Cernera, Mariangela Comparative Biological Evaluation of Epoxy Resin-Based and Calcium Silicate- Based Root Canal Sealers: An In Vitro and In Vivo Study. [Tesi di dottorato]

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Abstract

Aim: This study aimed to evaluate the cytocompatibility and bioactive potential of two calcium silicate–based endodontic sealers (Ceraseal and Fill Root) compared with a conventional epoxy resin–based sealer (AH Plus Jet), and to assess their biological behavior in vivo in a rat model of apical periodontitis. Methods: In the in vitro studies, Saos-2 osteoblast-like cells were exposed to different concentrations (6.25%, 12.5%, 25%, 50%) of conditioned media from the three sealers. Cell metabolic activity was assessed using the MTT assay, while the formation of mineralized deposits was evaluated by the Alizarin Red S coloration. In the in vivo study, 48 Wistar rats with experimentally induced apical periodontitis (divided into 3 groups) underwent root canal treatment with one of the tested sealers. Animals were occised after 4 or 8 weeks. MicroCT imaging was performed to quantify periapical bone changes, while histopathological analysis assessed inflammatory infiltrate and bone healing. PET imaging with [¹⁸F]-FDG was used to evaluate local metabolic activity. Data were analyzed using non-parametric statistical tests (Kruskal–Wallis, Spearman correlation; p < 0.05). Results: In vitro, calcium silicate–based sealers showed significantly higher cell viability and mineralizing activity compared with AH Plus Jet, particularly at lower extract concentrations. The in vivo experiments confirmed their biocompatibility, showing minimal inflammatory response, progressive bone repair, and reduced metabolic uptake in PET/CT scans. No significant adverse systemic effects were observed across experimental groups. Conclusion: The results demonstrate that calcium silicate–based sealers display favorable biological behavior both in vitro and in vivo. Their ability to support cell viability, promote mineralization, and favor periapical healing underscores their potential as bioactive alternatives to traditional resin-based materials in endodontic therapy, contributing to improved outcomes and long-term periradicular regeneration.

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