Comparative Evaluation of the Cytotoxic Effect of Different Intracanal Medicaments on Stem Cells of the Apical Papilla - A Cell Culture Study

Abstract

Background: Regenerative endodontics involves biologically driven techniques aimed at restoring compromised tissues, such as dentin, root structures, and the cellular components of the pulp–dentin complex. The effectiveness of these procedures largely relies on the viability of stem cells. Antibiotic pastes used for microbial elimination are often limited in concentration due to their potential toxicity to stem cells, while lower concentrations raise concerns regarding efficacy. Phytomedicines have been used extensively due to their efficacy and fewer adverse effects. Carnosic acid is one such phytomedicine which has proven to have a good effect against degenerative diseases because of their good regenerative potential. Moreover, studies have shown carnosic acid having better disinfection capacity than triple antibiotic pastes (TAP) as intracanal medicament. However, its regenerative potential in endodontics is yet to be known. Therefore, this study aims to investigate the cytotoxicity of carnosic acid on SCAPs from permanent human teeth in comparison with triple antibiotic paste. Objective: To evaluate and compare the cytotoxic effect of carnosic acid on stem cells from the apical papilla (SCAPs) of permanent human teeth Methodology: Stem cells removed from immature teeth were cultivated. After cultivation and third cell passage, modified TAP (metronidazole, ciprofloxacin, and clindamycin) and carnosic acid were placed in cell culture medium. After 1 and 3 days, cell viability in the culture medium was assessed using MTT method ([4,5‐dimethylthiazol‐2‐yl]‐2,5‐diphenyltetrazolium bromide) and ELISA (Enzyme‐linked immunosorbent assay). Results: Carnosic acid has shown more stem cells viability and hence is less cytotoxic than mTAP. Conclusion: Within the limitations of the current study, it can be concluded that Carnosic acid has a lower cytotoxic effect on the SCAPs than mTAP. Hence, its use as ICM in regenerative endodontics looks promising. However, further clinical studies are required.