Comparison of the biocompatibility of calcium silicate-based materials to mineral trioxide aggregate: Systematic review

Abstract

The objective of this systematic review was to evaluate the biocompatibility and interaction of bioceramic materials with animal and human mesenchymal cells in vitro and in vivo and to compare them with mineral trioxide aggregate (MTA). Two independent researchers conducted PubMed/Medline, Web of Science, and Scopus searches to identify studies published in English, without restrictions on year of publication using the following keywords: “root canal sealer,” “root repair material,” “cytotoxicity,” and “bioceramics.” The articles were selected following the PRISMA statement. A total of 1486 titles were identified in the initial search. However, only 18 studies met the inclusion and exclusion criteria. The results showed that bioceramic materials have biological properties similar to those of MTA, including low cytotoxicity as well as promoting cell proliferation and adhesion, low expression of inflammatory cytokines, and reduced pulp inflammation. This systematic review therefore suggests that the choice of repair bioceramic materials or MTA based on biocompatibility should be the professional's decision.

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

“…Concerning in vitro cytotoxicity, the results suggested lower cytotoxic potential from bioactive sealers, even though some conflicting evidence was found, particularly in regard to MTA Fillapex ® , which may be due to the release of lead in set conditions [51]. This lower in vitro cytotoxicity of bioactive sealers is in accordance with previous systematic reviews on the biological, physiochemical, and clinical properties of calcium silicate-based sealers in comparison with conventional materials [12][13][14].…”

“…The high risk of bias of the studies included in this systematic review represents a key limitation as well as the methodological heterogeneity, which has also been acknowledged in previous systematic reviews [13,14]. In fact, eligible studies exhibited a considerable risk of bias, with several studies lacking information on randomization processes, blinding, and outcome measures, thus highlighting the need for well-designed and well-reported preclinical and clinical studies.…”

“…Previous systematic reviews have focused primarily on the superior properties of calcium silicate-based sealers in comparison with conventional materials [12][13][14]. Here, we included all types of endodontic sealer and aimed at comparing in vitro and in vivo evidence.…”

“…In this context, we aimed to perform a systematic review of the literature on the in vitro cytotoxicity (as a measure of direct cellular toxicity) and in vivo biocompatibility (as inflammatory tissue reaction) of root canal sealers. As previous systematic reviews have focused on the superiority of calcium silicate-based sealers [12][13][14], here we aimed to include all types of sealers and both in vitro and in vivo studies in order to present a more complete perspective on the biocompatibility of endodontic sealers as well as to compare the results and understand how the evidence correlates between both types of study. Furthermore, we also aimed at understanding how the material set condition and concentration and the type and time of exposure influence the cytotoxicity and biocompatibility of these materials.…”

WITHDRAWN: Alkalizing properties of new calcium-silicate endodontic biomaterials

“…New MTA-like materials based on the original formulation and/or with minor modifications have been introduced in routine clinical practice. Powder of these materials is composed mainly of diand tri-calcium silicates, calcium phosphate, calcium hydroxide, as well as bismuth oxide or zirconium oxide as radiopacifier [1,2,4,5]. After mixing the powder with water, a chemical reaction occurs and is known as hydration [6,7], which produced primarily calcium hydroxide and formed a sticky calcium silicate hydrate gel (C-S-H gel) [6,8,9].…”