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

Sandro Tavares,Pietro Montemezzi,Andrea Pintor,Miriam Zaccaro Scelza,Carlos Fernando De Almeida Barros Mourão,Roberto Sacco,Marcela Magno,Gutemberg Alves

doi:10.3390/ma14195829

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).

Highlights

Endodontic therapy remains a challenge for immature permanent teeth since the cessation of root development can make the tooth more fragile, increasing root fracture rates in the medium- and long-term [1]
3.4.1. 10% EDTA Versus 10% Citric Acid Three studies [10,24,29] and six comparisons of means and standard deviation of TGF-β1 detected by enzyme-linked immunosorbent assay (ELISA) method after exposure to 10% EDTA versus 10% citric acid, in distinct exposure times, were included in this analysis (Figure 2)
138 samples were evaluated, and the mean difference of TGF-β1 released levels were higher for the 10% EDTA groups compared to 10% citric acid groups (MD −555.63 [−671.54, −439.72] p < 0.00001), with considerable heterogeneity (I2 = 89%) and very low certainty of evidence according to GRADE

Summary

Introduction

Endodontic therapy remains a challenge for immature permanent teeth since the cessation of root development can make the tooth more fragile, increasing root fracture rates in the medium- and long-term [1] In this sense, regenerative endodontics stands out by aiming to replace damaged dental structures through biological procedures, including the participation of cells of the dentin–pulp complex [2]. Regenerative endodontic therapies are necessary for immature teeth to maintain the viability of these structures and ensure the complete root maturation process [6,7] In this sense, a favorable microenvironment is required for the tissue neoformation process to occur during regenerative therapy, allowing the interaction of stem cells with the biomimetic scaffolds [3] on a process modulated by growth factors. Growth factors play an essential role as biological inductors [4]

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