A study on biocompatibility of three endodontic sealers: intensity and duration of tissue irritation

Camilla Christian Gomes Moura, Thais Cristina Cunha, Virgínia Oliveira Crema, Paula Dechichi, João Carlos Gabrielli Biffi, Camilla Christian Gomes Moura, Thais Cristina Cunha, Virgínia Oliveira Crema, Paula Dechichi, João Carlos Gabrielli Biffi

Abstract

Introduction: Several studies have evaluated the inflammatory reaction triggered by Epiphany (EPH), a contemporary endodontic sealer. However, they used conventional parameters, which need additional analysis to better understand the reactions induced by this sealer compared to other traditional sealers.

Methods and materials: The intensity and time span of tissue irritations for three endodontic sealers were assessed by inflammatory reactions, fibrous capsule measurement and mast cell counts. Tubes containing freshly mixed EPH, AH plus (AHP) and Endofill (ENF) were subcutaneously implanted into the backs of 28 Wistar rats. The side wall of the tube was used as the control. At 14, 21, 42 and 60 days, the connective tissue surrounding the implants (n=7) was stained for histopathological analysis. The Friedman test was applied to compare the results. The level of significance was set at 0.05.

Results: At days 14 and 21, a significant difference among the groups was observed, with the ENF showing the worst tissue response (P<0.001). ENF remained the most aggressive sealer at 42 and 60 days, compared with EPH (P<0.05). No differences were found for the fibrous capsule thicknesses among the groups in each period. The number of mast cells per field did not show difference among the sealers at 21 and 60 days.

Conclusions: EPH and AHP elicited similar patterns of irritation, as demonstrated by the inflammatory scores and fibrous capsule thicknesses. ENF caused the highest degree of tissue damage. The increase in mast cell counts observed during the early and late periods shows the possibility of late hypersensitivity to the test materials.

Keywords: Biocompatibility Testing; Biocompatible Materials; Endodontics; Root Canal Filling Materials; Root Canal Obturation; Root Canal Sealants; Subcutaneous Tissue.

Figures

Figure 1
Figure 1
Histological reaction around Endofill (ENF), AH plus (AHP) and Epiphany (EPH), at days 14 and 21. A) ENF 14 days; inflammatory infiltrate with the presence of dilated blood vessels (×1000); B) AHP 14 days; inflammatory infiltrate, presence of blood vessels (arrow) and giant cells (circle) ×100; C) EPH 14 days; Region of contact with the sealer. Note the presence of foreign body giant cells (circle) ×100; D) ENF 21 days; inflammatory infiltrate and cellular fibrous capsule (×400); E) Interface AHP connective tissue at 21 days (×100); F) EPH 21 days; Fibrous capsule and the presence of mast cells (arrow) ×100
Figure 2
Figure 2
Histological reaction around Endofill (ENF), AH plus (AHP) and Epiphany (EPH), at days 42 and 60. A) ENF 42 days; lymphocytic infiltrate (×400); B) AHP 42 days; thin fibrous capsule, presence of macrophages, giant cells (×100); C) EPH 42 days; region in contact with the sealer limited by a fibrous capsule (arrow), note the absence of inflammation (×100); D) ENF 60 days; panoramic view, presence of well-defined fibrous capsule (×40); E) AHP 42 days; presence of blood vessels (hollow arrow) and mast cells (arrow) ×1000; F) EPH 60 days; presence of fibrous capsule surrounding the sealer, blood vessels (hollow arrow) and mast cells (arrow) ×400
Figure 3
Figure 3
Plot Box showing median values of fibrous tissue thicknesses on Epiphany (EPH), AH plus (AHP) and Endofill (ENF) groups at days 14 ; A), 21; B), 42; C) and 60; D) Illustrative images of collagen fibers under polarization (Picrosirius red staining, magnification of ×400)
Figure 4
Figure 4
Plot Box showing median values of mast cells on Epiphany (EPH), AH plus (AHP) and Endofill (ENF) groups at days 21; A), 42; B) and 60; C). D-E) Illustrative images of mast cells (arrows) (Toluidene blue staining, magnification of ×200

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