Objectives In pulpal revascularization, a protective material is placed coronal to the blood clot to prevent recontamination and to facilitate osteogenic differentiation of mesenchynal stem cells to produce new dental tissues. Although mineral trioxide aggregate (MTA) has been the material of choice for clot protection, it is easily displaced into the clot during condensation. The present study evaluated the effects of recently-introduced calcium silicate cements (Biodentine and TheraCal LC) on the viability and osteogenic differentiation of human dental pulp stem cells (hDPSCs) by comparing with MTA Angelus. Methods Cell viability was assessed using XTT assay and flow cytometry. The osteogenic potential of hDPSCs exposed to calcium silicate cements was examined using qRT-PCR for osteogeic gene expressions, alkaline phosphatase enzyme activity, Alizarin red S staining and transmission electron microscopy of extracellular calcium deposits. Parametric statistical methods were employed for analyses of significant difference among groups, with α=0.05. Results The cytotoxic effects of Biodentine and TheraCal LC on hDPSCs were time- and concentration-dependent. Osteogenic differentiation of hDPSCs was enhanced after exposure to Biodentine that was depleted of its cytotoxic components. This effect was less readily observed in hDPSCs exposed to TheraCal LC, although both cements supported extracelluar mineralization better than the positive control (zinc oxide-eugenol–based cement). Significance A favorable tissue response is anticipated to occur with the use of Biodentine as a blood clot-protecting material for pulpal revascularizaiton. Further investigations with the use of in vivo animal models are required to validate the potential adverse biological effects of TheraCal LC on hDPSCs.

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Introduction MTA Plus (MTAP; Avalon Biomed Inc., Bradenton, FL) is a new calcium silicate cement with unknown cytotoxicity characteristics. The objectives of this study were to examine the effect of MTA Plus on the viability, apoptosis/necrosis profile and oxidative stress levels of rat odontoblast-like cells. Methods MDPC-23 cells were exposed to gray and white MTA Plus (GMTAP, WMTAP), gray and white ProRoot® MTA (GMTA, WMTA; Dentsply Tulsa Dental Specialties, Tulsa, OK) cements or their eluents. The cells were evaluated for: i) cell viability using XTT assay, ii) apoptosis/necrosis using flow cytometry and confocal laser scanning microscopy, and iii) oxidative stress by measuring reactive oxygen species. Results XTT assay showed that all test cements exhibited marked initial cytotoxicity that decreased with time. By the end of the third week, GMTAP and GMTA were comparable to untreated cells (negative control) in terms of cell viability, while WMTAP and WMTP were significantly lower than the untreated cells. Apoptosis/necrosis profiles of cells exposed to WMTAP and GMTAP were not significantly different from untreated cells, while cells exposed to WMTA and GMTA showed significantly less viable cells. All experimental groups exhibited reduction of intracellular ROS formation compared to untreated cells, although cells exposed to WMTA was not significantly different from untreated cells. Conclusions Both the gray and white versions of MTA Plus possess negligible in-vitro cytotoxic risks that are time and dilution dependent. They enrich the spectrum of hydraulic calcium silicate cements currently available to clinicians for endodontic applications.