science, Cochrane and SciELO databases, followed by a study selection, data extraction, and quality assessment following the PRISMA protocol. In vitro studies assessing the viability, proliferation, and/or differentiation of hSCAPs as well as their mineralization potential and/or osteogenic, odontogenic, cementogenic and/or angiogenic marker expression in contact with commercially available silicate-based materials were included in the present review. The search identified 73 preliminary references, of which 10 resulted to be eligible for qualitative synthesis. The modal materials studied were ProRoot MTA and Biodentine. Both bioceramic materials showed significant positive results when compared to a control for hSCAP cell viability, migration, and proliferation assays; a significant up-regulation of hSCAP odontogenic/osteogenic marker (ALP, DSPP, BSP, Runx2, OCN, OSX), angiogenic growth factor (VEGFA, FIGF) and pro-inflammatory cytokine (IL-1α, IL-1β, IL-6, TNF-α) expression; and a significant increase in hSCAP mineralized nodule formation assessed by Alizarin Red staining. Commercially available silicate-based materials considered in the present review can potentially induce mineralization and odontogenic/osteogenic differentiation of hSCAPs, thus prompting their use in regenerative endodontic procedures.
Collapse
Affiliation(s)
- José Luis Sanz
- Dental Pathology and Therapeutics Unit, Department of Stomatology, Universitat de València, 46010 Valencia, Spain; (J.L.S.); (A.A.); (C.L.)
| | - Leopoldo Forner
- Dental Pathology and Therapeutics Unit, Department of Stomatology, Universitat de València, 46010 Valencia, Spain; (J.L.S.); (A.A.); (C.L.)
- Correspondence: ; Tel.: +34-96386-4175
| | - Alicia Almudéver
- Dental Pathology and Therapeutics Unit, Department of Stomatology, Universitat de València, 46010 Valencia, Spain; (J.L.S.); (A.A.); (C.L.)
| | - Julia Guerrero-Gironés
- Special Care and Gerodontology Unit, Department of Stomatology, University of Murcia, 30100 Murcia, Spain;
| | - Carmen Llena
- Dental Pathology and Therapeutics Unit, Department of Stomatology, Universitat de València, 46010 Valencia, Spain; (J.L.S.); (A.A.); (C.L.)
| |
Collapse
|
37
|
Koutroulis A, Kuehne SA, Cooper PR, Camilleri J. The role of calcium ion release on biocompatibility and antimicrobial properties of hydraulic cements. Sci Rep 2019; 9:19019. [PMID: 31836731 PMCID: PMC6910940 DOI: 10.1038/s41598-019-55288-3] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/26/2019] [Indexed: 12/01/2022] Open
Abstract
Tricalcium silicate (TCS)-based materials produce calcium hydroxide as a byproduct of their hydration reaction. The present study investigated whether calcium ion release (CIR) affects their biological and antimicrobial properties when used as pulp protection materials. The effect of incorporation of micro-silica and calcium phosphate monobasic to radiopacified TCS-based materials was investigated. The commercial TCS-based Biodentine, Bio-C Pulpo, TotalFill Root Repair Material, TheraCal LC and a base/liner- ACTIVA BioACTIVE (Activa) were also evaluated. The hydration and CIR were monitored and correlated with biocompatibility and antimicrobial assessment of eluates. Overall, the additives altered the hydration and leaching profile of the prototype cements. The micro-silica inclusion resulted in a decreased long-term calcium hydroxide formation which was associated with neutralised cytotoxicity and antibacterial activity. Calcium phosphate did not alter the leaching profile, although a stronger antibacterial effect was induced. The commercial materials also had different CIR profiles. The water-based ones had higher CIR, and this was associated with stronger antimicrobial effect but not enhanced biological activity. Both TheraCal LC and Activa exhibited poor degree of conversion, low CIR, acceptable biocompatibility and moderate antibacterial activity. A positive correlation of CIR with antibacterial effectiveness was observed (0.3 < r < 0.49; p = 0.021, p = 0.011 for the two test bacterial cultures). No relation was shown between CIR and cytotoxicity (0.3 < r < 0.49; p = 0.150, p = 0.068 for the two cell cultures studied). The additives modified the CIR. The antimicrobial properties were dependent on the CIR; the cytotoxicity of the materials was unaffected.
Collapse
Affiliation(s)
- Andreas Koutroulis
- School of Dentistry, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, B5 7EG, Birmingham, United Kingdom
| | - Sarah A Kuehne
- School of Dentistry, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, B5 7EG, Birmingham, United Kingdom
| | - Paul R Cooper
- School of Dentistry, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, B5 7EG, Birmingham, United Kingdom.,Department of Oral Sciences, Faculty of Dentistry, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Josette Camilleri
- School of Dentistry, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, B5 7EG, Birmingham, United Kingdom.
| |
Collapse
|
38
|
Balbinot GDS, Leitune VCB, Nunes JS, Visioli F, Collares FM. Synthesis of sol-gel derived calcium silicate particles and development of a bioactive endodontic cement. Dent Mater 2019; 36:135-144. [PMID: 31784062 DOI: 10.1016/j.dental.2019.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 10/21/2019] [Accepted: 11/11/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The aim of this study is to produce sol-gel derived calcium silicate particles (CS) and evaluate the influence of different concentration of calcium tungstate in the physical, chemical, mechanical and biological properties of developed cements. METHODS Sol-gel route were used to synthesize calcium silicate particles that were characterized with x-ray difraction, Fourier transformed infrared spectroscopy, scanning electron microscopy, laser diffraction and nitrogen absorption. Cements were formulated with the addition of different concentrations of calcium tungstate (CaWO4), resulting in four experimental groups according to the CS:CaWO4 ratio: CS100 (100:0), CS90 (90:10), CS80 (80:20), CS70 (70:30). The setting time, radiopacity, compressive strength, pH, calcium release, cell proliferation and cell differentiation were used to characterize the cements. RESULTS CS particles were succesfully sinthesized. The addition of CaWO4 increased the radiopacity and did not influenced the setting time and the mechanical properties of cements. The pH of distilled water was increased for all groups and the CS100 and CS90 groups presented incresed calcium release. Reduced cell viability was found for CS70 while CS100 and CS90 presented higher ALP activity and % of mineralized nodules after 21 days. SIGNIFICANCE Sol-gel derived CS particles were sucssfully developed with potential to applied for the production of bioactive ceramic cements. The addition of 10% of CaWO4 resulted in cements with adequate properties and bioactivity being an alternative for regenerative endodontic treatments.
Collapse
Affiliation(s)
- Gabriela de Souza Balbinot
- Dental Materials Laboratory, School of Dentistry, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | | | - Julia Silveira Nunes
- Patology Laboratory, School of Dentistry, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Fernanda Visioli
- Patology Laboratory, School of Dentistry, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Fabricio Mezzomo Collares
- Dental Materials Laboratory, School of Dentistry, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil.
| |
Collapse
|
39
|
Youssef AR, Emara R, Taher MM, Al-Allaf FA, Almalki M, Almasri MA, Siddiqui SS. Effects of mineral trioxide aggregate, calcium hydroxide, biodentine and Emdogain on osteogenesis, Odontogenesis, angiogenesis and cell viability of dental pulp stem cells. BMC Oral Health 2019; 19:133. [PMID: 31266498 PMCID: PMC6604301 DOI: 10.1186/s12903-019-0827-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 06/19/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Vital pulp therapy preserves and maintains the integrity and the health of dental pulp tissue that has been injured by trauma, caries or restorative procedures. The enhancement of cells viability and formation of reparative dentine and new blood vessels are vital determinants of the success of direct pulp capping. Therefore, the aims of this study was to evaluate and compare the in vitro osteogenic, odontogenic and angiogenic effects of mineral trioxide aggregate (MTA), calcium hydroxide [Ca(OH)2], Biodentine and Emdogain on dental pulp stem cells (DPSCs) and examine the effects of the tested materials on cell viability. METHODS DPSCs were treated with MTA, Ca(OH)2, Biodentine or Emdogain. Untreated cells were used as control. The cell viability was measured by MTT assay on day 3. Real-Time PCR with SYBR green was used to quantify the gene expression levels of osteogenic markers (alkaline phosphatase and osteopontin), odontogenic marker (dentin sialophosphoprotein) and angiogenic factor (vascular endothelial growth factor) on day 7 and day 14. RESULTS All capping materials showed variable cytotoxicity against DPSCs (77% for Emdogain, 53% for MTA, 26% for Biodentine and 16% for Ca(OH)2 compared to control (P value < 0.0001). Osteopontin (OPN) and dentin sialophosphoprotein (DSPP) gene expression was increased by all four materials. However, alkaline phosphatase (ALP) was upregulated by all materials except Emdogain. Vascular endothelial growth factor (VEGF) expression was upregulated by all four tested materials except Ca(OH)2. CONCLUSIONS Our results suggest MTA, Biodentine and Emdogain exhibit similar attributes and may score better than Ca(OH)2. Emdogain could be a promising alternative to MTA and Biodentine in enhancing pulp repair capacity following dental pulp injury. However, further future research is required to assess the clinical outcomes and compare it with the in vitro findings.
Collapse
Affiliation(s)
- Abdel-Rahman Youssef
- Department of Basic and Clinical Oral Sciences, Faculty of Dentistry, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia. .,Department of Microbiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
| | - Ramy Emara
- Department of Restorative dentistry, Faculty of Dentistry, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Mohiuddin M Taher
- Department of Medical Genetics, Umm-Al-Qura University, Makkah, Kingdom of Saudi Arabia.,Science and Technology Unit Umm-Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Faisal A Al-Allaf
- Department of Medical Genetics, Umm-Al-Qura University, Makkah, Kingdom of Saudi Arabia.,Science and Technology Unit Umm-Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Majed Almalki
- Department of Restorative dentistry, Faculty of Dentistry, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Mazen A Almasri
- Oral Maxillofacial Surgery Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Shahid S Siddiqui
- Department of Basic and Clinical Oral Sciences, Faculty of Dentistry, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| |
Collapse
|
40
|
Liu J, Lu Y, Liu J, Jin C, Meng Y, Pei D. Influence of epigallocatechin-3-gallate in promoting proliferation and osteogenic differentiation of human periodontal ligament cells. BMC Oral Health 2019; 19:73. [PMID: 31046751 PMCID: PMC6498622 DOI: 10.1186/s12903-019-0768-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/16/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Epigallocatechin-3-gallate (EGCG) was recently proposed to have the potential to regulate bone metabolism, however, its influence on osteogenesis remains controversial. The present study aimed to investigate the effects of EGCG on the proliferation and osteogenesis of human periodontal ligament cells (hPDLCs). METHODS Cells were cultured in osteogenic medium and treated with EGCG at various concentrations. Cell proliferation was analyzed using a CCK-8 assay and acridine orange (AO)/ethidium bromide (EB) staining. Flow cytometry was used to measure the intracellular reactive oxygen species (ROS) potential of hPDLCs. The expression levels of osteogenic marker genes and proteins in hPDLCs, including type I collagen (COL1), runt-related transcription factor 2 (RUNX2), osteopontin (OPN), and osterix (OSX), were determined by quantitative real-time polymerase chain reaction (qRT-PCR) and western blot analysis. In addition, alkaline phosphatase (ALP) activity was monitored both quantitatively and qualitatively. Extracellular matrix mineralization was further analyzed by alizarin red S staining. RESULTS The results showed that EGCG concentrations from 6 to 10 μM increased the ROS level and inhibited the cell proliferation of hPDLCs. EGCG concentrations from 2 to 8 μM effectively increased extracellular matrix mineralization, in which 4 and 6 μM EGCG generated the most mineralizing nodules. The ALP activity and the mRNA and protein expression levels of the tested osteogenic markers were most strongly up-regulated by treatment with 4 and 6 μM EGCG. CONCLUSIONS The present study demonstrated that EGCG might promote the osteogenesis of hPDLCs in a dose-dependent manner, with concentrations of 4 and 6 μM EGCG showing the strongest osteogenic enhancement without cytotoxicity, indicating a promising role for EGCG in periodontal regeneration in patients with deficient alveolar bone in the future.
Collapse
Affiliation(s)
- Jie Liu
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China.,Department of Prosthodontics, College of Stomatology, Xi'an Jiaotong University, 98 Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Yi Lu
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Jin Liu
- Department of Periodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Changxiong Jin
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Yuchen Meng
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Dandan Pei
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China. .,Department of Prosthodontics, College of Stomatology, Xi'an Jiaotong University, 98 Xiwu Road, Xi'an, 710004, Shaanxi, China.
| |
Collapse
|
41
|
Fathy SM. Remineralization ability of two hydraulic calcium-silicate based dental pulp capping materials: Cell-independent model. J Clin Exp Dent 2019; 11:e360-e366. [PMID: 31110616 PMCID: PMC6522110 DOI: 10.4317/jced.55689] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/21/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND This study aimed to evaluate remineralizing ability of two hydraulic calcium-silicate cements (Biodentine and TheraCal LC). MATERIAL AND METHODS Artificial carious lesions were introduced into the pulpal floors (1-1.5 mm) and axial walls of occlusal prepared cavity halves through pH cycling. Cycling was made through demineralizing solution (pH 3), for 8 hours and remineralizing solution (pH 7) for 16 hours. The total period of pH cycling was 14 days. Prepared cavities with the tested materials seated directly on the pulpal floor and in contact with the axial walls were stored in phosphate buffer solutions (PBS) (pH 7.2-7.4). The changes in the weight percentages (wt%) of calcium (Ca) and phosphorus (P) were detected using SEM and energy dispersive X-ray spectroscopy with reference to sound dentin after three intervals (one week, 3 and 6 months). Data were statistically analyzed using two-way ANOVA and Tukey's post hoc test. RESULTS Demineralized dentin, next to Biodentine, showed statistically higher intensities of Ca and P wt% after the three periods of incubation (p< 0.05). Surface mapping of both tested cements and their adjacent demineralized dentin showed increase in overall distribution of previous ions. SEM of subsurface layer under both materials showed filling of most intra-tubular areas with rod-like mineralized structure without significant difference. CONCLUSIONS Biodentine has a higher ability to enrich the artificial carious dentin with significantly higher mineral contents available for remineralization. Both pulp-capping materials have significantly induced remineralization of demineralized dentin beneath them after total period of incubation. Key words:Artificial Caries, Hydraulic Cements, pH Cycling, Remineralization.
Collapse
Affiliation(s)
- Salma M Fathy
- Dental Biomaterials Dept., Faculty of Oral and Dental Medicine, Zagazig University, Egypt
| |
Collapse
|
42
|
Sanz JL, Rodríguez-Lozano FJ, Llena C, Sauro S, Forner L. Bioactivity of Bioceramic Materials Used in the Dentin-Pulp Complex Therapy: A Systematic Review. MATERIALS 2019; 12:ma12071015. [PMID: 30934746 PMCID: PMC6479584 DOI: 10.3390/ma12071015] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 12/14/2022]
Abstract
Dentistry-applied bioceramic materials are ceramic materials that are categorized as bioinert, bioactive and biodegradable. They share a common characteristic of being specifically designed to fulfil their function; they are able to act as root canal sealers, cements, root repair or filling materials. Bioactivity is only attributed to those materials which are capable of inducing a desired tissue response from the host. The aim of this study is to present a systematic review of available literature investigating bioactivity of dentistry-applied bioceramic materials towards dental pulp stem cells, including a bibliometric analysis of such a group of studies and a presentation of the parameters used to assess bioactivity, materials studied and a summary of results. The research question, based on the PICO model, aimed to assess the current knowledge on dentistry-based bioceramic materials by exploring to what extent they express bioactive properties in in vitro assays and animal studies when exposed to dental pulp stem cells, as opposed to a control or compared to different bioceramic material compositions, for their use in the dentin-pulp complex therapy. A systematic search of the literature was performed in six databases, followed by article selection, data extraction, and quality assessment. Studies assessing bioactivity of one or more bioceramic materials (both commercially available or novel/experimental) towards dental pulp stem cells (DPSCs) were included in our review. A total of 37 articles were included in our qualitative review. Quantification of osteogenic, odontogenic and angiogenic markers using reverse transcriptase polymerase chain reaction (RT-PCR) is the prevailing method used to evaluate bioceramic material bioactivity towards DPSCs in the current investigative state, followed by alkaline phosphatase (ALP) enzyme activity assays and Alizarin Red Staining (ARS) to assess mineralization potential. Mineral trioxide aggregate and Biodentine are the prevalent reference materials used to compare with newly introduced bioceramic materials. Available literature compares a wide range of bioceramic materials for bioactivity, consisting mostly of in vitro assays. The desirability of this property added to the rapid introduction of new material compositions makes this subject a clear candidate for future research.
Collapse
Affiliation(s)
- José Luis Sanz
- Department of Stomatology, Universitat de València, 46010 Valencia, Spain.
| | - Francisco Javier Rodríguez-Lozano
- Cellular Therapy and Hematopoietic Transplant Unit, Hematology Department, Virgen de la Arrixaca Clinical University Hospital, IMIB, University of Murcia, 30120 Murcia, Spain.
- School of Dentistry, Faculty of Medicine, University of Murcia, 30100 Murcia, Spain.
| | - Carmen Llena
- Department of Stomatology, Universitat de València, 46010 Valencia, Spain.
| | - Salvatore Sauro
- Department of Dentistry, Faculty of Health Sciences, Universidad CEU-Cardenal Herrera, 46115 Alfara del Patriarca (Valencia), Spain.
- Faculty of Dentistry, Oral & Craniofacial Sciences at King's College London, Floor 17 Tower Wing, Guy's Hospital, London SE1 9RT, UK.
| | - Leopoldo Forner
- Department of Stomatology, Universitat de València, 46010 Valencia, Spain.
| |
Collapse
|
43
|
Influence of ultrasonic agitation on bond strength, marginal adaptation, and tooth discoloration provided by three coronary barrier endodontic materials. Clin Oral Investig 2019; 23:4113-4122. [DOI: 10.1007/s00784-019-02850-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
|
44
|
Collado-González M, López-García S, García-Bernal D, Oñate-Sánchez RE, Tomás-Catalá CJ, Moraleda JM, Lozano A, Forner L, Rodríguez-Lozano FJ. Biological effects of acid-eroded MTA Repair HP and ProRoot MTA on human periodontal ligament stem cells. Clin Oral Investig 2019; 23:3915-3924. [PMID: 30684060 DOI: 10.1007/s00784-019-02822-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 01/16/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this study was to analyze the biological effects of MTA Repair HP and ProRoot MTA on human periodontal ligament stem cells (hPDLSCs) after exposure to acidic and neutral environments. MATERIALS AND METHODS Discs of each material (n = 30) were exposed to phosphate buffered saline (pH = 7.4) or butyric acid (pH = 5.2) for 7 days, and biological testing was carried out in vitro on hPDLSCs. Cell viability and apoptosis assays were performed using eluates of each root-end filling material. To evaluate cell attachment to the different materials, hPDLSCs were directly seeded onto the material surfaces and analyzed by scanning electron microscopy. The chemical composition of the root-end filling materials was determined by energy-dispersive x-ray and eluates were analyzed by inductively coupled plasma-mass spectrometry. Statistical differences were assessed by ANOVA and Tukey test (p < 0.05). RESULTS Under an acidic environment, both materials displayed similar ion release abilities, with the increased release of Si and Ca ions. Substantial changes in microstructure were observed for both materials after exposure to acidic pH. In addition, material exposure to an acidic environment showed a similar degree of cell adherence, and, surprisingly, MTA Repair HP exhibited higher cell viability rates at pH 5.2 than ProRoot MTA. CONCLUSIONS Exposure to an acidic environment promoted Si and Ca ion release from ProRoot MTA and MTA Repair HP. Moreover, we observed optimal biological properties of ProRoot MTA and MTA Repair HP in terms of cell viability, cell death, and cell attachment in both environments. CLINICAL RELEVANCE These results may suggest that MTA Repair HP and ProRoot exhibited optimal biological properties in terms of cell viability, cell death and cell attachment in acidic environment, being considered as materials for root-end filling and perforations.
Collapse
Affiliation(s)
- Mar Collado-González
- Cellular Therapy and Hematopoietic Transplant Unit, Hematology Department, Virgen de la Arrixaca Clinical University Hospital, IMIB-Arrixaca, University of Murcia, Murcia, Spain.,School of Dentistry, Faculty of Medicine, University of Murcia, Hospital Morales Meseguer 2pl., Av. Marqués de los Vélez s/n, 30008, Murcia, Spain
| | - Sergio López-García
- Cellular Therapy and Hematopoietic Transplant Unit, Hematology Department, Virgen de la Arrixaca Clinical University Hospital, IMIB-Arrixaca, University of Murcia, Murcia, Spain
| | - David García-Bernal
- Cellular Therapy and Hematopoietic Transplant Unit, Hematology Department, Virgen de la Arrixaca Clinical University Hospital, IMIB-Arrixaca, University of Murcia, Murcia, Spain.,Department of Internal Medicine, University of Murcia, Murcia, Spain
| | - Ricardo E Oñate-Sánchez
- School of Dentistry, Faculty of Medicine, University of Murcia, Hospital Morales Meseguer 2pl., Av. Marqués de los Vélez s/n, 30008, Murcia, Spain
| | - Christopher J Tomás-Catalá
- Cellular Therapy and Hematopoietic Transplant Unit, Hematology Department, Virgen de la Arrixaca Clinical University Hospital, IMIB-Arrixaca, University of Murcia, Murcia, Spain.,School of Dentistry, Faculty of Medicine, University of Murcia, Hospital Morales Meseguer 2pl., Av. Marqués de los Vélez s/n, 30008, Murcia, Spain
| | - Jose M Moraleda
- Cellular Therapy and Hematopoietic Transplant Unit, Hematology Department, Virgen de la Arrixaca Clinical University Hospital, IMIB-Arrixaca, University of Murcia, Murcia, Spain.,Department of Internal Medicine, University of Murcia, Murcia, Spain
| | - Adrián Lozano
- Department of Stomatology, University de Valencia, Valencia, Spain
| | - Leopoldo Forner
- Department of Stomatology, University de Valencia, Valencia, Spain
| | - Francisco J Rodríguez-Lozano
- Cellular Therapy and Hematopoietic Transplant Unit, Hematology Department, Virgen de la Arrixaca Clinical University Hospital, IMIB-Arrixaca, University of Murcia, Murcia, Spain. .,School of Dentistry, Faculty of Medicine, University of Murcia, Hospital Morales Meseguer 2pl., Av. Marqués de los Vélez s/n, 30008, Murcia, Spain.
| |
Collapse
|
45
|
SARZEDA GDR, BAHIA MS, DORIGUÊTTO PVT, DEVITO KL, LEITE APP. Análise da composição química dos cimentos MTA Angelus® branco, cinza e HP Repair® através de Microscopia Eletrônica de Varredura (MEV) acoplada a Espectrômetro de Energia Dispersiva (EDS). REVISTA DE ODONTOLOGIA DA UNESP 2019. [DOI: 10.1590/1807-2577.09319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Introdução Devido às suas propriedades biológicas e físico-químicas, o MTA tem sido indicado para diferentes situações clínicas na Endodontia. Objetivo O objetivo foi analisar a composição química dos cimentos MTA Angelus branco, cinza, e Repair HP. Material e método Foram confeccionados cinco corpos de prova de cada tipo de cimento estudado, com diâmetro de 4 mm e altura de 1 mm, utilizando fita condutora de carbono dupla face. Em seguida, as amostras foram analisadas com auxílio de um microscópio eletrônico de varredura acoplado ao aparelho de espectrometria de energia dispersiva. Posteriormente, foram submetidos ao teste estatístico Kolmogorov-Smirnov para verificar a normalidade. Os elementos químicos que apresentaram distribuição normal (média de 5%) foram submetidos ao teste ANOVA e o teste Kruskal-Wallis foi aplicado naqueles com distribuição assimétrica. Resultado Após a análise dos elementos químicos, foram observados para o MTA branco: O, Na, K, Mg, Al, Si, Ca e Bi; para o MTA cinza: O, Mg, Al, Si, Ca, Bi, Fe e S, e para o Repair HP: O, Al, Mg, Si, Ca, Fe, Sr, C, Rb e W. Foram identificados 14 elementos químicos nas amostras analisadas (O, Na, Al, Mg, Si, S, K, Ca, Fe, Sr, Bi, C, Rb e W). Destes, cinco foram encontrados em todos os cimentos estudados: O, Al, Mg, Si e Ca. Conclusão Os elementos Rb, W e C foram encontrados somente na nova formulação de MTA da Angelus, o Repair HP. Nas amostras analisadas, o Ca e o O foram os que se apresentaram em maior quantidade.
Collapse
|
46
|
Careddu R, Duncan HF. How does the pulpal response to Biodentine and ProRoot mineral trioxide aggregate compare in the laboratory and clinic? Br Dent J 2018; 225:sj.bdj.2018.864. [PMID: 30337724 DOI: 10.1038/sj.bdj.2018.864] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2018] [Indexed: 02/07/2023]
Affiliation(s)
- R Careddu
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Lincoln Place, Dublin 2, Ireland
| | - H F Duncan
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Lincoln Place, Dublin 2, Ireland
| |
Collapse
|
47
|
Emara R, Elhennawy K, Schwendicke F. Effects of calcium silicate cements on dental pulp cells: A systematic review. J Dent 2018; 77:18-36. [DOI: 10.1016/j.jdent.2018.08.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/01/2018] [Accepted: 08/03/2018] [Indexed: 02/03/2023] Open
|
48
|
Chen S, Shi L, Luo J, Engqvist H. Novel Fast-Setting Mineral Trioxide Aggregate: Its Formulation, Chemical-Physical Properties, and Cytocompatibility. ACS APPLIED MATERIALS & INTERFACES 2018; 10:20334-20341. [PMID: 29787235 DOI: 10.1021/acsami.8b04946] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
One of the main drawbacks that limits the application of mineral trioxide aggregate (MTA) in dental field is its long setting time. Mineral trioxide aggregate with accelerated setting properties and excellent chemical-physical and biological properties is still required. In this study, an innovative mineral trioxide aggregate, which consists of calcium silicates, calcium aluminates, and zirconium oxide, was designed to obtain fast-setting property. The optimized formulation can achieve initial setting in 10 min and final setting in 15 min, which are much faster than commercial mineral trioxide aggregate. In addition, the optimized fast-setting MTA showed adequate radiopacity and good biocompatibility. The ion concentrations after storage in water for 1 day were 52.3 mg/L Ca, 67.7 mg/L Al, 48.8 mg/L Si, and 11.7 mg/L Mg. The hydration products of hardened cements were investigated by X-ray diffraction, scanning electron microscopy, and Fourier transform infrared, showing the accelerated setting time was due to the formation of honeycomb-like calcium silicate hydrate gel. The novel MTA could be a promising material for dental applications.
Collapse
Affiliation(s)
| | - Liyang Shi
- College of Biology , Hunan University , Changsha 410082 , China
| | | | | |
Collapse
|
49
|
Direct pulp capping in primary molars using a resin-modified Portland cement-based material (TheraCal) compared to MTA with 12-month follow-up: a randomised clinical trial. Eur Arch Paediatr Dent 2018; 19:197-203. [PMID: 29767382 DOI: 10.1007/s40368-018-0348-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 04/17/2018] [Indexed: 01/07/2023]
Abstract
AIM This study was to compare the success of resin-modified Portland cement-based material (TheraCal) with MTA in direct pulp capping (DPC) of primary molars. METHODS Symmetrical bilateral primary molars (92) from 46 healthy subjects aged 5-7 years were included in this split-mouth randomised clinical trial. DPC for small non-contaminated pulp exposures using either TheraCal or MTA were randomly performed in symmetrical molars. Thereafter, teeth were restored with amalgam. Clinical and radiographic evaluations were performed at 6 and 12 month follow-ups. Data were analysed using Chi square test at a significance level of 0.05. RESULTS At the final follow-up session 74 teeth were available. After 12 months, the overall success rates for MTA and TheraCal were 94.5 and 91.8%, respectively. The difference between outcomes of the two groups was not statistically significant (P > 0.05). CONCLUSION Within the limitations of the current study, radiographic and clinical findings revealed that TheraCal exhibited a comparable outcome to MTA in DPC of primary molars after 12 months.
Collapse
|
50
|
Tsai CL, Ke MC, Chen YH, Kuo HK, Yu HJ, Chen CT, Tseng YC, Chuang PC, Wu PC. Mineral trioxide aggregate affects cell viability and induces apoptosis of stem cells from human exfoliated deciduous teeth. BMC Pharmacol Toxicol 2018; 19:21. [PMID: 29764492 PMCID: PMC5952617 DOI: 10.1186/s40360-018-0214-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 05/03/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mineral trioxide aggregate (MTA) is widely used for pulp-capping procedures in permanent teeth and as a gold standard material in endodontics. The aim of the study was to investigate the effect of MTA on cell viability and apoptosis when MTA is directly in contact with Stem Cells from Human Exfoliated Deciduous Teeth (SHEDs). METHODS MTA was mixed and coated in the bottom of a 24-well plate. SHEDs collected and cultured from normal exfoliated human deciduous teeth (passages 3-4) were seeded on square cover glasses. The glasses with seeded SHEDs were incubated in the plates with or without MTA coating. They were divided into four groups: MTA direct contact, direct control, MTA indirect contact, and indirect control. After 1, 2 and 3 days of culturing, cell morphology was observed and cell viability was assessed by the WST-1 cell cytotoxicity assay. TUNEL assay, immunofluorescent labeling and western blot analysis were used to study the effects of MTA on SHEDs apoptosis. RESULTS MTA impaired cell viability of SHEDs in 1, 2 and 3 days, and the effect of direct contact was more severe. Cell apoptosis with positive Annexin V and TUNEL staining was noted when there was direct contact with MTA. Western blot analysis revealed that Bcl-2 and Bcl-xL decreased after SHEDs were in contact with MTA. CONCLUSIONS This study shows that direct contact with 1 week post-set MTA significantly decreases the viability of SHEDs and induced cell apoptosis. The results suggest that there is a possible cytotoxic effect of pulp tissue when there is direct contact with MTA. Different responses would be expected due to the strong alkaline characteristics of fresh mixed MTA.
Collapse
Affiliation(s)
- Chia-Ling Tsai
- Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Mu-Chan Ke
- Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Hao Chen
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Da-Pi Road, Niao-Sung District, Kaohsiung, 88301, Taiwan, Republic of China
| | - Hsi-Kung Kuo
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Da-Pi Road, Niao-Sung District, Kaohsiung, 88301, Taiwan, Republic of China
| | - Hun-Ju Yu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Da-Pi Road, Niao-Sung District, Kaohsiung, 88301, Taiwan, Republic of China
| | - Chueh-Tan Chen
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Da-Pi Road, Niao-Sung District, Kaohsiung, 88301, Taiwan, Republic of China
| | - Ya-Chi Tseng
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Da-Pi Road, Niao-Sung District, Kaohsiung, 88301, Taiwan, Republic of China
| | - Pei-Chin Chuang
- Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Center for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Pei-Chang Wu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Da-Pi Road, Niao-Sung District, Kaohsiung, 88301, Taiwan, Republic of China.
| |
Collapse
|