Biocompatibility of Root Canal Sealers: A Systematic Review of In Vitro and In Vivo Studies

Abstract

(1) Aim: To perform a systematic review of the literature on the biocompatibility of root canal sealers that encompasses the various types of sealers that are commercially available as well as both in vitro and in vivo evidence. (2) Methods: This systematic review has been registered in PROSPERO (ID 140445) and was carried out according to PRISMA guidelines using the following databases: PubMed, Cochrane Library, ClinicalTrials.gov, Science Direct, and Web of Science Core Collection. Studies published between 2000 and 11 June 2019 that evaluated cytotoxicity (cell viability/proliferation) and biocompatibility (tissue response) of root canal sealers were included. (3) Results: From a total of 1249 studies, 73 in vitro and 21 in vivo studies were included. In general, studies suggest that root canal sealers elicit mild to severe toxic effects and that several factors may influence biocompatibility, e.g., material setting condition and time, material concentration, and type of exposure. Bioactive endodontic sealers seem to exhibit a lower toxic potential in vitro. (4) Conclusions: The available evidence shows that root canal sealers exhibit variable toxic potential at the cellular and tissue level. However, the methodological heterogeneity among studies included in this systematic review and the somewhat conflicting results do not allow a conclusion on which type of sealer presents higher biocompatibility. Further research is crucial to achieve a better understanding of the biological effects of root canal sealers.

Exploring Needle-Like Zinc Oxide Nanostructures for Improving Dental Resin Sealers: Design and Evaluation of Antibacterial, Physical and Chemical Properties

“…In the current study, water sorption and solubility values showed no statistical difference among groups. Lack of solubility has also been stated as an ideal characteristic of root canal filling materials [22] to prevent inflammatory processes in the apical region [23].…”

“…However, the maintenance of a range of functionalities of dental sealers during the root canal obturation is essential to attain the desired treatment outcome. Ideally, dental sealers should be capable of (1) penetrating and sealing the dentinal tubules; (2) binding intimately to both the organic and inorganic phases of dentin; (3) decreasing microorganisms viability and neutralizing their products; (4) predictably inducing a regenerative response, and (5) strengthening the root complex system [22,23].…”

Novel Bioactive and Therapeutic Root Canal Sealers with Antibacterial and Remineralization Properties

“…To date, concentrations higher than 0.15% NAg have rarely been used in polymeric dental resins [38,[92][93][94]. Although studies on the cytotoxicity of the aforementioned bioactive agents have shown favorable results, root canal sealers used as carriers for these additives have previously shown varying degrees of cytotoxicity [95,96]. Previous studies have shown that most root canal sealers from different classes show some cytotoxic effects upon their application [95].…”

“…Although studies on the cytotoxicity of the aforementioned bioactive agents have shown favorable results, root canal sealers used as carriers for these additives have previously shown varying degrees of cytotoxicity [95,96]. Previous studies have shown that most root canal sealers from different classes show some cytotoxic effects upon their application [95]. While most commercial root canals sealers exhibit some degrees of cytotoxicity, healing of the periapical lesions and repair of the damaged periapical tissues still occurred [95].…”

“…Previous studies have shown that most root canal sealers from different classes show some cytotoxic effects upon their application [95]. While most commercial root canals sealers exhibit some degrees of cytotoxicity, healing of the periapical lesions and repair of the damaged periapical tissues still occurred [95]. To date, there has been no definitive conclusion on which type of root canal sealer presents the best biocompatibility.…”