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Hosseinpour S, Gaudin A, Peters OA. A critical analysis of research methods and experimental models to study biocompatibility of endodontic materials. Int Endod J 2022; 55 Suppl 2:346-369. [PMID: 35124840 PMCID: PMC9315036 DOI: 10.1111/iej.13701] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/04/2022] [Indexed: 12/03/2022]
Abstract
Materials used for endodontics and with direct contact to tissues have a wide range of indications, from vital pulpal treatments to root filling materials and those used in endodontic surgery. In principle, interaction with dental materials may result in damage to tissues locally or systemically. Thus, a great variety of test methods are applied to evaluate a materials' potential risk of adverse biological effects to ensure their biocompatibility before commercialization. However, the results of biocompatibility evaluations are dependent on not only the tested materials but also the test methods due to the diversity of these effects and numerous variables involved. In addition, diverse biological effects require equally diverse assessments on a structured and planned approach. Such a structured assessment of the materials consists of four phases: general toxicity, local tissue irritation, pre‐clinical tests and clinical evaluations. Various types of screening assays are available; it is imperative to understand their advantages and limitations to recognize their appropriateness and for an accurate interpretation of their results. Recent scientific advances are rapidly introducing new materials to endodontics including nanomaterials, gene therapy and tissue engineering biomaterials. These new modalities open a new era to restore and regenerate dental tissues; however, all these new technologies can also present new hazards to patients. Before any clinical usage, new materials must be proven to be safe and not hazardous to health. Certain international standards exist for safety evaluation of dental materials (ISO 10993 series, ISO 7405 and ISO 14155‐1), but researchers often fail to follow these standards due to lack of access to standards, limitation of the guidelines and complexity of new experimental methods, which may cause technical errors. Moreover, many laboratories have developed their testing strategy for biocompatibility, which makes any comparison between findings more difficult. The purpose of this review was to discuss the concept of biocompatibility, structured test programmes and international standards for testing the biocompatibility of endodontic material biocompatibility. The text will further detail current test methods for evaluating the biocompatibility of endodontic materials, and their advantages and limitations.
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Affiliation(s)
- S Hosseinpour
- School of Dentistry The University of Queensland Herston QLD Australia
| | - A Gaudin
- Inserm UMR 1229 RMeS, Regenerative Medicine and Skeleton Université de Nantes ONIRIS Nantes France
- Université de Nantes UFR Odontologie Nantes France
| | - O A Peters
- School of Dentistry The University of Queensland Herston QLD Australia
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Bósio CC, Felippe GS, Bortoluzzi EA, Felippe MCS, Felippe WT, Rivero ERC. Subcutaneous connective tissue reactions to iRoot SP, mineral trioxide aggregate (MTA) Fillapex, DiaRoot BioAggregate and MTA. Int Endod J 2013; 47:667-74. [DOI: 10.1111/iej.12203] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C. C. Bósio
- Center of Health Sciences; Federal University of Santa Catarina; Florianópolis Santa Catarina Brazil
| | - G. S. Felippe
- Center of Health Sciences; Federal University of Santa Catarina; Florianópolis Santa Catarina Brazil
| | - E. A. Bortoluzzi
- Center of Health Sciences; Federal University of Santa Catarina; Florianópolis Santa Catarina Brazil
| | - M. C. S. Felippe
- Center of Health Sciences; Federal University of Santa Catarina; Florianópolis Santa Catarina Brazil
| | - W. T. Felippe
- Center of Health Sciences; Federal University of Santa Catarina; Florianópolis Santa Catarina Brazil
| | - E. R. C. Rivero
- Center of Health Sciences; Federal University of Santa Catarina; Florianópolis Santa Catarina Brazil
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Marques L, Holgado LA, Simões RD, Pereira JDAS, Floriano JF, Mota LSLS, Graeff CFO, Constantino CJL, Rodriguez-Perez MA, Matsumoto M, Kinoshita A. Subcutaneous tissue reaction and cytotoxicity of polyvinylidene fluoride and polyvinylidene fluoride-trifluoroethylene blends associated with natural polymers. J Biomed Mater Res B Appl Biomater 2013; 101:1284-93. [DOI: 10.1002/jbm.b.32941] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 02/05/2013] [Accepted: 03/06/2013] [Indexed: 01/14/2023]
Affiliation(s)
| | | | - Rebeca D. Simões
- Faculdade de Ciências e Tecnologia; UNESP Universidade Estadual Paulista; Presidente Prudente São Paulo Brazil
| | - João D. A. S. Pereira
- Faculdade de Ciências e Tecnologia; UNESP Universidade Estadual Paulista; Presidente Prudente São Paulo Brazil
| | - Juliana F. Floriano
- Faculdade de Ciências; UNESP Universidade Estadual Paulista; Bauru São Paulo Brazil
| | - Lígia S. L. S. Mota
- Instituto de Biociências, UNESP Universidade Estadual Paulista; Bauru São Paulo Brazil
| | - Carlos F. O. Graeff
- Faculdade de Ciências; UNESP Universidade Estadual Paulista; Bauru São Paulo Brazil
| | - Carlos J. L. Constantino
- Faculdade de Ciências e Tecnologia; UNESP Universidade Estadual Paulista; Presidente Prudente São Paulo Brazil
| | - Miguel. A. Rodriguez-Perez
- Condensed Matter Physics Department, CellMat Laboratory, Faculty of Science; University of Valladolid; Valladolid Spain
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Parirokh M, Mirsoltani B, Raoof M, Tabrizchi H, Haghdoost AA. Comparative study of subcutaneous tissue responses to a novel root-end filling material and white and grey mineral trioxide aggregate. Int Endod J 2010; 44:283-9. [PMID: 21091493 DOI: 10.1111/j.1365-2591.2010.01808.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To compare the subcutaneous tissue response to grey mineral trioxide aggregate (GMTA), white mineral trioxide aggregate (WMTA) and a new experimental cement (calcium enriched cement, CEM). METHODOLOGY Thirty-six Wistar male albino rats each received three implants, containing one of the tested materials, and an empty tube as a control. Seven, 30 and 60 days after implantation, the animals were sacrificed. After histological preparation and H&E staining, the specimens were evaluated for capsule thickness, necrosis, and for the type, the severity, and the extent of inflammation. Kruskal Wallis and Chi-square tests were used for data analysis. RESULTS After 1 week, CEM produced no necrosis compared to both types of WMTA and GMTA (P = 0.007). After 30 days, GMTA specimens had significantly less inflammation compared with WMTA and CEM (P = 0.011). After 60 days, less inflammation was associated with CEM specimens (P = 0.0001) compared to the other materials. Dystrophic calcifications in the connective tissue adjacent to all experimental material were detected. CONCLUSION Histological observation illustrated that all materials were well tolerated by the subcutaneous tissues.
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Affiliation(s)
- M Parirokh
- Oral and Dental Diseases Research Center, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
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de Oliveira RL, Oliveira Filho RS, Gomes HDC, de Franco MF, Enokihara MMSES, Duarte MAH. Influence of calcium hydroxide addition to AH Plus sealer on its biocompatibility. ACTA ACUST UNITED AC 2010; 109:e50-4. [DOI: 10.1016/j.tripleo.2009.08.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2008] [Revised: 08/13/2009] [Accepted: 08/14/2009] [Indexed: 11/29/2022]
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Abstract
This study compared the biocompatibility of two new calcium phosphate-based root canal sealers (CAPSEAL I, CAPSEAL II) with another type of commercially available calcium phosphate sealer (Apatite Root Sealer type I, Apatite Root Sealer type II) and a zinc oxide eugenol-based sealer (Pulp Canal Sealer EWT) after implanting them in the subcutaneous tissue of rats. After 1, 2, 4, and 12 weeks, the tubes were removed with the surrounding tissues. The tissue reactions were graded as being mild or 1, moderate or 2, and severe or 3 after a histopathological examination. The results were analyzed statistically with the Kruskal-Wallis test. The biocompatibility of the materials was interpreted according to the Federation Dentaire Internationale criteria (1980). The inflammatory reactions decreased with time. The new sealers showed a lower tissue response than any of the other sealers in all the experimental periods. All the tested sealers showed an acceptable biocompatibility.
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Affiliation(s)
- Jin-Su Kim
- Department of Conservative Dentistry, College of Dentistry, Seoul National University, 28 Yonmgon-Dong, Chongno-Gu, Seoul 110-749, Korea
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Abstract
Irrigation solutions and intracanal medicaments are used within the root canal to clean and aid in disinfecting the dentinal walls. Although these materials are intended to be contained within the root canal, they invariably contact the periapical tissues, either through inadvertent extrusion through the apex or leaching. This paper is a review on the methodology involved in biocompatibility testing followed by a discussion on biocompatibility of contemporary intracanal drugs and substances used in endodontics.
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Affiliation(s)
- C H J Hauman
- Department of Oral Rehabilitation, School of Dentistry, University of Otago, Dunedin, New Zealand.
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Kolokouris I, Economides N, Beltes P, Vlemmas I. In vivo comparison of the biocompatibility of two root canal sealers implanted into the subcutaneous connective tissue of rats. J Endod 1998; 24:82-5. [PMID: 9641136 DOI: 10.1016/s0099-2399(98)80082-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to evaluate the in vivo biocompatibility of Apexit (a calcium hydroxide) and Pulp Canal Sealer (a classic zinc oxide-eugenol), root canal sealers, after implantation in rat connective tissue. Forty-four white female Wistar-Furth rats were used. Each sealer was placed in Teflon tubes and implanted into specific dorsal subdermal tissues sites. Implants were removed after 5, 15, 60, and 120 days; fixed; and histologically prepared for microscopical evaluation. Severe inflammatory reactions with differing extensions of necrosis were observed with Apexit on the 5th and 15th days. The intensity of the reaction had diminished by the 60th day, and this reduction continued progressively through the 120th day. It was characterized by the presence of connective tissue with a few macrophages. Moderate to severe inflammation with confined areas of necrosis was observed in the Pulp Canal Sealer specimens on the 5th day. The intensity of the reaction diminished by the 15th, 60th, and 120th days, but remained slightly greater than Apexit through longterm observation periods.
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Affiliation(s)
- I Kolokouris
- Department of Dental Pathology, Faculty of Dentistry, Aristotelian University of Thessaloniki, Thessaloniki, Greece
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Abstract
Ketac-Endo, a new glass-ionomer cement for endodontic use as root canal sealer, and Tubli-Seal were tested for tissue biocompatibility in rat connective tissue. Forty-four white female Wistar-Furth rats were used. Each sealer was placed in Teflon tubes and implanted subcutaneously. The implants were removed after 5, 15, 60, and 120 days; fixed; and histologically prepared for microscopical evaluation. Mild inflammatory reaction was observed with Ketac-Endo on the 5th day. The connective tissue was infiltrated with plasma cells. Lymphocytes and macrophages were observed. The intensity of the reaction diminished by the 15th day, and this reduction continued progressively through the 60th and 120th days. Severe inflammation with differing extensions of necrosis was observed with Tubli-Seal on the 5th and 15th days, and the material remained irritating even after long-term implantation periods (60 and 120 days).
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Affiliation(s)
- I Kolokuris
- Department of Dental Pathology and Therapeutics, Faculty of Dentistry, Aristotelian University of Thessaloniki, Greece
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Abstract
An experimental radiopaque resin root canal sealer was tested for tissue biocompatibility in rat connective tissue. The controls were four widely used sealers: Sealapex, Kerr's sealer, AH-26, and Roth's sealer. Polyethylene tubes were filled with the sealers and allowed to set for 24 hours in 100% humidity. Each sealer was implanted in the connective tissue of Sprague-Dawley rats and removed after 3, 10, 20, 30, and 60 days, fixed, and histologically prepared for light microscope evaluation. At each time period there was practically no difference in the reaction of all the sealers. By 60 days, the total picture was one of well-tolerated biocompatibility.
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Affiliation(s)
- D Molloy
- Tufts University School of Dental Medicine, Boston, Mass
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Pascon EA, Leonardo MR, Safavi K, Langeland K. Tissue reaction to endodontic materials: methods, criteria, assessment, and observations. Oral Surg Oral Med Oral Pathol 1991; 72:222-37. [PMID: 1833711 DOI: 10.1016/0030-4220(91)90168-c] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The purpose of this study was to develop methods and criteria for the testing of the biocompatibility of endodontic materials. One hundred twenty-one teeth from 12 baboons (Papio anubis) were used to test three sealers: AH26, Kerr pulp canal sealer, and Kloroperka N.O. Gutta-percha cones were used as solid core in all cases. Under disinfected conditions, access preparation was performed, and with working length approximately 1.0 mm short of the foramen, the instrumentation of the root canal was started, using sodium hypochlorite (1%) for irrigation. After the root canals were cleaned and shaped, they were obturated with gutta-percha cones and the sealer, and by lateral condensation technique. Histologic periapical reactions were evaluated at 1, 7, 30, 365, 730, and 1095 days. The methods and criteria used were adequate for ranking of the biocompatibility of the tested materials in the short and long periods. At short observation periods (1 to 7 days) AH26 caused severe reactions, and Kerr pulp canal sealer and Kloroperka N.O., moderate and mild reactions, respectively. At 2- and 3-year observation periods the ranking was AH26, mild; Kerr pulp canal sealer, moderate; and Kloropercha N.O., severe.
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Affiliation(s)
- E A Pascon
- Department of Restorative Dentistry and Endodontology, School of Dental Medicine, University of Connecticut Health Center, Farmington
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Abstract
The cytotoxic effects on cultured rat bone cells of newly-developed root canal sealers and commercially available sealers were compared. Various root canal sealers were applied to cultured bone cells obtained from rat calvaria by the enzyme digestion method. Measurement of [3H]-thymidine incorporation, alkaline phosphatase activity, and calcium release were performed after 24 and 48 h. No significant difference was found in cellular DNA synthesis and alkaline phosphatase activity between cells exposed to New B-1, New B-5 and controls after exposure for 24 and 48 h. Cells in contact with Tubliseal, Diaket and AH-26 demonstrated a significant difference from controls in DNA synthesis and alkaline phosphatase activity. Calcium release at 24 h was significantly different in the cells treated with New B-1 and New B-5 than in controls. No appreciable difference was found, however, between New B-6, Sealapex and controls. At 48 h, cells treated with New B-1, New B-5 and New B-6 showed differed significantly difference from controls, but the cells exposed to Sealapex did not. The newly-developed root canal sealers had lower toxicity in vitro than five types of commercially available root canal sealers.
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Affiliation(s)
- K Takahara
- Department of Endodontics, School of Dentistry, Showa University, Tokyo
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Abstract
Silicone tubes filled with CRCS, a calcium hydroxide-based cement, were implanted at two different localizations in the right tibias of white male Wistar rats. A similar number of solid silicone rods were implanted in the left tibias of the same animals and were used as inert controls. Fifteen days after implantation the bone tissue reactions to these materials were evaluated by means of radiographic, histological, and histometric methods. The radiographic and histometric analysis of the tissues around the deep end of the implants showed that the amount of reactional bone formation in contact with CRCS was significantly lower than that observed in contact with the controls (p less than 0.01). Also, the cell counts obtained from the tissues in contact with CRCS were significantly less than those obtained from the controls (p less than 0.01). This methodology appears to be a refined procedure for analyzing the possible toxic effects of endodontic materials in bone tissues. However, we feel that more extensive experiments will be necessary before predicting the long-term results which could be obtained from this experimental model.
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Safavi KE, Spångberg L, Sapounas G, MacAlister TJ. In vitro evaluation of biocompatibility and marginal adaptation of root retrofilling materials. J Endod 1988; 14:538-42. [PMID: 3249190 DOI: 10.1016/s0099-2399(88)80086-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Zmener O, Guglielmotti MB, Cabrini RL. Biocompatibility of two calcium hydroxide-based endodontic sealers: a quantitative study in the subcutaneous connective tissue of the rat. J Endod 1988; 14:229-35. [PMID: 3075231 DOI: 10.1016/s0099-2399(88)80175-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Spångberg L, Safavi KE, Kaufman A, Pascon EA. Antimicrobial and toxic effect in vitro of a bisdequalinium acetate solution for endodontic use. J Endod 1988; 14:175-8. [PMID: 3268636 DOI: 10.1016/s0099-2399(88)80259-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Pascon EA, Introcaso JH, Langeland K. Development of predictable periapical lesion monitored by subtraction radiography. Endod Dent Traumatol 1987; 3:192-208. [PMID: 3326723 DOI: 10.1111/j.1600-9657.1987.tb00623.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Abstract
CRCS or calciobiotic root canal sealer (a calcium hydroxide-based sealer), Proco-sol and Tubliseal (both zinc oxide eugenol-based sealers), and Diaket-A (a polyvinyl-based sealer) were assessed for their relative cytotoxicities by their different cell migration effects by means of glass coverslip granulomas. Cytotoxicity was assessed by means of the influx of mononuclear cells or macrophages and their transformation into multinucleate giant cells. CRCS was shown to be the best sealer, followed by Proco-sol and Tubliseal. Diaket-A was the most cytotoxic of the sealers tested.
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