Influence of ethylenediaminetetraacetic acid on regenerative endodontics: A systematic review

Abstract

Background The effects of ethylenediaminetetraacetic acid (EDTA) on regenerative endodontic procedures (REPs) are controversial, because, despite releasing growth factors from dentine, some studies show negative effects on cell behaviour. Objectives The aim of the study was to investigate the influence of the use of EDTA in REP on the growth factors’ release, cell behaviour and tissue regeneration. Methods A systematic search was conducted (PubMed/Medline, Scopus, Cochrane Library, Web of Science, Embase, OpenGrey and reference lists) up to February 2021. Only in vivo and in vitro studies evaluating the effects of EDTA on the biological factors of dentine, pulp/periapical tissues and cell behaviour were eligible. Studies without a control group or available full text were excluded. The growth factors’ release was the primary outcome. Risk of bias in the in vitro and in vivo studies was performed according to Joanna Briggs Institute's Checklist and SYRCLE’s RoB tool, respectively. Results Of the 1848 articles retrieved, 36 were selected. Amongst these, 32 were in vitro, three animal studies and one with both models. The EDTA concentrations ranged from 3% to 15%, at different times. Regarding growth factors’ release (17 studies), 15 studies found significant transforming growth factor (TGF)‐β release after dentine conditioning with EDTA, and most found no influence on vascular endothelial growth factor release. Regarding cell behaviour (26 studies), eight studies showed no influence of EDTA‐treated dentine on cell viability, whereas, five, nine and six studies showed higher cell migration, adhesion and differentiation respectively. No influence of EDTA conditioning was observed in animal studies. In vitro studies had a low risk of bias, whereas animal studies had high risk of bias. Meta‐analysis was unfeasible. Discussion This review found that EDTA increased TGF‐β release and improved cell activity. However, well‐designed histological analyses using immature teeth models are needed. Conclusions High‐quality in vitro evidence suggests that EDTA‐treated dentine positively influences TGF‐β release, cell migration, attachment and differentiation; further research to evaluate its influence on tissue regeneration is necessary due to low methodological quality of the animal studies.

Uso del ácido etilendiaminotetraacético como irrigante en el tratamiento del conducto radicular

“…El EDTA es actualmente el solvente entérico más utilizado como enjuague endodóntico en combinación con hipoclorito de sodio 10 . Se considera un agente con propiedades más Marjorie Michelle Guananga-Manobanda; Nadia Fernanda Loja-Ortiz Emma Maricella Arroyo-Lalama 1040 compatibles con su sistema de canales y ambiente biológico.…”

Effect of erbium yttrium aluminium garnet laser dentin conditioning on dental pulp stem cells viability

“…A recent systematic review stated that EDTA conditioning has valuable advantages on REP. It promotes tissue neo-formation and speeds up the healing process by increasing dentin transforming growth factor-1 release and improving stem cell migration and differentiation [ 17 ]. Conversely, some research found that EDTA-treated dentin did not affect cell viability [ 18 ].…”

Impaired Tertiary Dentin Secretion After Shallow Injury in Tgfbr2-Deficient Dental Pulp Cells Is Rescued by Extended CGRP Signaling

“…The dentin proteome has been shown to promote neurite outgrowth [54,55] and to stimulate odontoblast differentiation and/or tertiary dentin secretion [56,57]. These growth factors in dentin can be released from the dentin into the pulp during endodontic treatments [58][59][60][61][62][63] and are being studied for their potential in regenerative endodontics. It is possible that the dentin similarities between our Tgfbr2 cko and WT mice may be masking a differential response that would occur if the proteomes were different.…”