In general , studies suggest that root canal sealers elicit mild to severe toxic effects and that several factors may influence biocompatibility , e.g. , material setting condition and time , material concentration , and type of exposure .
4 ) Conclusions : The available evidence shows that root canal sealers exhibit variable toxic potential at the cellular and tissue level .
However , the method ological heterogeneity among studies included in this systematic review and the somewhat conflicting results do not allow a conclusion on which type of sealer presents higher biocompatibility .
( 1 ) Aim : To perform a systematic review of the literature on the biocompatibility of  root canal sealers  that encompasses the various types of sealers that are commercially available as well as both in vitro and in vivo evidence . (
Cytotoxicity testing of endodontic sealers: a new method.
The purpose of this study was to compare ISO st and ards versus a new technique for in vitro evaluation of cytotoxicity of root canal sealers . The cytotoxicity of AH Plus , Cortisomol , and Sealapex was first recorded according to ISO st and ards on L 929 fibroblasts by the MTT assay . In parallel , 30 single-rooted teeth were cut at the cementum enamel junction ( CEJ ) , and the roots were prepared and sterilized before filling with the lateral condensation using one of three sealers ( n = 10 ) . The apexes of the roots were dipped into 1 ml of minimum essential medium for 1 , 2 , and 30 days renewing the medium every other day . After 24-h contact between the medium and the filled roots , the medium was used to measure the cytotoxicity on L 929 with the MTT assay . ISO st and ards always gave a statistically higher cytotoxicity than the root-dipping technique ( p < 0.0001 ) , whatever the sealer and the exposure time . The ISO st and ards showed statistically significant differences among the sealers ( p < 0.0001 ) . AH Plus was noncytotoxic , Cortisomol showed a high cytotoxicity decreasing over time ( p < 0.001 ) , and Sealapex displayed a high cytotoxicity that did not decrease over time ( NS ) . The new technique showed statistically significant differences among the sealers ( p = 0.001 ) , but the differences were so small that they were likely not clinical ly relevant . The high cytotoxicity of Sealapex decreased over time but the cytotoxicity of AH Plus and Cortisomol did not . The results show that the ISO st and ards may strongly over-evaluate the cytotoxicity of the endodontic sealers , emphasize the difference among the sealers , and may clinical ly correspond to a large overfilling . The new technique reduces the discrimination of the test and may clinical ly correspond to a classical filling . Therefore , both methods might be considered as clinical ly relevant , corresponding to classical and overfilling conditions
In general , studies suggest that root canal sealers elicit mild to severe toxic effects and that several factors may influence biocompatibility , e.g. , material setting condition and time , material concentration , and type of exposure .
4 ) Conclusions : The available evidence shows that root canal sealers exhibit variable toxic potential at the cellular and tissue level .
However , the method ological heterogeneity among studies included in this systematic review and the somewhat conflicting results do not allow a conclusion on which type of sealer presents higher biocompatibility .
( 1 ) Aim : To perform a systematic review of the literature on the biocompatibility of  root canal sealers  that encompasses the various types of sealers that are commercially available as well as both in vitro and in vivo evidence . (