Cytotoxicity and mutagenicity of AH26 and AH Plus sealers

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Discussion.
In this study, the cytotoxicity and mutagenicity of two root canal sealers, AH26 and AH Plus, were investigated in vitro. The cytotoxicity was dependent on concentration, setting time and the sealer used. Both materials exhibited reduced cytotoxicity when set for longer and did not have increased toxicity when eluted for a longer period. AH Plus showed significantly stronger cytotoxicity than AH26, both initially and after longer setting intervals. Such results would imply that the substances responsible for cytotoxicity of AH26 are released primarily during the first 24 h of setting. Although AH Plus set for 1 h did not increase cytotoxicity in prolonged eluation, it still exhibited strong cytotoxicity after 7 days. Schweikl et al. (1995) reported that eluates of mixed AH 26 set for 7 days were weakly toxic compared with freshly mixed material. Cytotoxicity of AH Plus found in this study is in accordance with findings of Schweikl & Schmalz (2000) who reported reduction of cell survival rates to 50% after exposure to 3 0 mg mL_1of this material. They claimed that eluating substance had a significant influence on cytotoxicity of materials tested, with the greatest toxic effect occurring with AH Plus before elution, followed by AH Plus eluted in DMSO; elutes of AH Plus in 0.9% sodium chloride were less toxic. This study has attempted to avoid the possible influence of DMSO itself by using the proportion of viable cells in the eluate to the number of viable cells in DMSO to assess cytotoxicity.
In the present study, three concentrations of AH26 and AH Plus (which have shown a range from mild to strong cytotoxic effect) were used to examine the mutagenic effect following the setting periods of 1 h, 24 h and 7 days. The results show that neither lower nor higher concentrations of these materials, and neither shorter nor longer setting periods increased the number of chromosomal aberrations or micronucleus induction.
Published data on the mutagenic effects of AH26 and AH Plus are conflicting. Schweikl et al. (1995) found that AH26wasmutagenic in the rodent cells mutation assay; the mutagenic effect of AH26 decreased with setting time, but continued for 7 days. Schweikl & Schmalz (2000), using the induction of micronuclei in Chinese hamster V79 as the end point of their study, observed mutagenicity of freshly mixed AH Plus eluated with DMSO, but no mutagenicity after 24 h setting time. Schweikl et al. (1995) have shown that the in vitro mutagenicity of AH26 is based mainly on an epoxy resin, bisphenol A diglycidylether. This component is also a ‘precursor’ of AH Plus (Schweikl & Schmalz 2000), but they did not find any mutagenic activity of mixed AH Plus after a setting time of 24 h.
In a previous study, both AH26 and AH Plus were mutagenic when assessed by the Ames test, but the mutagenic potential of AH Plus was shown to be weaker than that of AH26 (Jukic. et al. 2000). On the other hand, Leyhausen et al. (1999) found no mutagenic potential with the Ames test using same Salmonella strains. Thus, research data about mutagenic potential of AH26 and AH Plus obtained in vitro are at variance, even when they were obtained using similar test systems. However, the most important mutagenicity data, obtained with human cells, are missing. In the present study, the mutagenic effects of root canal sealers AH26 and AH Plus on human lymphocytes were examined and compared; there was no mutagenicity either in chromosomal aberration analysis or in the micronuclei induction for the examined eluates. The finding that AH26 and AH Plus may not be mutagenic for human lymphocytes in highly controlled conditions in vitro, may have important clinical implications. Although the results indicate inherent mutagenic potential of the materials tested, a short-term mutagenicity assay cannot predict mutagenic changes that can take many years or several generations to appear and the tested doses can be significantly different to the dose actually delivered.