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In endodontic microsurgery, it is likely that preoperative factors, particularly the tooth position and arch type, have a greater influence on the healing outcome than intra- and post-operative factors.

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The aim of this study was to assess the effect of three calcium silicate-based sealers (EndoSeal MTA, Nano-ceramic Sealer, and Wellroot ST) and two epoxy resin-based sealers (AH-Plus, AD Seal) on various aspects, such as cell viability, inflammatory response, and osteogenic potential, of human periodontal ligament stem cells (hPDLSCs). AH-Plus showed the lowest cell viability on hPDLSCs in all time periods in fresh media. In set media, hPDLSCs showed no significant differences in cell viability among all the tested materials. Wellroot ST showed the highest level of cell adhesion and the morphology of attached cells. AH-plus presented a significantly higher expression of IL-6 and IL-8 than the other sealers. AD Seal and three calcium silicate sealers showed high expression of the mesenchymal stem cell markers. ALP mRNA expression showed a significant increase in time-dependent manner on all of three calcium silicate-based sealers, which do not seem to interfere with the differentiation of hPDLSCs into osteoblasts. Based on the results from this study, calcium silicate-based sealers appear to be more biocompatible and less cytotoxic than epoxy resin-based sealers. Meanwhile, further and long-term clinical follow-up studies are required.

The aim of this study was to evaluate the biocompatibility of calcium silicate-based sealers (CeraSeal and EndoSeal TCS) and epoxy resin-based sealer (AH-Plus) in terms of cell viability, inflammatory response, expression of mesenchymal phenotype, osteogenic potential, cell attachment, and morphology, of human periodontal ligament stem cells (hPDLSCs). hPDLSCs were acquired from the premolars (n = 4) of four subjects, whose ages extended from 16 to 24 years of age. Flow cytometry analysis showed stemness of hPDLSCs was maintained in all materials. In cell viability test, AH-Plus showed the lowest cell viability, and CeraSeal showed significantly higher cell viability than others. In ELISA test, AH-Plus showed higher expression of IL-6 and IL-8 than calcium silicate-based sealers. In an osteogenic potential test, AH-Plus showed a lower expression level than other material; however, EndoSeal TCS showed a better expression level than others. All experiments were repeated at least three times per cell line. Scanning electronic microscopy studies showed low degree of cell proliferation on AH-Plus, and high degree of cell proliferation on calcium silicate-based sealers. In this study, calcium silicate-based sealers appear to be more biocompatible and less cytotoxic than epoxy-resin based sealers.