Cytotoxicity and bioactivity of mineral trioxide aggregate and bioactive endodontic type cements: A systematic review

Abstract

Background: Knowledge of the cytotoxicity and bioactivity of endodontic materials may assist in understanding their ability to promote dental pulp stem cell activity and pulp healing in primary teeth. Materials and methods: This systematic review was carried out by searching the electronic databases such as PubMed, Google Scholar, and Cochrane reviews for the articles published between January 2000 and December 2018 using the appropriate MeSH keywords. An independent investigator evaluated the abstracts and titles for possible inclusion, as per the stipulated inclusion and exclusion criteria. The topics considered for extracting data from each study were: cell lineage, cytotoxicity assay used, and type of material tested. Results: Seven eligible studies were selected for assessing the quality of evidence on the bioactivity of bioactive endodontic cements (BECs) (1 human cell line, 2 animal cell lines, and 4 in vitro, animal, and human studies) and 13 studies were selected for reviewing the quality of evidence on cytotoxicity (7 human cell lines, 4 animal cell lines, and 2 animal model studies). Very limited studies had been conducted on the bioactivity of materials other than mineral trioxide aggregate (MTA). With regards to cytotoxicity, the studies were diverse and most of the studies were based on MTT assay. Mineral trioxide aggregate is the most frequently used as well as studied root-end filling cement, and the literature evidence corroborated its reduced cytotoxicity and enhanced bioavailability. Conclusion: There was a lack of sufficient evidence to arrive at a consensus on the ideal material with minimal cytotoxicity and optimal bioactivity. More focused human/cell line-based studies are needed on the available root filling materials. Clinical significance: The present systematic review provides an update on the available literature evidence on the cytotoxicity and bioactivity of various BECs including MTAs and their influence on the different cells with respect to their composition and strength.