Calcium silicate-based cements (CSCs) are widely used in various endodontic treatments to promote wound healing and hard tissue formation. Chitosan-based accelerated Portland cement (APC-CT) is a promising and affordable material for endodontic use. This study investigated the effect of APC-CT on apoptosis, cell attachment, dentinogenic/osteogenic differentiation and mineralization activity of stem cells from human exfoliated deciduous teeth (SHED). APC-CT was prepared with various concentrations of chitosan (CT) solution (0%, 0.625%, 1.25% and 2.5% (w/v)). Cell attachment was determined by direct contact analysis using field emission scanning electron microscopy (FESEM); while the material extracts were used for the analyses of apoptosis by flow cytometry, dentinogenic/osteogenic marker expression by real-time PCR and mineralization activity by Alizarin Red and Von Kossa staining. The cells effectively attached to the surfaces of APC and APC-CT, acquiring flattened elongated and rounded-shape morphology. Treatment of SHED with APC and APC-CT extracts showed no apoptotic effect. APC-CT induced upregulation of DSPP, MEPE, DMP-1, OPN, OCN, OPG and RANKL expression levels in SHED after 14 days, whereas RUNX2, ALP and COL1A1 expression levels were downregulated. Mineralization assays showed a progressive increase in the formation of calcium deposits in cells with material containing higher CT concentration and with incubation time. In conclusion, APC-CT is nontoxic and promotes dentinogenic/osteogenic differentiation and mineralization activity of SHED, indicating its regenerative potential as a promising substitute for the commercially available CSCs to induce dentin/bone regeneration.

Introduction: Biodentine is a well-known endodontic material that is applied in various endodontic therapies. Enterococcus faecalis (E. faecalis) is associated with endodontic failure and persistent periapical infection. The purpose of this systematic review was to summarize the available evidence regarding the antibacterial activity of Biodentine against E. faecalis and to compare it to other commercial endodontic materials.Methods: An electronic search of literature was conducted in PubMed, Scopus, Web of Science, and Google Scholar in addition to a manual search in specialized journals up to May 2024. The eligibility criteria, data extraction, and evaluation of risk of bias were assessed by two independent authors. The risk of bias was evaluated in accordance with Modified CONSORT checklist items for pre-clinical in vitro studies on dental materials.Results: Out of 343 studies, thirty-seven fulfilled the inclusion criteria and were included in this review. Thirty studies reported a good antibacterial efficacy of Biodentine against E. faecalis. Biodentine was superior to or, at least, as efficacious as MTA, MTA Angelus, GIC, RMGIC, DiaRoot BioAggregate, NeoPutty, iRoot FS, MTA Repair HP, MTA Biorep, Well-Root PT, Activa, NeoMTA 2, Calcimol LC, TotalFill, and IRM. The findings were supported by studies with medium to high risk of bias (low quality).Conclusions: Considering the limitations of this systematic review, there is accumulating evidence on the antibacterial activity of Biodentine against E. faecalis in context of endodontics. However, randomized clinical trials with well-designed and robust methodologies are required in order to provide information about its clinical behaviour.

Aim: The aim of this in vitro study was to evaluate the antibacterial activity of gypsum-based biomaterial with different concentrations of chitosan (GP/CT) and to compare with the commercial dental materials, Dycal and glass ionomer cement (GIC) against the Streptococcus mutans. Materials and Methods: GP/CT was prepared with different concentrations of CT to GP of 0%, 10%, 20%, 40%, and 80% (w/w). The antibacterial study was carried out using agar diffusion method on Mueller-Hinton agar (MHA) against S. mutans. Uniform wells were prepared at equidistant points in the base layer of MHA. The wells were filled with the materials immediately after manipulation and preincubated for 2 h and then incubated. The means of inhibition zones were measured at 48 and 72 h. Results: The results revealed that higher means of inhibition zone were observed in a dose-dependent manner with higher concentrations of CT. GP/80%CT showed more effective antibacterial effect than GP/20%CT and GP/10%CT with significant degree and also with GP/40%CT with no significant result (P < 0.05), while GP/0%CT showed no inhibition of bacterial growth. GP/80%CT showed no statistically significant difference with GIC and Dycal on day 3. In addition, no significant bacterial growth inhibition was observed between GP/40%CT and GIC. Conclusion: Gypsum-based biomaterial has potent antibacterial activity against S. mutans when CT added. Higher antibacterial activity of GP/CT biomaterial was observed in a dose-dependent manner with higher concentrations of CT. GP/80%CT exhibits the antibacterial effect similar to that of Dycal and GIC.