Viability of human Mesenchymal stem cells from the periradicular region at different concentrations of sodium hypochlorite – systematic review
More details
Hide details
Faculdade de Odontologia, Universidade de Pernambuco, Campus Santo Amaro, Pernambuco, Brasil. Programa de Pós- Graduação em Odontologia, Universidade de Pernambuco, Pernambuco Recife, Brazil
Corresponding author
Michelle Almeida Silva   

Faculdade de Odontologia, Universidade de Pernambuco, Campus Santo Amaro, Pernambuco, Brasil. Programa de Pós-Graduação em Odontologia, Universidade de Pernambuco, Pernambuco Recife, Campus Santo Amaro, Pernambuco, Brasil. Programa d, 58025-300, Recife, Brazil
Pulp revascularization is the procedure that stimulates apical development and root maturation which is essential to secure both survival and viability of stem cells for the success of the regenerative endodontic treatment. The aim of this review is to investigate whether different concentrations of sodium hypochlorite (NaOCl) allow greater viability of human mesenchymal stem cells (MSCs) from the periradicular region, without compromising root canals disinfection. The review is registered in the PROSPERO database under protocol ID CRD42020203863. A search was conducted with no language restrictions in the Medline/PubMed, Scopus, Web of Science databases, as well as a manual research, between March – June 2022, followed by study selection and data extraction according to the PRISMA protocol. The search initially identified 999 articles, of which 883 articles remained after the exclusion of duplicates. Of these, 11 were selected for full reading; 5 of which were considered eligible to compose the qualitative synthesis. Articles that used human mesenchymal stem cells from the apical papilla and periodontal ligament were included. The studies agreed that there is more than 50% loss of cell viability when the culture is in contact with high concentrations (5–6%) of NaOCl after 10 minutes of contact. Low concentrations of NaOCl (0.5–2.5%) provided 80–40% cell viability when in contact for 24 hours. The results of in vitro studies assessed in this review indicate that low concentrations of NaOCl allow higher viability of stem cells from the periradicular region, therefore, they are more recommended in cases of pulp revascularization.
Zhujiang A, Kim SG. Regenerative Endodontic Treatment of an Immature Necrotic Molar with Arrested Root Development by Using Recombinant Human Platelet-derived Growth Factor: A Case Report. J Endod. 2016;42(1):72–75. https:/ 10.1016/j.joen.2015.08.026.
Kim SG, Malek M, Sigurdsson A, Lin LM, Kahler B. Regenerative endodontics: a comprehensive review. Int Endod J. 2018;51(12):1367–1388. https:/
Saoud TMA, Ricucci D, Lin LM, Gaengler P. Regeneration and Repair in Endodontics-A Special Issue of the Regenerative Endodontics-A New Era in Clinical Endodontics. Dent J (Basel). 2016;4(1):3. https:/ 10.3390/dj4010003.
Zhou T, Pan J, Wu P, Huang R, Du W, Zhou Y, et al. Dental Follicle Cells: Roles in Development and Beyond. Stem cells international. 2019;9159605. https:/
Galler KM, Krastl G, Simon S, Van Gorp G, Meschi, N, Vahedi B, Lambrechts P. European Society of Endodontology position statement: Revitalization procedures. Int. Endod J. 2016;49(8):717–723. https:/ 10.1111/iej.12629.
Kontakiotis EG, Filippatos CG, Tzanetakis GN, Agrafioti A. Regenerative endodontic therapy: a data analysis of clinical protocols. J Endod. 2015;41(2):146–154. https:/
Swimberghe RCD, Coenye T, De Moor RJG, Meire MA. Biofilm model systems for root canal disinfection: a literature review. Int Endod J. 2019; 52 (5):604–628. https:/
Rai S, Rangappa AK. Disinfection in regenerative endodontics and effect of commonly used antimicrobials on stem cell fate: A comprehensive review. SRM Journal of Research in Dental Sciences. 2021;12(3):146–151. https:/10.4103/srmjrds.srmjrds_76_20.
Martin DE, Henry MA, de Almeida JFA, Khaing ZZ. Concentration-dependent Effect of Sodium Hypochlorite on Stem Cells of Apical Papilla Survival and Differentiation. J Endod. 2014;40(1): 51–55. https:/
Ayoub S, Cheayto A, Bassam S, Najar M, Berbéri A, Fayyad-Kazan M. The Effects of Intracanal Irrigants and Medicaments on Dental-Derived Stem Cells Fate in Regenerative Endodontics: An update. Stem Cell Rev. 2020;16(4):650–660. https:/
Naik SV, Prakash AJ, Attiguppe RP. A survey on awareness and knowledge among dentist practicing regenerative endodontics towards current regenerative endodontic protocols and the scaffolds used in regenerative dentistry. Saudi Dent J. 2023;35(5):559–566.
Marques MM, Diniz IMA, de Cara SPHM, Pedroni ACF, Abe GL, D’Almeida-Couto RS, et al. Photobiomodulation of Dental Derived Mesenchymal Stem Cells: A Systematic Review. Photomed Laser Surg. 2016;34(11):500–508. https:/
Mollashahi NF, Saberi E, Karkehabadi H. Evaluation of cytotoxic effects of various endodontic irrigation solutions on the survival of stem cell of human apical papilla. Iran Endod J. 2016;11(4):293–297. https:/
Scott II MB, Zilinski GS, Kirkpatrick TC, Himel VT, Sabey KA, Lallier TE. The Effects of Irrigants on the Survival of Human Stem Cells of the Apical Papilla, Including Endocyn. J Endod. 2018;44(2):263–268. https:/
Sherestha S, Torneck CD, Kishen A. Dentin Conditioning with Bioactive Molecule Releasing Nanoparticle System Enhances Adherence, Viability, and Differentiation of Stem Cells from Apical Papilla. J Endod. 2016;42(5):717–723. https:/
Liu S, Zhai H, Fu S, Cui C, Xu J, Jiang J, et al. Evaluation of the cytotoxic effects of sodium hypochlorite on human dental stem cells. Trop J Pharm Res. 2018;17(12):2375–80. https:/
Trubiani O, Pizzicannella J, Caputi S, Marchisio M, Mazzon E, Paganelli R, et al. Periodontal Ligament Stem Cells: Current Knowledge and Future Perspectives. Stem Cells Dev. 2019;28(15):995–1003. https:/
Tzanetakis GN, Giannakoulas DG, Papanakou S, Gizani S, Lygidakis N. Regenerative endodontic therapy of immature permanent molars with pulp necrosis: a cases series and a literature review. Eur Arch Paediatr Dent. 2021;22(3):515–525. https:/
Yoshpe M, Kaufman AY, Lin S, Ashkenazi M. Regenerative endodontics: a promising tool to promote periapical healing and root maturation of necrotic immature permanent molars with apical periodontitis using platelet-rich fibrin (PRF). Eur Arch Paediatr Dent. 2021;22(3):527–534. https:/ 10.1007/s40368-020-00572-4.
Plotino G, Grande NM, Mercade M. Photodynamic therapy in endodontics. Int Endod J. 2019;52(6):760–774. https:/ 10.1111/iej.13057.
Elnaggar SE, El Backly RM, Zaazou AM, Morsy Elshabrawy S, Abdallah AA. Effect of different irrigation protocols for applications in regenerative endodontics on mechanical properties of root dentin. Aust Endod J. 2021;47(2):228–235. https:/
Rabello DGD, Corazza BJM, Ferreira LL, Santamaria MP, Gomes APM, Martinho FC. Does supplemental photodynamic therapy optimize the disinfection of bacteria and endotoxins in one-visit and two-visit root canal therapy? A randomized clinical trial. Photodiagnosis Photodyn Ther. 2017;19:205–211. https:/
Sasanakul P, Ampornaramveth RS, Chivatxaranukul P. Influence of Adjuncts to Irrigation in the Disinfection of Large Root Canals. J Endod. 2019;45(3):332–337. https:/ 10.1016/j.joen.2018.11.015.
Gazzaneo I, Vieira GCS, Pérez AR, Alves FRF, Gonçalves LS, Mdala I, et al. Root Canal Disinfection by Single- and Multiple-instrument Systems: Effects of Sodium Hypochlorite Volume, Concentration, and Retention. J Endod. 2019;45(6):736–741. https:/
Rupam K, Kanwalpreet KB, Deepali3, Shantun M, Aashish H. Comparison of Efficacy of 2.5% Vs 5.25% Concentrations of Sodium Hypochlorite Augmented by Different Irrigation Techniques in Eradication of Enterococcus Faecalis – An In-Vitro Study. Annals of R.S.C.B. 2021;25(1):6227–6236.
Alkahtani A, Alkahtany SM, Anil S. An in vitro evaluation of the cytotoxicity of varying concentrations of sodium hypochlorite on human mesenchymal stem cells. J Contemp Dent Pract. 2014;15(4):473–481. https:/
Reshma Raj VP, Varma RB, Sureshkumar J, Kumaran P, Xavier AM, Madhavan M. Comparison of cytotoxicity and smear layer removal efficacy of triphala (an Indian ayurvedic herbal formulation) and 5.25% sodium hypochlorite as root canal irrigants: An in vitro study. J Indian Soc Pedod Prev Dent. 2020;38(4):343–349. https:/
Galler KM. Clinical procedures for revitalization: current knowledge and considerations. Endod J. 2016;49(10):926–36. https:/ 10.1111/iej.12606.
Zeng Q, Nguyen S, Zhang H, Chebrolu HP, Alzebdeh D, Badi MA, et al. Release of Growth Factors into Root Canal by Irrigations in Regenerative Endodontics. J Endod. 2016;42(12):1760–1766. https:/ 10.1016/j.joen.2016.04.029.
Taweewattanapaisan P, Jantarat J, Ounjai P, Janebodin K. The Effects of EDTA on Blood Clot in Regenerative Endodontic Procedures. J Endod. 2019;45(3):281–286. https:/
Aspesi M, Kopper PMP, de Carvalho Deluca M C, Matte BF, Brand, LM, Grecca FS, Scarparo RK, et al. Cytotoxic, migration, and angiogenic effects of intracanal irrigants on cells involved in revascularization of immature teeth. Arch Oral Biol. 2021;121:104980. https:/ 10.1016/j.archoralbio.2020.104980.