Efeitos biológicos de cimentos à base de silicato de cálcio sobre a polpa dental para a pulpotomia de dentes permanentes

Abstract

Introduction/Objective: This paper reviewed the main studies in the literature that compare the biological effects of cements based on calcium silicate, with the objective of presenting dentists the behavior of these cements for use in the treatment of pulpotomy. Methodology: The search for scientific articles was carried out using the Pubmed database, based on the combination of the descriptors “calcium silicate cements”, “biocompatibility”, “pulpotomy”, “clinical trial” and “mineral trioxide aggregate”, preferably including the studies published in the international journals “International Endodontic Journal” and “Journal of Endodontics”, in the last eight years. The selected articles were divided into 1) in vitro and in vivo laboratory studies and, 2) clinical studies in humans. Literature Review: With regard to biocompatibility and the formation of mineralized tissue, 10 articles published between 2015 and 2022 that compared repairing cements based on calcium silicate using laboratory methodologies were included. As for clinical findings, 11 articles published between 2014 and 2022 were studied, which compared different repairing cements based on calcium silicate used during pulpotomy treatment. Results/Discussion: The biological effects were evaluated through in vitro experiments using undifferentiated mesenchymal cells, and in vivo methodologies applying the cements on vital pulps of animals and humans, as well as in polyethylene tubes on the back of animals. These effects were mainly interpreted through histological analyzes stained with hematoxylin-eosin and/or immunohistochemistry. Clinical studies of pulpotomy with different sealers investigated the results based on the presence of coronary staining, persistence or remission of signs and symptoms of inflammation and radiographic manifestation. In general, ProRoot MTA cement represented the most tested material in clinical and laboratory tests and, despite the high success rates, it seems to promote coronary staining. Given this limitation, Biodentine cement presented results similar to MTA, with the advantage of offering greater color stability. In contrast, TheraCal cement demonstrated less efficacy, exhibiting less biocompatibility and irregular dentin bridge formation. Conclusion: From the analyzed articles, it was observed favorable biocompatibility of most cements based on calcium silicate with results comparable to MTA, but there is still no consensus in the literature about the most effective material for pulpotomy. From a clinical point of view, randomized studies with longer follow-up times are needed to compare different cements, in order to encourage the insertion of pulpotomy as an alternative treatment in the dental surgeon's clinical routine.