Restorative Dentistry & Endodontics

Research Article

Direct cellular responses of a human periodontal ligament stem cell line to root canal sealers and white mineral trioxide aggregate: an in vitro study: Atsushi Tomokiyo, Kenta Tsuchiya, Keita Ipposhi, Salvatore Sauro, Jukka P. Matinlinna, Fumiko Minowa, Hidehiko Sano, Hidefumi Maeda; J Korean Acad Conserv Dent ;Published online October 23, 2026; DOI: https://doi.org/10.5395/rde.2026.51.e45 [Epub ahead of print]

Abstract PDF Supplementary Material: Objectives
Root canal sealers may contact periodontal ligament (PDL) tissues through the apical foramen; therefore, their biological compatibility is critical for periapical healing. This study evaluated the direct cellular responses of human PDL stem cells (PDLSCs) to selected root canal sealers and white mineral trioxide aggregate (WMTA). Methods: Disc-shaped specimens of AH Plus (AH; Dentsply Sirona), GuttaFlow 2 (GF; Coltene), GuttaFlow Bioseal (Bio; Coltene), and ProRoot MTA (WMTA) were directly placed onto cultured clonal human PDLSCs (cell line 2–23). Cell viability, gene expression related to proliferation (CCND1, CCNE1), collagen synthesis (COL1, COL3), and mineralization (BMP2, OPN, CEMP1), collagen deposition, mineralized matrix formation, surface characteristics, and Ca2+ release were evaluated using MTT assay, real-time quantitative polymerase chain reaction, histochemical staining, scanning electron microscopy/ energy-dispersive X-ray spectroscopy, and ion release analysis. Results: AH exhibited marked cytotoxicity, whereas GF, Bio, and WMTA showed higher cytocompatibility. Bio significantly increased proliferation-related gene expression at 7 days. Although early collagen deposition was lower in the Bio and WMTA groups, both materials induced significantly greater mineralized matrix formation after 28 days, accompanied by upregulation of BMP2, OPN, and CEMP1. WMTA showed a rapid initial Ca2+ release, whereas Bio demonstrated a gradual and sustained release profile. Conclusions: The evaluated materials exhibited distinct cellular effects on PDLSCs. The bioceramic silicone-based sealer (Bio) demonstrated favorable cytocompatibility and promoted mineralization-related responses comparable to WMTA, suggesting its potential to support periapical tissue healing. Therefore, Bio and WMTA may enhance PDLSC viability and mineralization, supporting improved periapical healing and long-term treatment outcomes.

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