Cytotoxicity and Oxidative Stress Induction by Root Canal Sealers in Human Periodontal Ligament Fibroblasts: An in vitro Study.

Introduction:The aim of the study was to investigate the in vitro cytotoxicity, the profile of cell death, and the level of oxidative stress in human periodontal ligament fibroblasts (HPdLFs) after exposure to selected root canal sealers. Methods and Materials:Freshly mixed or set Endomethasone N (EN), RealSeal (RSEAL), Roeko Seal Automix (RSA), and Sealapex (SP) were incubated with HPdLFs. Fluorescein isothiocyanate (FITC)-annexin V (AnV) and propidium iodide (PI) staining followed by flow cytometry was used to identify the effects of the materials on cell viability and the profile of cell death. 2,7-dichlorodihydrofluorescein diacetate (DCFH-DA) with fluorescence-activated cell sorting was used to determine reactive oxygen species (ROS) formation in HPdLFs. Statistical analyses were performed using one-way ANOVA followed by post hoc tests, and significance was determined at P<0.05. Results:All materials reduced the viability of the cultured cells compared with the controls (P<0.05). Fresh SP and EN, and set RSA generated an increase of necrotic cells (P<0.05), whilst fresh RSEAL and RSA induced an elevation of apoptotic cells (P<0.001). Set RSEAL caused a rise in both apoptotic and necrotic cells compared with the controls (P<0.05). Fresh EN, RSEAL, and SP resulted in increased intracellular ROS generation compared with the negative control (P<0.001), whilst fresh RSA and all set materials were ineffective. Conclusions:This in vitro study showed us the materials tested were characterized by differentiated cytotoxic effects on HPdLFs. The fresh and set forms of sealers were capable of eliciting toxic action, inducing apoptosis and/or necrosis in HPdLFs. The toxic effects of fresh EN, RSEAL, and SP might have been due to the induction of oxidative stress in human periodontal fibroblasts. The cytotoxicity of RSA seemed to be related to the involvement of other mechanisms.