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.
Highlights
Root canal therapy encompasses the sequence of procedures with the aim of treating the infected canal of a tooth, resulting in the resolution of the infectious process and in the prevention of microbial invasion in the intervened tooth [1].Materials 2019, 12, 4113; doi:10.3390/ma12244113 www.mdpi.com/journal/materialsThe usage of endodontic sealers to perform root canal fillings in obturation procedures is an established mainstay in endodontics and plays a key role in the success of the treatment [2]
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
A total of 1249 studies were screened based on the title and abstract, from which 1068 were excluded, resulting in 181 full-text studies that were considered potentially eligible for inclusion, including 146 in vitro studies, 32 in vivo studies, and three studies with both in vitro and in vivo testing
Summary
The usage of endodontic sealers to perform root canal fillings in obturation procedures is an established mainstay in endodontics and plays a key role in the success of the treatment [2]. These materials should exhibit a set of characteristics that allow successful root canal filling with resolution of periapical inflammatory and/or infectious processes and prevent further microbial contamination [2]. In this context, Grossman previously listed the properties of an ideal sealer:. No sealer has yet fulfilled the entire set of Grossman’s criteria [2]
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