Premixed calcium silicate-based root canal sealers have better biological properties than AH Plus: A systematic review and meta-analysis of in vivo animal studies and <i>in vitro</i> laboratory studies.

Abstract

<h4>Objectives</h4>The aim was to determine whether premixed calcium silicate-based root canal sealers have better biological properties than AH Plus.<h4>Materials and methods</h4>Searches of studies published up to January 2023 were performed in the PubMed/MEDLINE and EMBASE and via other methods (databases of the International Endodontic Journal, Journal of Endodontics, and gray literature). The inclusion criteria were <i>in vivo</i> animal and <i>in vitro</i> studies that analyzed the response in the dorsal subcutaneous tissue of rats, cell viability, and genotoxicity. Systematic Review Centre for Laboratory Animal Experimentation Risk of Bias (RoB) tool for <i>in vivo</i> studies and modified CONSORT checklist for <i>in vitro</i> were appraised. Meta-analysis was performed using the Stata.<h4>Results</h4>Fifty-two studies were included. In the RoB, <i>in vivo</i> studies fulfilled 20%-50% of the items and <i>in vitro</i> 60%-100%. The studies included in the meta-analysis demonstrated better histocompatibility with the premixed calcium silicate-based sealers at 30 days and greater cell viability with these sealers when used in undiluted extracts in experimental period of 72 h and in extracts with 1:2 and 1:4 dilution in 24 and 72 h. In contrast, no difference between materials was found concerning genotoxicity.<h4>Conclusion</h4>Premixed calcium silicate-based root canal sealers have better histocompatibility and are less cytotoxic than the epoxy resin-based sealer AH Plus, demonstrating favorable biological behavior.