Abstract
The implementation of hydraulic calcium silicate-based endodontic cements (HCSCs) in biologically based endodontic procedures for the primary dentition has been recently investigated, focusing on the biological response of stem cells from human exfoliated deciduous teeth (SHEDs) towards them. The present systematic review aimed to present a qualitative synthesis of the available literature consisting of in vitro assays, which assessed the cytocompatibility and bioactive properties of HCSCs in direct contact with SHEDs. Following the PRISMA statement, an electronic database search was carried out in Medline, Scopus, Embase, Web of Science, and SciELO on March 31st and updated on November 16th, 2020. In vitro studies evaluating the biological response of SHEDs to the treatment with HCSCs were eligible. Within the term biological response, assays assessing the cytocompatibility (i.e., cell viability, migration, proliferation), cell plasticity or differentiation (i.e., osteo/odontogenic marker expression), and bioactivity or biomineralization (i.e., mineralized nodule formation) were included. A total of seven studies were included after the selection process. The study sample comprised an extensive range of cell viability, migration, proliferation, adhesion, and bioactivity assays regarding the biological response of SHEDs towards five different commercially available HCSCs (MTA, ProRoot MTA, Biodentine, iRoot BP Plus, and Theracal LC). Biodentine, MTA, and iRoot BP Plus showed significant positive results in cytocompatibility and bioactivity assays when cultured with SHEDs. The results from in vitro assays assessing the cytocompatibility and bioactivity of the HCSCs MTA, Biodentine, and iRoot BP Plus towards SHEDs support their use in vital pulp treatment for the primary dentition.
Highlights
The preservation of primary or deciduous teeth until their physiological exfoliation is essential for the correct development of the dental arches, the maxillae, and eruption of the permanent dentition [1]
Cell viability assays revealed significant positive results for Mineral Trioxide Aggregate (MTA) [28,29,31,34], BD [28,32,34], and iRoot BP Plus (iRP) [28] treatment when compared to a negative control group (SHEDs cultured in unconditioned medium), whereas stem cells from human exfoliated deciduous teeth (SHEDs) culture with TLC exhibited a significantly lower cell viability than the negative control [34]
Treatment with iRP produced significantly higher cell viability and migration rates when compared to MTA, but both of them were significantly higher than the negative control [29]
Summary
The preservation of primary or deciduous teeth until their physiological exfoliation is essential for the correct development of the dental arches, the maxillae, and eruption of the permanent dentition [1]. Dental trauma and carious lesions may act as potential factors for the premature loss of primary teeth. Both of these factors, depending on their severity, extension, and evolution, may damage the dentin-pulp complex and induce a subsequent inflammatory and reparative response from the affected tissue [2]. This response is encompassed within the term reparative dentinogenesis, a physiological process of tissue neoformation, which involves an intricate interrelation of molecular signaling cascades [3]. Various stem cell phenotypes have been isolated and characterized within the group of DSCs, categorized attending to the source from which they are obtained [5,6]
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