Immunomodulatory Effects of Endodontic Sealers: A Systematic Review

• Published in: Dentistry journal 2023-02, Vol.11 (2), p.54
• Main Authors: Guo, Jindong, Peters, Ove A, Hosseinpour, Sepanta
• Format: Article
• Language: English
• Subjects: Analysis; Biocompatibility; Biodegradable materials; Biological products; Biomaterials; Biomedical materials; Citation management software; Collagen; Cytokines; Cytotoxicity; Database searching; endodontic materials; Endodontics; Fibroblasts; Genotype & phenotype; Granulomas; Healing; Immune response; Immune system; Immunomodulation; In vivo methods and tests; Inflammation; Interleukin 1; Interleukin 6; Internet/Web search services; Kinases; Macrophages; mRNA; Neutrophils; NF-κB protein; Nitric-oxide synthase; Online searching; regenerative endodontics; Reviews; sealer; Sealers; Sealing compounds; Search engines; Systematic Review; Tissue engineering; Tissues; Titanium alloys; Tumor necrosis factor-TNF; Tumor necrosis factor-α
• ISSN: 2304-6767; 2304-6767
• DOI: 10.3390/dj11020054

Inflammation is a crucial step prior to healing, and the regulatory effects of endodontic materials on the immune response can influence tissue repair. This review aimed to answer whether endodontic sealers can modulate the immune cells and inflammation. An electronic search in Scopus, Web of Science, PubMed, and Google Scholar databases were performed. This systematic review was mainly based on PRISMA guidelines, and the risk of bias was evaluated by SYRCLEs and the Modified CONSORT checklist for in vivo and in vitro studies, respectively. In total, 28 articles: 22 in vitro studies, and six in vivo studies were included in this systematic review. AH Plus and AH 26 can down-regulate iNOS mRNA, while S-PRG sealers can down-regulate p65 of NF-κB pathways to inhibit the production of TNF-α, IL-1, and IL-6. In vitro and in vivo studies suggested that various endodontic sealers exhibited immunomodulatory impact in macrophages polarization and inflammatory cytokine production, which could promote healing, tissue repair, and inhibit inflammation. Since the paradigm change from immune inert biomaterials to bioactive materials, endodontic materials, particularly sealers, are required to have modulatory effects in clinical conditions. New generations of endodontic sealers could hamper detrimental inflammatory responses and maintain periodontal tissue, which represent a breakthrough in biocompatibility and functionality of endodontic biomaterials.