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Bioactivity Potential of Bioceramic-Based Root Canal Sealers: A Scoping Review. LIFE (BASEL, SWITZERLAND) 2022; 12:life12111853. [PMID: 36430988 PMCID: PMC9697500 DOI: 10.3390/life12111853] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/19/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Bioceramic-based root canal sealers are novel materials with a bioactivity potential that stands out compared with conventional root canal sealers. However, the term bioactivity may be overused and is often misunderstood. Hence, the objective of this study was to synthesize and map key concepts related to the bioactivity analysis of bioceramic-based root canal sealers. METHODS The present scoping review is reported in accordance with the PRISMA-ScR Statement and is registered in the Open Science Framework. Two blinded reviewers carried out a comprehensive search in six databases up to January 10th, 2022: MEDLINE, Scopus, Embase, Web of Science, Cochrane Library, and Lilacs/BBO. Eligibility was considered for in vitro and in vivo studies that evaluated the bioactivity potential of bioceramic-based root canal sealers. RESULTS A total of 53 studies were included in the qualitative synthesis. In vitro bioactivity was evaluated through the mineralization potential, formation of carbonated apatite on the surface, and the gene expression related to proteins involved in the mineralization process. Meanwhile, for in vivo studies, staining techniques associated with immunohistochemical tests were mainly used to detect mineralization on the material-host tissue interface. CONCLUSIONS According to the methodology used, the most prevalent methods to assess bioactivity in acellular form were the immersion of the material in Hank's balanced salt solution, followed by surface observation with scanning electron microscopy and energy dispersive X-ray. In cell cultures, the chosen method was usually Alizarin Red staining, followed by the evaluation of alkaline phosphatase enzymatic activity and the use of molecular biology tests.
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de Oliveira PHC, Gomes Filho JE, Rodrigues MJDS, da Silva CC, Cardoso CDBM, Cosme daSilva L, Ervolino E, Cintra LTA. Influence of supplement administration of omega-3 on the subcutaneous tissue response of endodontic sealers in Wistar rats. Int Endod J 2022; 55:1026-1041. [PMID: 35791796 DOI: 10.1111/iej.13795] [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: 02/22/2021] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/29/2022]
Abstract
AIM Natural substances such as omega-3 have been used in the medical field due to their numerous properties and, in particular, modulating effect on the systemic and local inflammatory processes. Thus, this study evaluated the influence of omega-3 supplementation on the subcutaneous tissue response of endodontic sealers in Wistar Rats. METHODOLOGY Polyethylene tubes were implanted in the subcutaneous tissue of 48 animals (one empty for control and three filled with Sealapex, AH Plus or Endofill). The animals were treated with omega-3 (TO) or water (TW). Treatments started 15 days before implantation until euthanasia. After 5, 15 and 30 days (n = 8), animals were euthanized and polyethylene tubes and surrounding tissue were removed and processed for histological analysis. The inflammatory reaction was analysed by Haematoxylin and Eosin stain and immunolabelling for IL-6 and TNF-α. The collagen maturity was analysed by picrosirius red stain and calcium deposition by von Kossa stain and polarized light. Results were statistically analysed (p < .05). RESULTS Amongst TW sealer groups, Endofill evoked a more intense inflammatory infiltrate compared with AH Plus and control in the 30-day period (p = .009). However, in TO sealer groups, there was no difference amongst the sealers and control in all periods (p > .05). Comparing each sealer as a function of the supplementation with water or omega-3, there are differences for Endofill (p = .001) and Sealapex (p = .005) in the 30-day period, presenting lower inflammatory infiltrate in the animals treated with omega-3. A higher percentage of immature fibres was observed at 15 and 30 days in the TO group, compared with the TW group (p < .05). The deposition of calcium particles was observed only by Sealapex in all periods, despite the supplementation procedure. CONCLUSIONS Omega-3 supplementation influence the tissue reactions of endodontic sealers, modulating inflammation, the immunolabelling of IL-6 and TNF-α, the repair process and it does not interfere with calcium deposition.
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Affiliation(s)
- Pedro Henrique Chaves de Oliveira
- Endodontic Section, Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (Unesp), Araçatuba, Brazil
| | - João Eduardo Gomes Filho
- Endodontic Section, Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (Unesp), Araçatuba, Brazil
| | - Michael Júnio da Silva Rodrigues
- Endodontic Section, Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (Unesp), Araçatuba, Brazil
| | - Cristiane Cantiga da Silva
- Endodontic Section, Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (Unesp), Araçatuba, Brazil
| | - Carolina da Barros Moraes Cardoso
- Endodontic Section, Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (Unesp), Araçatuba, Brazil
| | - Leopoldo Cosme daSilva
- Endodontic Section, Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (Unesp), Araçatuba, Brazil.,Department of Endodontics, School of Dentistry, Alagoas Federal University (UFAL), Maceió, Brazil
| | - Edilson Ervolino
- Department of Basic Science, School of Dentistry, São Paulo State University (Unesp), Araçatuba, Brazil
| | - Luciano Tavares Angelo Cintra
- Endodontic Section, Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (Unesp), Araçatuba, Brazil.,Dental Assistance Center for Disabled Persons (CAOE) of the São Paulo State University (UNESP), School of Dentistry, Araçatuba, Brazil
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Cintra LTA, Gomes MS, da Silva CC, Faria FD, Benetti F, Cosme-Silva L, Samuel RO, Pinheiro TN, Estrela C, González AC, Segura-Egea JJ. Evolution of endodontic medicine: a critical narrative review of the interrelationship between endodontics and systemic pathological conditions. Odontology 2021; 109:741-769. [PMID: 34240297 DOI: 10.1007/s10266-021-00636-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/04/2021] [Indexed: 12/12/2022]
Abstract
Endodontics has gained emphasis in the scientific community in recent years due to the increase in clinical and in animal models studies focused on endodontic medicine, which aims to evaluate the interrelationship between systemic and periapical tissues pathological conditions. These studies have shown that systemic changes can boost the pathogenesis of endodontic infection, favoring its development and progression. A contrary relationship is reported in numerous studies that affirm the potential of endodontic infection to trigger systemic damage and may lead to the worsening of pre-existing pathologies. Recently, the potential of filling materials to develop systemic changes such as neurological alterations had been evaluated, also showing that systemic diseases can negatively influence tissue responses to filling materials after endodontic treatment. Despite advances in endodontic medicine studies, there are still gaps in knowledge on the mechanisms of interactions between apical periodontitis (AP) and systemic diseases and much research to be done. In this sense, this critical narrative literature review aimed to show the evolution of studies in endodontic medicine to help the endodontist to know the role of systemic diseases in the pathogenesis of AP and the possible interference in the repair of periapical tissues after endodontic treatment, as well as to evidence the systemic complications that can be triggered or aggravated in the presence of endodontic infection.
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Affiliation(s)
- Luciano Tavares Angelo Cintra
- Department of Preventive and Restorative Dentistry, Endodontic Section, School of Dentistry, São Paulo State University (Unesp), José Bonifácio, 1193, Vila Mendonça, Araçatuba, SP, CEP 16015-050, Brazil. .,Dental Assistance Center for Disabled Persons (CAOE) of the São Paulo State University (Unesp), School of Dentistry, Araçatuba, SP, Brazil.
| | - Maximiliano Schünke Gomes
- Departament of Odontology, School of Dentistry and Medical and Dental Center, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Cristiane Cantiga da Silva
- Department of Preventive and Restorative Dentistry, Endodontic Section, School of Dentistry, São Paulo State University (Unesp), José Bonifácio, 1193, Vila Mendonça, Araçatuba, SP, CEP 16015-050, Brazil
| | - Flávio Duarte Faria
- Department of Preventive and Restorative Dentistry, Endodontic Section, School of Dentistry, São Paulo State University (Unesp), José Bonifácio, 1193, Vila Mendonça, Araçatuba, SP, CEP 16015-050, Brazil
| | - Francine Benetti
- Department of Restorative Dentistry, School of Dentistry, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Leopoldo Cosme-Silva
- Department of Clinics and Surgery, School of Dentistry, Federal University of Alfenas (Unifal), Alfenas, MG, Brazil
| | - Renata Oliveira Samuel
- Department of Clinical Dentistry, Dental School, Universidade de Uberaba, Uberaba, MG, Brazil
| | - Tiago Novaes Pinheiro
- Department of Oral Pathology and Oral Medicine, Dental School of Amazonas State University, Manaus, AM, Brazil
| | - Carlos Estrela
- Department of Stomatologic Sciences, School of Dentistry, Federal University of Goiás (UFG), Goiânia, GO, Brazil
| | | | - Juan José Segura-Egea
- Department of Stomatology, School of Dentistry, University of Sevilla, Sevilla, Spain
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Talabani RM, Garib BT, Masaeli R, Zandsalimi K, Ketabat F. Biomineralization of three calcium silicate-based cements after implantation in rat subcutaneous tissue. Restor Dent Endod 2021; 46:e1. [PMID: 33680890 PMCID: PMC7906840 DOI: 10.5395/rde.2021.46.e1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 07/22/2020] [Accepted: 08/07/2020] [Indexed: 01/07/2023] Open
Abstract
Objectives The aim of this study was to evaluate the dystrophic mineralization deposits from 3 calcium silicate-based cements (Micro-Mega mineral trioxide aggregate [MM-MTA], Biodentine [BD], and EndoSequence Root Repair Material [ESRRM] putty) over time after subcutaneous implantation into rats. Materials and Methods Forty-five silicon tubes containing the tested materials and 15 empty tubes (serving as a control group) were subcutaneously implanted into the backs of 15 Wistar rats. At 1, 4, and 8 weeks after implantation, the animals were euthanized (n = 5 animals/group), and the silicon tubes were removed with the surrounding tissues. Histopathological tissue sections were stained with von Kossa stain to assess mineralization. Scanning electron microscopy and energy-dispersive X-ray spectroscopy (SEM/EDX) were also used to assess the chemical components of the surface precipitates deposited on the implant and the pattern of calcium and phosphorus distribution at the material-tissue interface. The calcium-to-phosphorus ratios were compared using the non-parametric Kruskal-Wallis test at a significance level of 5%. Results The von Kossa staining showed that both BD and ESRRM putty induced mineralization starting at week 1; this mineralization increased further until the end of the study. In contrast, MM-MTA induced dystrophic calcification later, from 4 weeks onward. SEM/EDX showed no statistically significant differences in the calcium- and phosphorus-rich areas among the 3 materials at any time point (p > 0.05). Conclusions After subcutaneous implantation, biomineralization of the 3-calcium silicate-based cements started early and increased over time, and all 3 tested cements generated calcium- and phosphorus-containing surface precipitates.
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Affiliation(s)
| | | | - Reza Masaeli
- Department of Dental Biomaterial, Tehran University of Medical Sciences, Tehran, Iran
| | - Kavosh Zandsalimi
- Department of Life Sciences Engineering, Faculty of New Sciences and Technologies, University of Tehran, Tehran, Iran
| | - Farinaz Ketabat
- Division of Biomedical Engineering, University of Saskatchewan, Saskatoon, Canada
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Song W, Sun W, Chen L, Yuan Z. In vivo Biocompatibility and Bioactivity of Calcium Silicate-Based Bioceramics in Endodontics. Front Bioeng Biotechnol 2020; 8:580954. [PMID: 33195142 PMCID: PMC7658386 DOI: 10.3389/fbioe.2020.580954] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/31/2020] [Indexed: 12/14/2022] Open
Abstract
Endodontic therapy aims to preserve or repair the activity and function of pulp and periapical tissues. Due to their excellent biological features, a substantial number of calcium silicate-based bioceramics have been introduced into endodontics and simultaneously increased the success rate of endodontic treatment. The present manuscript describes the in vivo biocompatibility and bioactivity of four types of calcium silicate-based bioceramics in endodontics.
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Affiliation(s)
- Wencheng Song
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, China
| | - Wei Sun
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, China
| | - Lili Chen
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, China
| | - Zhenglin Yuan
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, China
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de Azevedo Queiroz ÍO, Gonçalves LO, Takamiya AS, Rezende GC, Machado T, Siveiri-Araujo G, Ervolino E, Oliveira SHP, Gomes-Filho JE. Hyperglycemic condition influence on mineral trioxide aggregate biocompatibility and biomineralization. J Biomed Mater Res B Appl Biomater 2019; 108:663-673. [PMID: 31106523 DOI: 10.1002/jbm.b.34420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 04/08/2019] [Accepted: 05/05/2019] [Indexed: 01/22/2023]
Abstract
This study aimed to investigate in vitro and in vivo the influence of hyperglycemic condition on biocompatibility and biomineralization of gray mineral trioxide aggregate (GMTA) and white mineral trioxide aggregate (WMTA). For the in vitro study, fibroblast-like cells L929 were cultured under high or normal glucose concentration to investigate the effects of both MTA's on cell proliferation and inflammatory cytokines production IL-1β, IL-6, and TNF-α. For the in vivo study, polyethylene tubes containing MTA materials and empty tubes were implanted into dorsal connective tissues of Wistar rats previously assigned normal and hyperglycemic. After 7 and 30 days, the tubes with surrounding tissues were removed and subjected to histological, fluorescence and immunohistochemical analyzes of IL-1β, IL-6, and TNF-α. In vitro study showed that, under high glucose condition, GMTA reduced cell proliferation and IL-6 production compared with WMTA. Moreover, in vivo study revealed that hyperglycemic condition did not modify the inflammatory response and cytokines production in the tissue close to both materials. Independently of hyperglycemic status, mineralized areas were observed with both materials, but the fluorescence intensity of WMTA was diminished on 14 days in hyperglycemic animals. It is possible to conclude that GMTA was able to inhibit the proliferation rate and IL-6 production under high glucose concentration in vitro. Furthermore, cytokines production and inflammatory response were not upregulated in hyperglycemic animals; however, a decrease in the calcium deposition was observed in presence of WMTA, suggesting a delay in the mineralization process.
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Affiliation(s)
| | - Luanna O Gonçalves
- Department of Endodontics, Araçatuba Dental School, UNESP, Araçatuba, Brazil
| | - Aline S Takamiya
- Department of Dental Materials and Prosthodontics, Araçatuba Dental School, UNESP, Araçatuba, Brazil
| | - Gabriely C Rezende
- Department of Endodontics, Araçatuba Dental School, UNESP, Araçatuba, Brazil
| | - Thiago Machado
- Department of Oral and Maxillofacial Surgery and Integrated Clinic, Araçatuba Dental School, UNESP, Araçatuba, Brazil
| | | | - Edilson Ervolino
- Department of Basic Science, Araçatuba Dental School, UNESP, Araçatuba, Brazil
| | - Sandra H P Oliveira
- Department of Basic Science, Araçatuba Dental School, UNESP, Araçatuba, Brazil
| | - João E Gomes-Filho
- Department of Endodontics, Araçatuba Dental School, UNESP, Araçatuba, Brazil
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Benetti F, de Azevedo Queiroz ÍO, Oliveira PHCD, Conti LC, Azuma MM, Oliveira SHPD, Cintra LTA. Cytotoxicity and biocompatibility of a new bioceramic endodontic sealer containing calcium hydroxide. Braz Oral Res 2019; 33:e042. [PMID: 31508725 DOI: 10.1590/1807-3107bor-2019.vol33.0042] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 04/11/2019] [Indexed: 01/23/2023] Open
Abstract
This study evaluated the cytotoxicity and biocompatibility of a new bioceramic endodontic sealer (i.e., Sealer Plus BC) in comparison with those of MTA Fillapex and AH Plus. L929 fibroblasts were cultured and Alamar Blue was used to evaluate cell viability of diluted extracts (1:50, 1:100, and 1:200) from each sealer at 24 h. Polyethylene tubes that were filled with material or empty (as a control) were implanted in the subcutaneous tissue of rats. The rats were killed after 7 and 30 d (n = 8), and the tubes were removed for histological analysis. Parametric data was analyzed using a one-way ANOVA test, and nonparametric data was analyzed via the Kruskal-Wallis test followed by the Dunn test (p < 0.05). A reduction in cell viability was observed in the extracts that were more diluted for Sealer Plus BC when compared to that of Control and AH Plus (p < 0.05). However, the 1:50 dilution of the Sealer Plus BC was similar to that of the Control (p > 0.05). Conversely, more diluted extracts of MTA Fillapex (1:200) and AH Plus (1:100 and 1:200) were similar to the Control (p > 0.05). Histological analysis performed at 7 d did not indicate any significant difference between tissue response for all materials, and the fibrous capsule was thick (p > 0.05). At 30 d, Sealer Plus BC was similar to the Control (p > 0.05) and MTA Fillapex and AH Plus exhibited greater inflammation than the Control (p < 0.05). The fibrous capsule was thin for the Control and for most specimens of Sealer Plus BC and AH Plus. Thus, Sealer Plus BC is biocompatible when compared to MTA Fillapex and AH Plus, and it is less cytotoxic when less-diluted extracts are used.
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Affiliation(s)
- Francine Benetti
- Departament of Endodontics, School of Dentistry, Universidade Estaudal Paulista - Unesp, Araçatuba, SP, Brazil
| | | | | | - Leticia Citelli Conti
- Departament of Endodontics, School of Dentistry, Universidade Estaudal Paulista - Unesp, Araçatuba, SP, Brazil
| | - Mariane Maffei Azuma
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan, Ann Arbor, aMI, USA
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Holland R, Gomes JE, Cintra LTA, Queiroz ÍODA, Estrela C. Factors affecting the periapical healing process of endodontically treated teeth. J Appl Oral Sci 2017; 25:465-476. [PMID: 29069143 PMCID: PMC5804382 DOI: 10.1590/1678-7757-2016-0464] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 03/11/2017] [Indexed: 12/20/2022] Open
Abstract
Tissue repair is an essential process that reestablishes tissue integrity and regular function. Nevertheless, different therapeutic factors and clinical conditions may interfere in this process of periapical healing. This review aims to discuss the important therapeutic factors associated with the clinical protocol used during root canal treatment and to highlight the systemic conditions associated with the periapical healing process of endodontically treated teeth. The antibacterial strategies indicated in the conventional treatment of an inflamed and infected pulp and the modulation of the host's immune response may assist in tissue repair, if wound healing has been hindered by infection. Systemic conditions, such as diabetes mellitus and hypertension, can also inhibit wound healing. The success of root canal treatment is affected by the correct choice of clinical protocol. These factors are dependent on the sanitization process (instrumentation, irrigant solution, irrigating strategies, and intracanal dressing), the apical limit of the root canal preparation and obturation, and the quality of the sealer. The challenges affecting the healing process of endodontically treated teeth include control of the inflammation of pulp or infectious processes and simultaneous neutralization of unpredictable provocations to the periapical tissue. Along with these factors, one must understand the local and general clinical conditions (systemic health of the patient) that affect the outcome of root canal treatment prediction.
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Affiliation(s)
- Roberto Holland
- Universidade Estadual Paulista, Faculdade de Odontologia de Araçatuba, Departamento de Odontologia Restauradora, Araçatuba, SP, Brasil
| | - João Eduardo Gomes
- Universidade Estadual Paulista, Faculdade de Odontologia de Araçatuba, Departamento de Odontologia Restauradora, Araçatuba, SP, Brasil
| | - Luciano Tavares Angelo Cintra
- Universidade Estadual Paulista, Faculdade de Odontologia de Araçatuba, Departamento de Odontologia Restauradora, Araçatuba, SP, Brasil
| | - Índia Olinta de Azevedo Queiroz
- Universidade Estadual Paulista, Faculdade de Odontologia de Araçatuba, Departamento de Odontologia Restauradora, Araçatuba, SP, Brasil
| | - Carlos Estrela
- Universidade Federal de Goiás, Faculdade de Odontologia, Departamento de Ciências Estomatológicas, Goiânia, GO, Brasil
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