Anti-inflammatory effect of amalgam on periapical lesion cells in culture
Abstract
Background/Aim. Amalgam has been used for years in dentistry, but the controversy on its adverse effects, both on local oral/dental tissues and systemic health, still exists. When used for retrograde filling in apical surgery, amalgam comes in close contact with the periapical tissue, and it is sometimes responsible for the induction of periapical lesion (PL) or its exacerbation. Therefore, the aim of the study was to examine the effect of amalgam on cytotoxicity and production of pro-inflammatory cytokine by cells isolated from PL. Methods. Conditioned medium from freshly prepared amalgam (ACM) was performed according to the ISO 10993-12 by incubating the alloy in RPMI medium (0.2 g/mL) for 3 days at 37°C. Cells were isolated from 20 human PLs after apicoectomy by collagenase/DNA-ase digestion and cultured with different dilutions of ACM. Cytotoxicity was determined by MTT assay (n = 7 cultures) and apoptosis/necrosis assays (n = 8 cultures), whereas cytokine production was measured by a Flow Cytomix Microbeads Assay (n = 8 cultures). Results. Undiluted (100%) and 75% ACM was cytotoxic due to induction of apoptosis of PL cells. Non-cytotoxic concentrations of ACM (50% and 25%) inhibited the production of pro-inflammatory cytokines (TNF-α, IL-1β, IL-6, and IL-8), concentration-dependently. Conclusion. For the first time, our results showed an unexpected anti-inflammatory property of amalgam on PL cells, which could be beneficial for PL healing after apicoectomy.
References
Mahler DB. The high-copper dental amalgam alloys. J Dent Res 1997; 76(1): 537‒41.
Bhagat K, Goel M, Bhagat N. Root End Filling Materials and Recent Advances: A Review. EC Dent Sci 2017; 12: 46‒57.
Mjor IA, Jokstad A, Qvist V. Longevity of posterior restora-tions. Int Dent J 1990; 40(1): 11‒7.
Hohenfeldt PR, Aurelio JA, Gerstein H. Electrochemical corro-sion in the failure of apical amalgam. Report of two cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1985; 60(6): 658‒60.
Pleva J. Corrosion and mercury release from dental amalgam. J Orthomol Med 1989; 4(3): 141‒58.
Kaga M, Seale N, Hanawa T, Ferracane J, Waite D, Okabe T. Cy-totoxicity of amalgams, alloys, and their elements and phases. Dent Mater 1991; 7(1): 68‒72.
Bodrumlu E. Biocompatibility of retrograde root filling materi-als: a review. Aust Endod J 2008; 34(1): 30‒5.
Osborne JW, Norman RD, Gale EN. A 14-year clinical assess-ment of 12 amalgam alloys. Quintessence Int 1991; 22(11): 857‒64.
Kaga M, Seale N, Hanawa T, Ferracane J, Okabe T. Cytotoxicity of amalgams. J Dent Res 1988; 67(9): 1221‒4.
Leirskar J. On the mechanism of cytotoxicity of silver and copper amalgams in a cell culture system. Eur J Oral Sci 1974; 82(1): 74‒81.
Meryon S. The effect of zinc on the biocompatibility of dental amalgams in vitro. Biomaterials 1984; 5(5): 293‒7.
Enwonwu C. Potential health hazard of use of mercury in den-tistry: critical review of the literature. Environ Res 1987; 42(1): 257‒74.
Moszczyński P. Mercury compounds and the immune system: a review. Int J Occup Med Environ Health 1997; 10(3): 247‒58.
Enestrom S, Hultman P. Does amalgam affect the immune sys-tem? A controversial issue. Int Arch Allergy Immunol 1995; 106(3): 180‒203.
Meurman JH, Porko C, Murtomaa H. Patients complaining about amalgam‐related symptoms suffer more often from ill-nesses and chronic craniofacial pain than their controls. Eur J Oral Sci 1990; 98(2): 167‒72.
Flanders DH, James GA, Burch B, Dockum N. Comparative his-topathologic study of zinc-free amalgram and Cavit in connec-tive tissue of the rat. J Endod 1975; 1(2): 56‒9.
Torabinejad M, Hong CU, Pitt Ford TR, Kaiyawasam SP. Tissue reaction to implanted super-EBA and mineral trioxide aggre-gate in the mandible of guinea pigs: a preliminary report. J Endod 1995; 21(11): 569‒71.
Nair PN. On the causes of persistent apical periodontitis: a re-view. Int Endod J 2006; 39(4): 249‒81.
Keiser K, Johnson CC, Tipton DA. Cytotoxicity of mineral triox-ide aggregate using human periodontal ligament fibroblasts. J Endod 2000; 26(5): 288‒91.
Tai KW, Chang YC. Cytotoxicity evaluation of perforation re-pair materials on human periodontal ligament cells in vitro. J Endod 2000; 26(7): 395‒7.
Lin CP, Chen YJ, Lee YL, Wang JS, Chang MC, Lan WH, et al. Effects of root-end filling materials and eugenol on mito-chondrial dehydrogenase activity and cytotoxicity to human periodontal ligament fibroblasts. J Biomed Mater Res 2004; 71(2): 429‒40.
Colic M, Gazivoda D, Vucevic D, Vasilijic S, Rudolf R, Lukic A. Proinflammatory and immunoregulatory mechanisms in peri-apical lesions. Mol Immunol 2009; 47(1): 101‒13.
Letzel H, van 't Hof MA, Vrijhoef MM, Marshall GW Jr, Mar-shall SJ. A controlled clinical study of amalgam restorations: survival, failures, and causes of failure. Dent Mater 1989; 5(2): 115‒21.
Čolić M, Lukić A, Vučević D, Milosavljević P, Majstorović I, Marja-nović M, et al. Correlation between phenotypic characteristics of mononuclear cells isolated from human periapical lesions and their in vitro production of Th1 and Th2 cytokines. Arch Oral Biol 2006; 51(12): 1120‒30.
Ferracane JL, Mafiana P, Cooper C, Okabe T. Time-dependent dissolution of amalgams into saline solution. J Dent Res 1987; 66(8): 1331‒5.
Greenlee-Wacker MC. Clearance of apoptotic neutrophils and resolution of inflammation. Immunol Rev 2016; 273(1): 357‒70.
Schwenk M, Klein R, Templeton DM. Immunological effects of mercury (IUPAC Technical Report). Pure Appl Chem 2009; 81(1): 153‒67.
Shenker BJ, Berthold P, Decker S, Mayro J, Rooney C, Vitale L, et al. Immunotoxic Effects of Mercuric Compounds on Human Lymphocytes and Monocytes. II. Alterations in Cell Viability. Immunopharmacol Immunotoxicol 1992; 14(3): 555‒77.
Baek SH, Plenk Jr H, Kim S. Periapical tissue responses and cementum regeneration with amalgam, SuperEBA, and MTA as root-end filling materials. J Endod 2005; 31(6): 444‒9.
Schedle A, Rausch‐Fan XH, Samorapoompichit P, Franz A, Leutmezer F, Spittler A, et al. Effects of dental amalgam and heavy metal cations on cytokine production by peripheral blood mononuclear cells in vitro. J Biomed Mater Res 1998; 42(1): 76‒84.
Soleo L, Colosio C, Alinovi R, Guarneri D, Russo A, Lovreglio P, et al. Immunologic effects of exposure to low levels of inor-ganic mercury. Med Lav 2002; 93(3): 225‒32.
Podzimek S, Tomka M, Nemeth T, Himmlova L, Matucha P, Pro-chazkova J. Influence of metals on cytokines production in connection with successful implantation therapy in dentistry. Neuro Endocrinol Lett 2010; 31(5): 657‒62.
Ilday NO, Celik N, Dilsiz A, Alp HH, Aydin T, Seven N, et al. The effects of overhang amalgam restoration on levels of cy-tokines, gingival crevicular fluid volume and some periodontal parameters. Am J Dent 2016; 29(5): 266‒70.
Bjorkman L, Brokstad KA, Moen K, Jonsson R. Minor changes in serum levels of cytokines after removal of amalgam restora-tions. Toxicol Lett 2012; 211(2): 120‒5.
Braz-Silva PH, Bergamini ML, Mardegan AP, De Rosa CS, Has-seus B, Jonasson P. Inflammatory profile of chronic apical peri-odontitis: a literature review. Acta Odontol Scand 2019; 77(3): 173‒80.
Naufel AO, Aguiar MCF, Madeira FM, Abreu LG. Treg and Th17 cells in inflammatory periapical disease: a systematic re-view. Braz Oral Res 2017; 31: e103.