Comparative Biocompatibility and Osteogenic Potential of Two Bioceramic Sealers

Introduction: Endodontic sealers have traditionally been used to seal dentinal tubules, creating a homogenous interface between the obturation material and the dentinal walls. However, bioceramic sealers have potential added benefits because of their bioactivity. After adequate endodontic therapy, osseous healing is largely dependent on the differentiation and activity of osteoblasts. We hypothesized that EndoSequence BC Sealer (Brasseler, Savannah, GA) and ProRoot ES (Dentsply Tulsa Dental Specialties, Johnson City, TN) have superior biocompatibility and osteogenic potential compared with Roth (Roth International, Chicago, IL) and AH Plus (Dentsply DeTrey Gmbh, Konstanz, Germany) sealers. Methods: A murine osteoblast precursor cell line (IDG-SW3) was exposed to a wide range of concentrations for each of the sealers for 7 days. The relative cell viability was determined by luminescence assay based on adenosine triphosphate quantification (CellTiter-Glo [Promega, Madison, Wisconsin]). The osteogenic potential was determined by fluorescence microscopy of DMP-1 expression, alizarin red staining, and real-time reverse transcription polymerase chain reaction with primers specific for known markers of osteogenesis such as DMP-1, ALP, and Phex. Data were analyzed with 2-way analysis of variance or 1-way analysis of variance with the Bonferroni post hoc test. Results: Both bioceramic sealers have excellent biocompatibility even at high concentrations. Conversely, cell death was detected when Roth and AH Plus were used at concentrations 100x lower than the bioceramic groups. Importantly, both bioceramic sealers significantly enhanced osteoblastic differentiation although greater responses were noted with EndoSequence BC Sealer. This was evidenced by increased DMP-1 expression, robust up-regulation of osteogenic marker gene expression, and superior mineral deposition. Osteoblastic differentiation and function were significantly impaired when Roth or AH Plus sealer was used. Conclusions: EndoSequence BC Sealer and ProRoot ES were significantly more biocompatible and promoted osteoblastic differentiation, a bioactivity not found in AH Plus and Roth sealers.