Potential of irrigants and medicaments in regenerative endodontics: insights from a systematic review on dentin growth factor release

Abstract

This study systematically reviews the literature on protocols used in regenerative endodontic procedures, focusing on the relationship between irrigants, intracanal medicaments, and the release of dentin-derived growth factors, which form one of the foundational pillars of regenerative endodontics. Systematic searches were conducted in PubMed, Web of Science, Scopus, Google Scholar, and gray literature for English studies (2015-2024). The included studies investigated growth factor release associated with irrigants or intracanal medicaments in human dentin. QUIN tool assessed methodological quality. Of the three-thousand-seven-hundred-and-seventy-four screened, seventeen studies were included in the review. Ethylenediaminetetraacetic acid (EDTA), either alone or combined with sodium hypochlorite (NaOCl) or chlorhexidine, and 10% citric acid were the most effective in releasing TGF-β1 and BMPs (BMP2 and BMP7). Although this systematic review demonstrates methodological heterogeneity among studies, there was a tendency for increased levels of TGF-β1 and BMP with the use of EDTA (10 or 17%) associated or not with NaOCl or chlorhexidine, while the release of VEGF and FGF2 was minimal or undetectable. Regarding the intracanal medicaments, the use of calcium hydroxide paste (Ca(OH)₂) paste demonstrated an increase in TGF-β1 release. However, this result should be interpreted with caution due to the limited number of available studies.

Keywords: Dentin; Regeneration; Tissue engineering; Tooth root; Transforming growth factor beta 1; Vascular endothelial growth factor receptor-1.