Osteogenic and Angiogenic Response to Calcium Silicate–based Endodontic Sealers

• Silicate endodontic sealers were assayed for the osteogenic and angiogenic response.
• Extracts caused dose- and time-dependent effects on osteoblasts and endothelial cells.
• Diluted extracts of MTA ProRoot and MTA Plus induced the osteogenic response.
• Diluted extracts of MTA ProRoot and MTA Plus enhanced endothelial functionality.
• Effects on osteogenic and angiogenic response are key players on the sealers' outcome.

IntroductionCalcium silicate–based endodontic sealers are reported to favor the regeneration of periradicular tissues, a process requiring concerted osteogenic and angiogenic events. This study compared 4 calcium silicate–based sealers for the effects of their extracts on osteogenic and angiogenic cell behavior.MethodsExtracts from ProRoot MTA (Dentsply Tulsa Dental, Tulsa, OK), MTA Plus (Prevest Denpro Limited, Jammu City, India), MTA Fillapex (Angelus, Londrina, PR, Brazil), and Biodentine (Septodont, Saint-Maur-des-Fosses, France) were prepared from freshly mixed sealers (0.1 g/cm2/mL extraction medium) and diluted (1:2–1:20). The sealers were compared for the dose- and time-dependent effects on the proliferation and differentiation of human mesenchymal stem cells (hMSCs) and human umbilical vein endothelial cells (HUVECs). An ex vivo osteogenic assay (regeneration of neonatal mice parietal bone defects) and an in vivo angiogenesis assay (chorioallantoic membrane assay) were performed.ResultsDiluted extracts from MTA ProRoot and MTA Plus had evident stimulatory effects on the proliferation of hMSCs, alkaline phosphatase activity, and ex vivo regeneration of bone defects. They also increased HUVEC growth; allowed normal tubularlike network organization; and, in vivo, did not affect angiogenesis. Comparatively, Biodentine also elicited a favorable response on hMSCs and HUVECs, but the overall osteogenic and angiogenic outcome was slightly lower. MTA Fillapex exhibited the highest toxicity in hMSCs and HUVECs and, unlike the other sealers, only allowed a partial regeneration of bone defects.ConclusionsThe sealers caused dose- and time-dependent effects on the osteoblastic and endothelial response, eliciting similar cytocompatibility profiles. Results suggest that the induction of both osteogenic and angiogenic events may contribute to the sealers' regenerative outcome.