Effect of Different Root Canal Irrigant Solutions on the Release of Dentin-Growth Factors: A Systematic Review and Meta-Analysis

Abstract

Irrigant solutions are used to promote dentin-growth factors (GF) release for regenerative endodontics. This review aimed to evaluate the reports comparing the release of GFs using different root canal irrigant solutions. Eligible studies compared the in vitro GF release in human teeth after the use of at least two distinct solutions. A search was conducted on Pubmed, Scopus, Web of Science, and Lilacs on 11 August 2021. Risk of bias was assessed using SciRAP. Study characteristics and quantitative data were extracted, and meta-analyses were performed for the mean difference (95% confidence interval) of the release of transforming growth factors Beta 1 (TGF-β1) by EDTA compared to other irrigants. Of sixteen eligible studies, eight were included in quantitative analysis. ELISA assays showed higher TGF-β1 release from 10% EDTA compared to 10% citric acid (p < 0.00001). Immunogold assays showed higher levels of TGF-β1 for 17% EDTA (p < 0.00001) compared to 10% citric acid. GRADE identified a low to very low certainty of evidence. These results point to an increased release of TGF-β1 in dentin treated with EDTA. The high heterogeneity and very low certainty of the evidence demand further studies before EDTA indication as a better irrigant for regenerative endodontics. Registration: CRD42020160871 (PROSPERO).

Cytotoxicity and Efficacy in Debris and Smear Layer Removal of HOCl-Based Irrigating Solution: An In Vitro Study

“…Root canal instrumentation aims to remove necrotic pulp tissues, mechanically disrupt the biofilm matrix and facilitate the flow of the irrigant within the entire length of the root canal [ 4 ]. However, endodontic treatment of immature permanent teeth may limit the removal of root dentin to a minimum, since the cessation of root development makes the tooth more susceptible to fracture [ 5 ]. In these clinical situations, the debridement of the root canal system is mainly achieved by chemical means [ 6 ], which may also require special safety precautions due to the open root apex.…”

“…However, cytotoxicity is a well-known shortcoming of NaOCl that may cause the rapid destruction of periodontal tissues and provoke acute pain, swelling and hematoma when extruded beyond the root canal system [ 12 ]. The inadvertent extrusion of NaOCl can be extremely deleterious in immature permanent teeth, leading to the compromised viability of stem cells, which typically reside in close proximity to the root apex and guide the root formation process jointly with Hertwig’s epithelial root sheath [ 5 , 13 ]. Moreover, EDTA associated with NaOCl has proved to induce dentin erosion and adversely affect the dentin microstructure by altering the primary ratio of organic and inorganic components [ 14 ].…”

“…Moreover, EDTA associated with NaOCl has proved to induce dentin erosion and adversely affect the dentin microstructure by altering the primary ratio of organic and inorganic components [ 14 ]. All these deleterious effects, leading to a significant decrease in dentin’s elastic modulus and flexural strength, as well as potential cellular damage, may jeopardize the long-term prognosis of the tooth [ 5 , 15 ]. Therefore, super-oxidized, or electrochemically activated, water has been previously suggested as one of the potential alternatives for the conventional application of NaOCl and EDTA [ 16 ].…”

Methodological quality assessment criteria for the evaluation of laboratory‐based studies included in systematic reviews within the specialty of Endodontology: A development protocol

“…Further, these studies may also highlight limitations in the design of clinical studies, such as heterogeneity, bias, poorly formulated research questions, or limitations for collecting optimum samples for analysis or improper comparisons, etc. As a reflection of these advantages, during 2021, several systematic reviews of laboratory‐based studies were published in Endodontology albeit with a range of methodologies (Bohrer et al, 2021; de Jesus Oliveira et al, 2021; Portela et al, 2021; Sanz et al, 2021; Tavares et al, 2021; Uzunoglu‐Özyürek et al, 2021).…”

Dentin slice model of dental stem cells in a fibrin-agarose construct for dental pulp regeneration

“…20 However, dentin irrigation must be considered in a regeneration model because it is crucial for the disinfection of the root canal and the MSCs' survival and proliferation. 21 This study aimed to implement a dentin slice model with MSCs derived from dental tissues in a fibrinagarose construct for dental pulp regeneration. This model would be a new option for future clinical practice with potential application in regenerative medicine.…”