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Reis-Prado AHD, Toledo PTA, Nunes GP, Ferreira PAV, Rahimnejad M, Dal-Fabbro R, Abreu LG, Bottino MC, Benetti F. Citric Acid Conditioning as an Alternative to EDTA for Growth Factors Release and Stem Cell Response in Regenerative Endodontics: A Systematic Review of In Vitro Studies. J Endod 2024; 50:129-143. [PMID: 37984798 DOI: 10.1016/j.joen.2023.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/11/2023] [Accepted: 11/13/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Citric acid (CA) conditioning may be a promising alternative to ethylenediaminetetraacetic acid (EDTA) in regenerative endodontic procedures, as reported to improve growth factors' release from dentin. This review systematically investigated the effect of CA conditioning on the growth factors release from dentin and cell behavior compared to EDTA conditioning. METHODS Searches were conducted (PubMed/MEDLINE, Scopus, Web of Science, Embase, SciELO, Cochrane Library, and grey literature) until May-2023. Only in vitro studies that evaluated the effects of CA on growth factors' release from dentin and cell behavior outcomes compared to EDTA were included. The studies were critically appraised using a modified Joanna Briggs Institute's checklist. Meta-analysis was unfeasible. RESULTS Out of the 335 articles screened, nine were included. Among these, three studies used dentin discs/roots from permanent human teeth; the rest combined them with stem cells. 10% CA for 5 or 10 minute was the most used protocol. Meanwhile, EDTA concentrations ranged from 10% to 17%. In eight studies examining the release of growth factors, five reported a significant release of transforming growth factor-β after dentin conditioning with 10% CA compared to 17% EDTA. Regarding cell behavior (6 studies), three studies assessed cell viability. The findings revealed that 10% CA conditioning showed cell viability similar to those of 17% EDTA. Additionally, in two out of three studies, it was observed that 10% CA conditioning did not affect cell morphology. The studies had a low risk of bias. CONCLUSIONS The use of 10% CA to condition dentin for 5-10 minutes resulted in a notable transforming growth factor -β1 release, but its cell responses were similar to those of EDTA.
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Affiliation(s)
- A H Dos Reis-Prado
- Restorative Dentistry, Universidade Federal de Minas Gerais (UFMG), School of Dentistry, Belo Horizonte, Minas Gerais, Brazil; Cariology, Restorative Sciences and Endodontics, University of Michigan, School of Dentistry, Ann Arbor, Michigan
| | - P T A Toledo
- Cariology, Restorative Sciences and Endodontics, University of Michigan, School of Dentistry, Ann Arbor, Michigan; Preventive and Restorative Dentistry, São Paulo State University (Unesp), School of Dentistry, Araçatuba, São Paulo, Brazil
| | - G P Nunes
- Laboratory for Bone Metabolism and Regeneration, University of Porto, Faculty of Dental Medicine, Porto, Portugal
| | - P A V Ferreira
- Restorative Dentistry, Universidade Federal de Minas Gerais (UFMG), School of Dentistry, Belo Horizonte, Minas Gerais, Brazil
| | - M Rahimnejad
- Cariology, Restorative Sciences and Endodontics, University of Michigan, School of Dentistry, Ann Arbor, Michigan
| | - R Dal-Fabbro
- Cariology, Restorative Sciences and Endodontics, University of Michigan, School of Dentistry, Ann Arbor, Michigan
| | - L G Abreu
- Child's and Adolescent's Oral Health, Universidade Federal de Minas Gerais (UFMG), School of Dentistry, Belo Horizonte, Minas Gerais, Brazil
| | - M C Bottino
- Cariology, Restorative Sciences and Endodontics, University of Michigan, School of Dentistry, Ann Arbor, Michigan
| | - F Benetti
- Restorative Dentistry, Universidade Federal de Minas Gerais (UFMG), School of Dentistry, Belo Horizonte, Minas Gerais, Brazil.
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da Silva Magalhães K, Kuerten Gil AC, Goulart TS, Schuldt DPV, Coelho BS, Figueiredo DDR, Garcia LDFR, de Almeida J. Efficacy of disinfection procedures performed prior to regenerative endodontic therapy: An integrative review. AUST ENDOD J 2023; 49:418-427. [PMID: 35932453 DOI: 10.1111/aej.12670] [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: 01/24/2022] [Accepted: 07/17/2022] [Indexed: 11/30/2022]
Abstract
The aim of this integrative review was to identify whether the disinfection procedures performed prior to regenerative endodontic treatment were effective on biofilm removal from the root canals. The research was based on PubMed, Latin American and Caribbean Health Sciences Literature (Lilacs) and Scientific Electronic Library Online (SciELO) databases. Four articles were selected; one of the studies was in vivo and the others ex vivo. Different disinfection procedures were studied, characterised mainly by the use of intracanal medication, highlighting the double antibiotic paste, triple antibiotic paste and calcium hydroxide paste. Disinfection ability was evaluated against Enterococcus faecalis and multispecies biofilms by using the fluorescence technique and colony forming unit counting, for 7 to 21 days. Double antibiotic paste and triple antibiotic paste demonstrated excellent antibiofilm activity, unlike CH paste that showed limited disinfection, even when associated with different antimicrobial agents. Triple antibiotic paste was the most effective medication against biofilm.
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Affiliation(s)
| | - Ana Clara Kuerten Gil
- Department of Endodontics, University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Taynara Santos Goulart
- Department of Endodontics, University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil
| | | | - Beatriz Serrato Coelho
- Department of Endodontics, University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil
| | | | | | - Josiane de Almeida
- Department of Endodontics, University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil
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Farhad A, Saatchi M, Bagherieh S. Effect of citric acid versus ethylenediaminetetraacetic acid on radiographic root development in regenerative endodontic treatment: An animal study. J Endod 2022; 48:535-541. [PMID: 35026229 DOI: 10.1016/j.joen.2022.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/26/2021] [Accepted: 01/03/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Regenerative endodontic treatment was introduced aiming to reinforce the root and enable further root development. In the process of dentin mineralization, bioactive molecules are entrapped in the dentin matrix, which can be later released by rinsing the dentin with chelating agents. This study aimed to compare the effects of citric acid and ethylenediaminetetraacetic acid (EDTA) on radiographic root development in regenerative endodontic treatment in an animal model. METHODS Premolars of three beagle dogs were used in this study. The teeth at one side of the jaw were irrigated with EDTA according to the regeneration protocol of the American Association of Endodontists (AAE). The teeth in the other quadrant were irrigated with citric acid in the second treatment session. Follow-up radiographs were obtained at six months, and the primary and final data were analyzed in SPSS using the Analysis of covariance (ANCOVA). RESULTS There was no significant difference between the two irrigating solutions regarding the increase in root length (P=0.668); however, EDTA showed significantly superior efficacy in increasing the root dentin thickness compared with citric acid (P=0.022). CONCLUSIONS Within the limitations of this study, the use of citric acid versus EDTA was not superior on radiographic root development in regenerative endodontic treatment.
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Affiliation(s)
- Alireza Farhad
- Department of Endodontics, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Saatchi
- Department of Endodontics, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shervin Bagherieh
- Department of Endodontics, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran.
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Ayoub S, Cheayto A, Bassam S, Najar M, Berbéri A, Fayyad-Kazan M. The Effects of Intracanal Irrigants and Medicaments on Dental-Derived Stem Cells Fate in Regenerative Endodontics: An update. Stem Cell Rev Rep 2020; 16:650-660. [PMID: 32394343 DOI: 10.1007/s12015-020-09982-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Regenerative endodontics is a biologically based treatment designed for immature permanent teeth with necrotic pulp to replace dentin and root structures, as well as dental pulp cells. This procedure has become a part of novel modality in endodontics therapeutic manner, and it is considered as an alternative to apexification. In the last decade, numerous case reports, which describe this procedure, have been published. This therapeutic approach succeeded due to its lower financial cost and ease of performance. Although the clinical protocol of this procedure is not standardized and the effects of irrigants and medicaments on dental stem cells fate remain somewhat ambiguous, however when successful, it is an improvement of endodontics treatment protocols which leads to continued root development, increased dentinal wall thickness, and apical closure of immature teeth. To ensure a successful regenerative procedure, it is essential to investigate the appropriate disinfection protocols and the use of biocompatible molecules in order to control the release of growth factors and the differentiation of stem cells. This is the first review in the literature to summarize the present knowledge regarding the effect of intracanal irrigants and medicaments on the dental derived stem cells fate in regenerative endodontic procedures.
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Affiliation(s)
- Sara Ayoub
- Department of Prosthodontics, Faculty of Dental Medicine, Lebanese University, Hadath, Beirut, Lebanon
| | - Ali Cheayto
- Department of Restorative Dentistry and Endodontics, Faculty of Dental Medicine, Lebanese University, Hadath, Beirut, Lebanon
| | - Sanaa Bassam
- Department of Restorative Dentistry and Endodontics, Faculty of Dental Medicine, Lebanese University, Hadath, Beirut, Lebanon
| | - Mehdi Najar
- Genetics and Immune Cell Therapy Unit, Faculty of Sciences, University Mohammed Premier, Oujda, Morocco.,Osteoarthritis Research Unit, Department of Medicine, Research Center (CRCHUM), University of Montreal Hospital, University of Montreal, Montreal, QC, Canada
| | - Antoine Berbéri
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Lebanese University, Hadath, Beirut, Lebanon
| | - Mohammad Fayyad-Kazan
- Laboratory of Cancer biology and Molecular Immunology, Faculty of Sciences-I, Lebanese University, Hadath, Beirut, Lebanon. .,Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon.
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