What is the impact of Endodontic Irrigant Solutions on the Viability of Stem Cells from Apical Papilla in an in-vitro setting: A Systematic Review

Background: The success of regenerative endodontic procedures (REPs) is significantly influenced by the choice of endodontic irrigant solution. However, the impact of these solutions on the viability of stem cells from the apical papilla (SCAP), a critical component of the REP, remains a subject of ongoing debate. Objective: This study aimed to investigate the effects of various endodontic irrigant solutions on the viability of stem cells from the apical papilla in an in vitro setting. Methods: A systematic literature search was conducted using databases such as PubMed/Medline, Scopus, the Cochrane Library, Web of Science, Embase, gray literature, and reference lists up to August 2023. The search was limited to in vitro studies investigating the impact of endodontic irrigant solutions on SCAP viability. The risk of bias in these studies was evaluated using the Joanna Briggs Institute's checklist. Results: Of the 131 articles retrieved, 14 were selected for review. The effects of eighteen different root canal irrigants, such as ethylenediaminetetraacetic acid, sodium hypochlorite, chlorhexidine, and citric acid, on the viability of SCAPs were evaluated. The risk-of-bias analysis showed a high risk in sample randomization and size justification but a low risk in other areas. Discussion: The effects of endodontic irrigant solutions on the viability of SCAPs are concentration dependent. Concentrations higher than 1.5% sodium hypochlorite, 2 % chlorhexidine, 10 % citric acid, and 2.5 % EDTA significantly reduced cell viability. However, additional research is necessary to determine the effect of these irrigants on tissue regeneration.