Chatterjee Ishika, Agrawal Pratik, Sinha Yash, Majee Neelanjana, Bansal Sonali
Department of Conservative Dentistry and Endodontics, Kalinga Institute of Dental Sciences, Bhubaneswar, IND.
Department of Conservative Dentistry and Endodontics, Kalinga Institute of Dental Sciences, Kalinga Institute of Industrial Technology (KIIT) Deemed to be University, Bhubaneswar, IND.
Cureus. 2025 Jul 29;17(7):e88990. doi: 10.7759/cureus.88990. eCollection 2025 Jul.
Regenerative endodontics utilizes stem cell biology and bioactive materials to restore pulp vitality. Human dental pulp stem cells (hDPSCs), with their self-renewal and odontogenic differentiation potential, are central to regenerative endodontics. Hydraulic calcium silicate-based cements (HCSCs), such as mineral trioxide aggregate (MTA) and Biodentine (Septodont, Saint-Maur-des-Fossés, France), are widely used in vital pulp therapies to promote pulp vitality recovery. This research evaluates the response of hDPSCs to HCSCs through a meta-analysis that assesses their cytocompatibility and bioactive effects on hDPSCs in laboratory conditions. The review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered at PROSPERO (CRD42023473456). A complete search of PubMed, Scopus, and Web of Science databases included all scientific articles between 2014 and 2023. Research involving hDPSCs exposed to HCSCs included in vitro investigations that studied both cell survival and proliferation, as well as migration, adhesion, and odontogenic differentiation. The risk assessment for potential bias in the studies used the Cochrane ROB-2 tool. The monitoring process for assessing the effects of pooled cell viability relied on RevMan 5.3 software (The Cochrane Collaboration, London, UK) for the execution of this meta-analysis. Quality synthesis included 16 studies, while the meta-analysis included three studies. The majority of research findings demonstrate that MTA, when combined with Biodentine, particularly at concentrations of 0.2-2 mg/mL, along with accelerated MTA and a calcium-enriched mixture (CEM, BioniqueDent, Tehran, Iran), effectively boosted hDPSC cell viability and migration, while also promoting their odontogenic differentiation. The laboratory tests demonstrated that TheraCal LC (BISCO, Inc., Schaumburg, IL, USA) produced toxic effects, but TheraCal PT exhibited non-toxic properties. Based on meta-analyzed data, the control groups attained a standardized mean difference of -0.26 (95% CI: -0.90 to 0.38), though this difference proved non-significant at p > 0.05. The examination of funnel plots found no indication of important publication bias. The vital pulp treatment success of MTA, Biodentine, accelerated MTA, and CEM as hydraulic calcium silicate-based biomaterials becomes more evident due to their induction of positive hDPSC biological outcomes, such as enhanced cell viability and migration and enhanced odontogenic differentiation potential. In addition, in vivo research, along with clinical trials, must precede material selection optimization for implementing regenerative endodontic treatments.
再生牙髓治疗利用干细胞生物学和生物活性材料来恢复牙髓活力。人牙髓干细胞（hDPSCs）具有自我更新和牙源性分化潜能，是再生牙髓治疗的核心。水硬性硅酸钙基水门汀（HCSCs），如三氧化矿物凝聚体（MTA）和碧兰麻（法国圣莫尔-德-福塞斯Septodont公司），广泛应用于活髓治疗以促进牙髓活力恢复。本研究通过一项荟萃分析评估hDPSCs对HCSCs的反应，该分析在实验室条件下评估它们对hDPSCs的细胞相容性和生物活性作用。该综述遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南，并在国际前瞻性系统评价注册库（PROSPERO）注册（注册号：CRD42023473456）。对PubMed、Scopus和Web of Science数据库进行全面检索，纳入了2014年至2023年期间的所有科学文章。涉及hDPSCs暴露于HCSCs的研究包括体外研究，这些研究同时考察了细胞存活、增殖以及迁移、黏附和牙源性分化。使用Cochrane偏倚风险评估工具（ROB-2）对研究中的潜在偏倚进行风险评估。评估合并细胞活力效应的监测过程依赖于RevMan 5.3软件（英国伦敦Cochrane协作网）来执行此项荟萃分析。定性综合纳入了16项研究，而荟萃分析纳入了3项研究。大多数研究结果表明，MTA与碧兰麻联合使用时，特别是在浓度为0.2 - 2 mg/mL时，以及加速MTA和富钙混合物（CEM，伊朗德黑兰BioniqueDent公司），能有效提高hDPSC细胞活力和迁移能力，同时促进其牙源性分化。实验室测试表明，TheraCal LC（美国伊利诺伊州绍姆堡BISCO公司）产生毒性作用，但TheraCal PT表现出无毒性。基于荟萃分析数据，对照组的标准化平均差为-0.26（95%置信区间：-0.90至0.38），不过在p > 0.05时，该差异无统计学意义。漏斗图检查未发现重要发表偏倚的迹象。作为水硬性硅酸钙基生物材料，MTA、碧兰麻、加速MTA和CEM在活髓治疗中的成功愈发明显，因为它们能诱导hDPSC产生积极的生物学结果，如增强细胞活力和迁移能力以及增强牙源性分化潜能。此外，在进行再生牙髓治疗的材料选择优化之前，必须开展体内研究以及临床试验。
