Effects of incorporating natural substances into sodium alginate in the cultivation of human dental pulp stem cells: a systematic review with meta-analysis

Abstract

Objective: This study aimed to evaluate, through a systematic review with meta-analysis, the effects of incorporating natural substances into sodium alginate scaffolds on human dental pulp stem cells (hDPSCs), considering outcomes such as adhesion, proliferation, and differentiation. Material and Methods: A comprehensive literature search was conducted in PubMed, LILACS, Scopus, Web of Science, and Embase using the MeSH descriptors “Stem Cells” and “Alginates,” combined with the Boolean operator “AND” and their respective entry terms. In vitro studies without language or date restrictions that incorporated natural substances into alginate and evaluated their effects on hDPSCs were included. Two independent reviewers performed study selection and data extraction. Risk of bias was assessed, and Cohen’s d with 95% confidence intervals (CIs) was calculated for proliferation outcomes. Results: Out of 14,290 records retrieved, five studies met the inclusion criteria, all with a low risk of bias. Three studies (n = 48 samples) were included in the meta-analysis, which revealed a significant positive effect of incorporating natural substances on hDPSC proliferation (Cohen’s d = 2.66; 95% CI = 1.27–4.05). Substances such as hydroxyapatite, gelatin, agarose, plasma rich in growth factors (PRGF), growth factors, nano-hydroxyapatite, and lactose-modified chitosan (QTL) were used to enhance alginate properties. Notably, hydroxyapatite and PRGF improved both proliferation and osteogenic differentiation. Conclusion: The incorporation of natural substances into sodium alginate scaffolds appears to enhance biological responses of hDPSCs, supporting their potential use in regenerative endodontics and tissue engineering.

KEYWORDS

Dental pulp; Sodium alginate; Stem cell; Tissue engineering; Tissue Scaffold.