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Hristov K, Doitchinova L, Gateva N. Regenerative endodontic treatment of immature permanent teeth after mechanical instrumentation with XP-Endo Finisher. Folia Med (Plovdiv) 2023; 65:460-467. [PMID: 38351823 DOI: 10.3897/folmed.65.e80063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/18/2022] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION The traditional treatment of immature permanent teeth with necrotic pulp involves creating an apical barrier by using calcium hydroxide or an MTA plug for an extended period of time. A novel therapeutic approach called regenerative endodontic procedures (REP) is used to allow root development to continue.
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Elbahary S, Rosen E, Haj-Yahya S, Elias MG, Talmi S, Tsesis I, Slutzky H. The Effect of General Anesthesia on the Outcome of Root Canal Treatment in Pediatric Patients—A Retrospective Cohort Study. CHILDREN 2023; 10:children10030520. [PMID: 36980078 PMCID: PMC10047262 DOI: 10.3390/children10030520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/03/2023] [Accepted: 03/04/2023] [Indexed: 03/09/2023]
Abstract
This study aimed to evaluate the effect of general anesthesia (GA) on the 1-year outcome of Root Canal Treatment (RCT) performed in pediatric patients and to compare it to the outcome of RCT in pediatric patients without GA. Patients admitted for RCT in permanent dentition in a public hospital, dated 2015 to 2020, age 8–15 with a minimum of one year follow-up period, were included in the study. The sample consisted of 326 teeth from 269 patients treated by a single operator, with a recall rate of 81%. Overall, 124 teeth were treated under GA and 142 teeth were without GA. The mean follow-up time was 31.5 months. Data underwent statistical analysis and the significance threshold was set for p < 0.05. Of the total cases, 90% showed favorable outcomes. A significantly higher favorable outcome was seen in the GA group than in the non-GA group (98% and 85%, respectively, p < 0.001). The outcome was significantly affected by the type and quality of the coronal restoration, degree of root development, and lesion size (p < 0.05). According to the current study, in uncooperative pediatric patients, a more favorable outcome of root canal treatment can be obtained under GA than LA if the procedure is carried out with immediate restoration.
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Affiliation(s)
- Shlomo Elbahary
- Department of Endodontics, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
- Correspondence:
| | - Eyal Rosen
- Department of Endodontics, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
| | - Sohad Haj-Yahya
- Department of Endodontics, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
| | - Maysa Ghrayeb Elias
- Department of Endodontics, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
| | - Shany Talmi
- Department of Endodontics, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
| | - Igor Tsesis
- Department of Endodontics, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
| | - Hagay Slutzky
- Department of Prosthodontics, Goldschleger School of Dental Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
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Lin S, Moreinos D, Wisblech D, Rotstein I. Regenerative endodontic therapy for external inflammatory lateral resorption following traumatic dental injuries: Evidence assessment of best practices. Int Endod J 2022; 55:1165-1176. [PMID: 35947093 PMCID: PMC9828210 DOI: 10.1111/iej.13811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND External inflammatory lateral resorption (EILR) following dental trauma is a severe complication that can lead to significant root loss and tooth extraction. OBJECTIVE The aim of this project was to review current evidence in the literature on regenerative endodontic therapy (RET) for EILR following traumatic injuries and assess the best treatment practices. METHODS Publications appearing in PubMed, from January 1, 2001 to January 9, 2022 were studied. Inclusion criteria were: (a) Publications in English; (b) Publications on RET and EILR; (c) Teeth subjected to dental trauma; and (d) Presence of intracanal bleeding and blood clots. Exclusion criteria were: (a) Conference proceedings; (b) Lectures; (c) Abstracts; and (d) Letters to editor; (e) Non-English publications. RESULTS 355 publications were analysed. Nine met all inclusion criteria. In 10 (58.8%) teeth, triple antibiotic paste was used for an average of 26 days. Double antibiotic paste was used in 3 (17.6%) teeth for an average of 14 days. In 3 (17.6%) cases, calcium hydroxide (Ca(OH)2 ) was used for 14 days and negative pressure irrigation was applied once on 1 (6%) tooth. DISCUSSION Using RET to treat EILR has some advantages compared to long term CA(OH)2 dressing. RET requires shorter dressing time compared to CA(OH)2 . This can significantly improve patient compliance. Additionally, in immature teeth, RET helps to arrest root resorption leading to continued root maturogenesis and revascularization. It is recommended that a meticulous follow-up should be conducted when RET is performed to assure early detection of treatment failure. CONCLUSIONS RET appears to be a good treatment modality producing biologic repair and improving prognosis in cases of EILR in post-traumatic tooth/pulp injuries. The key limitation of this study is that all publications included were either case reports or case series that usually tend to report successful outcome.
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Affiliation(s)
- Shaul Lin
- The Israeli National Center for Trauma & Emergency Medicine ResearchGertner InstituteTel HashomerIsrael,Department of EndodonticsRambam Health Care CampusHaifaIsrael,The Ruth and Bruce Rappaport Faculty of MedicineTechnion ‐ Israel Institute of TechnologyHaifaIsrael
| | - Daniel Moreinos
- Endodontic DepartmentOral and Maxillofacial Institute, Galilee Medical CenterNahariyaIsrael,The Azrieli Faculty of MedicineBar‐Ilan UniversitySafedIsrael
| | - Dekel Wisblech
- Department of EndodonticsRambam Health Care CampusHaifaIsrael
| | - Ilan Rotstein
- University of Southern CaliforniaLos AngelesCaliforniaUSA
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Evaluation of Attitude and Knowledge of Endodontic, Pedodontic and SBARD Residents in Saudi Arabia toward Regenerative Endodontics-A National Survey. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58040545. [PMID: 35454383 PMCID: PMC9030200 DOI: 10.3390/medicina58040545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/13/2022] [Accepted: 04/13/2022] [Indexed: 11/30/2022]
Abstract
Background and Objectives: There are no guidelines on the regenerative endodontic procedures that should be followed in dental treatment. Thus, it is essential to learn the knowledge, attitudes, and opinions about regenerative endodontics among dental practitioners, particularly endodontists, as they are the first providers of this type of dental treatment. Aim: This study aimed to assess the knowledge and attitudes among residents of the Saudi Board of Advanced Restorative Dentistry (SBARD) in Saudi Arabia. Methods & Materials: A questionnaire-based survey was conducted among 128 residents of endodontics, pedodontics, and the SBARD in Saudi Arabia. The questionnaire was distributed to participants using the available electronic measures such as emails and social media. The questionnaire was made by Google Forms, and responses were received directly in the excel sheet in the email. The data were exported as an excel file, coded, and analyzed, and the p-value < 0.05 was set as significant. Results: More than 50% (74 dentists) of the participants reported receiving continuing education in regenerative treatment, with a significant difference found among specialty (p = 0.023). No significant association was found between knowledge, gender, and type of postgraduate study. The vast majority (89.1%) of the participants believed regenerative endodontics should be incorporated into dentistry curricula. About two-thirds (78.2%) of the participants declared their ability to attend future training courses in a regenerative endodontic, whereas 10.9% did not, and 10.9% were unsure. Conclusions: The dental practitioners were enthusiastic and interested in regenerative and stem cell treatment. The results also suggested incorporating regenerative treatment into the dental curriculum and signaled the need for more continued training courses.
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Wikström A, Brundin M, Romani Vestman N, Rakhimova O, Tsilingaridis G. Endodontic pulp revitalization in traumatized necrotic immature permanent incisors: Early failures and long-term outcomes - a longitudinal cohort study. Int Endod J 2022; 55:630-645. [PMID: 35332566 PMCID: PMC9325385 DOI: 10.1111/iej.13735] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 11/29/2022]
Abstract
Aim This prospective cohort study evaluates clinical and radiographical outcomes of endodontic pulp revitalization (PR) of traumatized necrotic incisors. Methodology Pulp revitalization was performed in 75 traumatized necrotic immature incisors from 71 patients. The radiographic outcome measures were continued root formation (width and length), root resorption, apex closure, periapical index, and root development stage. The clinical outcome measures were percussion pain, palpation pain, pathological tooth mobility, swelling, sinus tract, ankylosis, crown discolouration, response to pulp sensitivity test, and subjective pain. Treatment outcomes were categorized as a success based on the absence of clinical symptoms and when radiographic evidence was present for apical healing and continued root development. The performed statistical tests were repeated measures anova, pairwise comparisons of interactions (t‐test), McNemar's test, and linear regression model. Results In 45 of 75 teeth (60%), PR was successful with the resolution of clinical and radiographic signs and continued root development. PR failed due to the absence of bleeding (n = 19) and persistent infection (n = 11). PR showed statistically significant increases in root length (11%), and dentinal wall thickness (30%), root maturation (pre‐operative 3.38 [CI 1.88; 4.88]; post‐operative 4.04, [CI 2.56; 5.52]) apical closure (71.4%), healing of pre‐operative apical periodontitis (100%), and healing of pre‐operative inflammatory root resorptions (100%). Three predictive variables for continued root maturation were identified – root development stage at entry (p = .0001, β 0.649), [CI 0.431; 0.867], trauma to the soft tissues (p = .026, β −0.012), [CI −0.0225; −0.015], and pre‐operative dentinal wall thickness (p = .009, β −0.001); [CI −0.001; 0.0001]. Conclusions Our findings indicate that PR provides satisfactory clinical and radiographical outcomes in traumatized necrotic incisors. The failed cases were related to lack of bleeding and persistent infections, indicating that new techniques are needed to improve the predictability of PR.
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Affiliation(s)
- Alina Wikström
- Division of Orthodontics and Paediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Alfred Nobels allé 8, Box 4064, SE-141 04, Huddinge, Sweden.,Department of Endodontics, Public Dental Health Services. Eastmaninstitutet, Dalagatan 11, Box 6031, 102 31, Stockholm, Sweden.,Centre of Paediatric Oral Health, Alfred Nobels allé 8, Box 4064, SE-141 04, Huddinge, Sweden
| | - Malin Brundin
- Department of Endodontics, Umeå University, Umeå, Sweden
| | - Nelly Romani Vestman
- Department of Endodontics, County Council of Västerbotten, Umeå, Sweden.,Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | | | - Georgios Tsilingaridis
- Division of Orthodontics and Paediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Alfred Nobels allé 8, Box 4064, SE-141 04, Huddinge, Sweden.,Centre of Paediatric Oral Health, Alfred Nobels allé 8, Box 4064, SE-141 04, Huddinge, Sweden
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Sismanoglu S, Ercal P. The cytotoxic effects of various endodontic irrigants on the viability of dental mesenchymal stem cells. AUST ENDOD J 2021; 48:305-312. [PMID: 34590392 DOI: 10.1111/aej.12570] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/12/2021] [Accepted: 09/19/2021] [Indexed: 12/11/2022]
Abstract
This study aimed to evaluate cytotoxic effects of various irrigation solutions used in regenerative endodontic treatments (RETs) on mesenchymal stem cells, and further examine the long-term effect of hypochlorous acid (HOCl) on the cell viability and alkaline phosphatase (ALP) activity. Stem cells were exposed to various concentrations of NaOCl, EDTA, chlorhexidine (CHX), etidronic acid (HEDP)/NaOCl combination and HOCl. HOCl was tested for its effects on ALP activity up to 21 days. Additionally, cell viability was measured fluorescently using calcein AM. The most cytotoxic irrigant was CHX even with the lowest concentration. NaOCl and HEDP/NaOCl with 1:100 dilution decreased viability to around 40%. HOCl showed the lowest cytotoxicity among all tested irrigants. HOCl also showed no significant reduction in ALP activity compared with the controls. The cytotoxicity of endodontic irrigants was time and concentration dependent. HOCl demonstrated promising results regarding viability and ALP activity, since RETs require host stem cell survival.
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Affiliation(s)
- Soner Sismanoglu
- Department of Restorative Dentistry, Faculty of Dentistry, Altınbaş University, Istanbul, Turkey
| | - Pinar Ercal
- Centre for Oral Immunobiology and Regenerative Medicine and Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University London (QMUL), London, UK
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Meng M, Chen Y, Ren H, Zhang Q, Chen S, Zhou X, Zou J. Effect of tetracyclines on pulpal and periodontal healing after tooth replantation: a systematic review of human and animal studies. BMC Oral Health 2021; 21:289. [PMID: 34090399 PMCID: PMC8180113 DOI: 10.1186/s12903-021-01615-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 05/09/2021] [Indexed: 02/08/2023] Open
Abstract
Background Pulpal and periodontal healing are two main concerns of delayed replantation of avulsed teeth. The objective of this review was to evaluate the effectiveness of topical and systemic application of tetracyclines on pulpal and periodontal healing after tooth replantation. Methods A comprehensive electronic search was conducted in six databases. This systematic review was carried out according to Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results After exclusion of 246 irrelevant papers, 14 animal studies and one human study were included in this review. The human study showed that avulsed permanent teeth treated with doxycycline did not show a better clinical outcome for pulp and periodontal healing compared with treatment with normal saline. As for animal studies, significant more pulpal healing was observed in immature teeth treated with topical doxycycline in two researches, while another one study showed that there is no difference between teeth treated with normal saline and teeth treated with doxycycline. Systemic doxycycline exerted no significant effect on pulpal revascularization illustrated by one research. Only one out of four articles illustrated the positive effect of systemic tetracyclines on periodontal healing. One paper reported that intracanal application of demeclocycline promoted favorable periodontal healing. Two articles showed topical doxycycline contributed to favorable periodontal healing, while five studies showed no significant effect of topical tetracyclines on periodontal healing. Conclusions As a result of data heterogeneity and limitations of the studies, the effect of topical or systemic application of tetracyclines on pulpal and periodontal healing is inconclusive. More studies are required to get more clinically significant conclusions.
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Affiliation(s)
- Mingmei Meng
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Sichuan, China.,Departments of Pediatric Dentistry and Orthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China
| | - Yandi Chen
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Sichuan, China.,Departments of Pediatric Dentistry and Orthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China
| | - Huidi Ren
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Sichuan, China.,Departments of Pediatric Dentistry and Orthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China
| | - Qiong Zhang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Sichuan, China.,Departments of Pediatric Dentistry and Orthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China
| | - Song Chen
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Sichuan, China.,Departments of Pediatric Dentistry and Orthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Sichuan, China. .,Department of Endodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China.
| | - Jing Zou
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Sichuan, China. .,Departments of Pediatric Dentistry and Orthodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China.
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Novel Approaches for the Treatment of Necrotic Immature Teeth Using Regenerative Endodontic Procedures: A Systematic Review and Meta-Analysis. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11115199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The induction of a blood clot allowing apical revascularization with a subsequent apical closure was reported several decades ago. Recent research has been focused on examining different scaffolds for regenerative endodontic procedures (REPs). The aim of this study was to analyze the main outcomes in novel REP reported in the literature. The search was conducted using six databases. Only clinical trials aiming at the study of scaffolds for REP in the treatment of necrotic immature teeth were included. The risk of bias was assessed by the Risk of Bias 2 tool. Additionally, the quality of the included studies was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. A summary of individual studies and a meta-analysis were performed. Relative risks of data from clinical success and root length changes were used from the studies, and these were combined using a random-effects meta-analysis. The meta-analysis results reveal that the main outcomes showed no differences between the patients who received REP with scaffolds or only REP. Limitations include that the certainty of evidence was low and that there was significant heterogeneity in the scaffolds used in the included studies. The data suggest that the blood clot remains as the gold standard for REP.
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Divya D, Naik SV, Raju OS, Shivani B, Basappa N, Betur AP. Conceptual combination of disinfection in regenerative endodontics: Conventional versus laser-assisted disinfection. J Conserv Dent 2021; 24:252-259. [PMID: 35035150 PMCID: PMC8717846 DOI: 10.4103/jcd.jcd_96_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/28/2021] [Accepted: 09/20/2021] [Indexed: 02/01/2023] Open
Abstract
Background: Successful regeneration depends on four key elements of tissue engineering such as stem cells, growth factors, scaffold and sterile environment. Therefore, regenerative endodontic therapy requires higher degree of disinfection for successful outcomes. Aims and Objective: To evaluate the clinical and radiographic outcome using conventional and laser assisted disinfection in regenerative endodontics at 1, 3 and 6 months. Materials and Methods: 18 children with necrotic young permanent teeth were selected for the study. In Group A, in the first appointment AAE (American Association of Endodontics, Clinical Consideration for Regenerative Endodontic Procedure - 2016) disinfection protocol was employed. In Group B laser assisted disinfection (810 nm diode laser, 1 W, 20 ms Pulse length and 20 ms interval duration) was performed. Microbial samples were obtained before and after disinfection to check the level of disinfection. The cases were followed up at 1 month, 3 months and 6 months interval and evaluated for clinical outcome, periapical healing and apical response. Data were statistically analyzed with level of significance set 1% or 5% accordingly (P<0.01 or P<0.05) Results: On intragroup comparison there was significant reduction in bacterial count before and after disinfection with respect to laser assisted disinfection group. (P value = 0.007) There was no significant change in the clinical outcome score in laser group at 1,3- and 6-months interval. Periapical healing score showed statistically significant results in laser group when followed from 3 months to 6 months (P value = 0.04). Conclusion: Along with AAE 2016 protocol, use of laser assisted disinfection resulted in improved quality of disinfection and an expeditious clinical outcome and periapical healing in necrotic young permanent teeth. Keywords: Disinfection; laser; regenerative endodontics; sodium hypochlorite; tooth apex
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Affiliation(s)
- D Divya
- Department of Pedodontics and Preventive Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka, India
| | - Saraswathi V Naik
- Department of Pedodontics and Preventive Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka, India
| | - O S Raju
- Department of Pedodontics and Preventive Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka, India
| | - Bellal Shivani
- Department of Pedodontics and Preventive Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka, India
| | - N Basappa
- Department of Pedodontics and Preventive Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka, India
| | - Archana P Betur
- Department of Pedodontics and Preventive Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka, India
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ÇİMEN C, ŞEN S, ŞENAY E, BEZGİN T. PRF USED AS A SCAFFOLD IN PULP REGENERATION: CASE SERIES. CUMHURIYET DENTAL JOURNAL 2021. [DOI: 10.7126/cumudj.833807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Jain G, Goel A, Rajkumar B, Bedi RS, Bharti D, Sawardeker A. Evaluation of Effectiveness of Intracanal Medicaments on Viability of Stem Cells of Apical Papilla. J Pharm Bioallied Sci 2020; 12:S228-S232. [PMID: 33149462 PMCID: PMC7595550 DOI: 10.4103/jpbs.jpbs_67_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/02/2020] [Accepted: 03/02/2020] [Indexed: 11/06/2022] Open
Abstract
Introduction: Regeneration, in the field of endodontics, is the process of restoring and maintaining both architectural form and biological functions of damaged tooth. Presently, regenerative endodontics is not hypothetical and is an alternative to conventional apexification procedures. There is a deficient knowledge concerning the role of intracanal medicaments and their effect on dental stem cells. Aim: The aim of this study was to evaluate the effectiveness of commonly used intracanal medicaments on the viability of dental stem cells of the apical papilla (SCAPs). Materials and Methods: SCAPs were cultured and subjected to various concentrations including triple antibiotic paste, double antibiotic paste, Augmentin, and calcium hydroxide (Ca(OH)2). Viable percentage of stem cell counts was obtained 3 days after treatment. Results: All three antibiotics used hereby significantly decreased SCAP cell survival at particular concentrations, whereas Ca(OH)2 showed stimulating effect on SCAP survival. Conclusion: As per results obtained within limitations of this study, use of Ca(OH)2 in regenerative endodontics in comparison to different commonly used antimicrobial combinations is recommended. Hereby, for clinical use, we suggest adequate concentrations of antimicrobials with adequate antibacterial efficacy should be used.
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Affiliation(s)
- Gaurav Jain
- Department of Conservative Dentistry and Endodontics, Saraswati Dental College, Lucknow, Uttar Pradesh, India
| | - Akriti Goel
- Department of Conservative Dentistry and Endodontics, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Balakrishnan Rajkumar
- Department of Conservative Dentistry and Endodontics, BBD College of Dental Sciences, Lucknow, Uttar Pradesh, India
| | - Ravinder Singh Bedi
- Department of Oral and Maxillofacial Surgery, Saraswati Dental College, Lucknow, Uttar Pradesh, India
| | - Divya Bharti
- Department of Conservative Dentistry and Endodontics, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Anuradha Sawardeker
- Department of Conservative Dentistry and Endodontics, King George's Medical University, Lucknow, Uttar Pradesh, India
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Regenerating the Pulp-Dentine Complex Using Autologous Platelet Concentrates: A Critical Appraisal of the Current Histological Evidence. Tissue Eng Regen Med 2020; 18:37-48. [PMID: 33150561 PMCID: PMC7862478 DOI: 10.1007/s13770-020-00291-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/06/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Autologous platelet concentrates such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) have gained overwhelming popularity in regenerative endodontics. Clinical evidence reveals the lack of a particular advantage of using PRP or PRF over an evoked blood clot in promoting canal wall thickening and/or continued root development in immature necrotic teeth. Moreover, despite stimulating tissue repair and repopulating the root canals of immature and mature permanent teeth, the new vital tissue may not possess the functional activity of the native pulp tissue. Methods: To better understand the origin, nature, and long-term fate of the tissue types found within the pulp space, we critically examine all available histo-/morphological evidence for pulp–dentine complex regeneration using PRP and/or PRF, alone or together with an evoked blood clot, specialised or unspecialised primary cells, and other biomaterials. Results: Histological data from clinical studies is scant. Reportedly, the inner dentinal surface supports cementum-like tissue formation, but this interface likely deviates in structure and function from the native cementodentinal junction. Presence of bone-like tissue within the pulp space is intriguing since de novo osteogenesis requires closely coordinated recruitment and differentiation of osteoprogenitor cells. Compared to untreated necrotic teeth, an evoked blood clot (with/without PRF) improves fracture resistance. Tooth regeneration using PRF and dental bud cells is unreliable and the constituent neoformed tissues are poorly organised. Conclusion: PRP/PRF fail to demonstrate a significant advantage over an induced blood clot, alone. The true nature of neoformed tissues remains poorly characterised while their response to subsequent insult/injury is unexplored.
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Jiang X, Liu H. An uncommon type of segmental root development after revitalization. Int Endod J 2020; 53:1728-1741. [PMID: 32781478 DOI: 10.1111/iej.13387] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 01/09/2023]
Abstract
AIM To describe four cases of an uncommon type of segmental root development after endodontic revitalization procedures. The formation, development and prognosis of this phenomenon are discussed, along with the causes and preventive measures. SUMMARY This report describes one immature maxillary anterior tooth with an extensive periapical lesion after partial extrusion caused by trauma and three immature mandibular premolars with extensive periapical lesions after fracture of the dens evaginatus. All four teeth underwent revitalization procedures. During follow-up, an uncommon type of segmental root development was observed in each case, where the apical segment appeared to detach from the body of the root and developed separately. In all cases, the detached apical root segments continued to develop with a shape and structure similar to that of a normal root tip. However, further development of the root body did not appear to occur. The follow-up times of the present cases were 11, 60, 41 and 67 months, respectively. All four teeth remain intact and functioned normally without symptoms. Cases 2 and 3 displayed positive reactions to electrical pulp tests during follow-up. KEY LEARNING POINTS Trauma and extensive periapical inflammation may result in the detachment of Hertwig's epithelial root sheath (HERS) and apical papilla from the root, thus creating a separate apical root segment. Formation of an apical root segment could be regarded as evidence of displacement of the HERS and apical papilla. Once this occurs, there is no chance that the main root of the tooth will develop into a normal-sized root. This type of segmental root development is always possible. If the teeth have suffered from severe trauma or have long-term and large periapical lesions before revitalization, the possibility of segmental root development should be considered. During the process of revitalization, intracanal bleeding is induced by rotating a pre-curved K-file 2 mm past the apical foramen. This procedure should be done gently to protect the apical structures and avoid iatrogenic factors that could lead to abnormal root development.
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Affiliation(s)
- X Jiang
- Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - H Liu
- Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
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Ayoub S, Cheayto A, Bassam S, Najar M, Berbéri A, Fayyad-Kazan M. The Effects of Intracanal Irrigants and Medicaments on Dental-Derived Stem Cells Fate in Regenerative Endodontics: An update. Stem Cell Rev Rep 2020; 16:650-660. [PMID: 32394343 DOI: 10.1007/s12015-020-09982-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Regenerative endodontics is a biologically based treatment designed for immature permanent teeth with necrotic pulp to replace dentin and root structures, as well as dental pulp cells. This procedure has become a part of novel modality in endodontics therapeutic manner, and it is considered as an alternative to apexification. In the last decade, numerous case reports, which describe this procedure, have been published. This therapeutic approach succeeded due to its lower financial cost and ease of performance. Although the clinical protocol of this procedure is not standardized and the effects of irrigants and medicaments on dental stem cells fate remain somewhat ambiguous, however when successful, it is an improvement of endodontics treatment protocols which leads to continued root development, increased dentinal wall thickness, and apical closure of immature teeth. To ensure a successful regenerative procedure, it is essential to investigate the appropriate disinfection protocols and the use of biocompatible molecules in order to control the release of growth factors and the differentiation of stem cells. This is the first review in the literature to summarize the present knowledge regarding the effect of intracanal irrigants and medicaments on the dental derived stem cells fate in regenerative endodontic procedures.
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Affiliation(s)
- Sara Ayoub
- Department of Prosthodontics, Faculty of Dental Medicine, Lebanese University, Hadath, Beirut, Lebanon
| | - Ali Cheayto
- Department of Restorative Dentistry and Endodontics, Faculty of Dental Medicine, Lebanese University, Hadath, Beirut, Lebanon
| | - Sanaa Bassam
- Department of Restorative Dentistry and Endodontics, Faculty of Dental Medicine, Lebanese University, Hadath, Beirut, Lebanon
| | - Mehdi Najar
- Genetics and Immune Cell Therapy Unit, Faculty of Sciences, University Mohammed Premier, Oujda, Morocco.,Osteoarthritis Research Unit, Department of Medicine, Research Center (CRCHUM), University of Montreal Hospital, University of Montreal, Montreal, QC, Canada
| | - Antoine Berbéri
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Lebanese University, Hadath, Beirut, Lebanon
| | - Mohammad Fayyad-Kazan
- Laboratory of Cancer biology and Molecular Immunology, Faculty of Sciences-I, Lebanese University, Hadath, Beirut, Lebanon. .,Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon.
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Doni, Mulyawati E, Santosa P, Nugraheni T. Revascularization of nonvital immature incisor with asymptomatic apical periodontitis. SCIENTIFIC DENTAL JOURNAL 2020. [DOI: 10.4103/sdj.sdj_25_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Wattanapakkavong K, Srisuwan T. Release of Transforming Growth Factor Beta 1 from Human Tooth Dentin after Application of Either ProRoot MTA or Biodentine as a Coronal Barrier. J Endod 2019; 45:701-705. [DOI: 10.1016/j.joen.2019.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/08/2019] [Accepted: 03/16/2019] [Indexed: 12/28/2022]
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17
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Bracks IV, Espaladori MC, Barros P, de Brito LCN, Vieira LQ, Ribeiro Sobrinho AP. Effect of ethylenediaminetetraacetic acid irrigation on immune-inflammatory response in teeth submitted to regenerative endodontic therapy. Int Endod J 2019; 52:1457-1465. [PMID: 31046128 DOI: 10.1111/iej.13136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 04/29/2019] [Indexed: 12/28/2022]
Abstract
AIM To analyse longitudinally the immune-inflammatory response in teeth of mice that underwent a regenerative protocol with or without the use of ethylenediaminetetraacetic acid (EDTA) to irrigate the root canal system. METHODOLOGY First maxillary molars of mice were devitalized using size 10 and 15 files. Teeth were divided into the following groups: Empty - the canals were left empty; Blood Clot (BC) - the canals were filled with a blood clot; and EDTA + Blood - the canals were irrigated with 0.06 mL of 17% EDTA for 1 min and filled with a blood clot. Access cavities were restored with Coltosol® . Animals were sacrificed at 7, 14 or 21 days after the operative procedures, and teeth were collected. RNA was extracted, mRNA expression of the cytokines IGF, NGF, IL-1α, IL-10, TGF and VEGF was assessed using real-time PCR, and the anova Kruskal-Wallis test was used. RESULTS IL-1 mRNA expression was significantly higher in the EDTA + BC group than in the Empty and BC groups at the 7th and 14th days of evaluation (P < 0.05). IL-10 mRNA expression was similar across the three groups at all time periods. TGF-β mRNA expression in the EDTA + BC group was significantly higher on the 7th and 21st days than on the 14th (P < 0.05); at day 21, TGF-β mRNA expression was similar between the BC and EDTA + BC groups but significantly higher than in the Empty group (P < 0.05). IGF mRNA expression was significantly higher in the EDTA + BC group than in the other groups at all time periods. VEGF mRNA expression remained unchanged throughout the experimental period in all groups (P > 0.05). NGF mRNA expression was similar amongst all groups at the 7th and 21st days (P > 0.05). At the 14th day, however, there was a significant increase in NGF mRNA expression in the EDTA + Blood group (P < 0.05) when compared with the expression in the other groups. CONCLUSION EDTA promoted increased expression of factors that have the potential to improve the outcome of regenerative endodontic treatment.
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Affiliation(s)
- I V Bracks
- Department of Operative Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - M C Espaladori
- Department of Operative Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - P Barros
- Department of Biochemistry and Immunology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - L C N de Brito
- Department of Endodontics, School of Dentistry, Itaúna University, Itaúna, MG, Brazil
| | - L Q Vieira
- Department of Biochemistry and Immunology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - A P Ribeiro Sobrinho
- Department of Operative Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
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Regenerative Endodontics: A Systematic Analysis of the Failed Cases. J Endod 2019; 45:567-577. [DOI: 10.1016/j.joen.2019.02.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/24/2019] [Accepted: 02/01/2019] [Indexed: 01/04/2023]
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19
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Ulusoy AT, Turedi I, Cimen M, Cehreli ZC. Evaluation of Blood Clot, Platelet-rich Plasma, Platelet-rich Fibrin, and Platelet Pellet as Scaffolds in Regenerative Endodontic Treatment: A Prospective Randomized Trial. J Endod 2019; 45:560-566. [PMID: 30935618 DOI: 10.1016/j.joen.2019.02.002] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 01/28/2019] [Accepted: 02/01/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Regenerative endodontic procedures (REPs) using autologous platelet concentrates as scaffolds can improve the biologic outcome of treatment. This prospective, randomized trial compared the clinical and radiographic performance of REPs using platelet-rich plasma (PRP), platelet-rich fibrin (PRF), a platelet pellet (PP), and an induced blot clot (BC). METHODS Sixty-seven healthy children (aged 8-11 years) with 88 immature necrotic incisors were included. After the root canal disinfection step, the teeth were randomly assigned into 1 of the following groups (n = 22/group) according to the scaffold used: PRP, PRF, PP, and BC. In the PRP, PRF, and PP groups, the platelet concentrates were introduced into the root canal without prior induction of apical bleeding. Treatment outcomes were assessed using a combined clinical and radiographic scoring system, whereas the changes in root dimensions were compared using linear measurements of root length and width with ImageJ (National Institutes of Health, Bethesda, MD) and Turboreg (Biomedical Imaging Group, Swiss Federal Institute of Technology, Lausanne, Switzerland) and planar measurements using the radiographic root area (RRA) and radiographic canal area (RCA) techniques. One-way analysis of variance, the Duncan multiple range test, the Kruskal-Wallis test, the Mann-Whitney U test, and chi-square dependency tests were used for statistical analysis of data (all P = .05). RESULTS Except for 2 teeth in the PRF and BC groups, all teeth showed similar and high success scores (periapical healing, radiographic root development, and positive response to sensitivity tests) after an average follow-up time of 28.25 ± 1.2 months. Of all teeth, 73.9% showed complete apical closure with similar closure rates among groups (P > .05) and a greater tendency for conical-shaped apical closure than a blunt apex. Although linear measurements indicated a similar increase in root length and width among all groups (P > .05), the RRA of the BC group was significantly greater than those of the PRF and PP groups, and the RCA of the BC group was significantly greater than PRP, PRF, and PP (all P < .05) when the follow-up time was not used as a factor. Eighty-six percent of the teeth showed a positive response to sensitivity tests with similar initial response times (P > .05). CONCLUSIONS PRP, PRF, and PP can yield similar clinical and radiographic outcomes to BC without the need for prior apical bleeding and with significantly less tendency for root canal obliteration. RRA and RCA may reveal minor differences that cannot be determined by linear measurements.
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Affiliation(s)
- Ayca Tuba Ulusoy
- Department of Pediatric Dentistry, Ondokuz Mayis Univesity, Faculty of Dentistry, Samsun, Turkey.
| | - Irem Turedi
- Rize Oral and Dental Health Center, Rize, Turkey
| | - Muge Cimen
- Department of Pediatric Dentistry, Istanbul Okan University, Faculty of Dentistry, Istanbul, Turkey
| | - Zafer C Cehreli
- Department of Pediatric Dentistry, Hacettepe Univesity, Faculty of Dentistry, Ankara, Turkey; Department of Pediatric Dentistry, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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Regenerative Endodontic Procedures Using Contemporary Endodontic Materials. MATERIALS 2019; 12:ma12060908. [PMID: 30893790 PMCID: PMC6471897 DOI: 10.3390/ma12060908] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 02/28/2019] [Accepted: 03/13/2019] [Indexed: 12/12/2022]
Abstract
Calcium hydroxide apexification and Mineral Trioxide Aggregate (MTA) apexification are classical treatments for necrotic immature permanent teeth. The first tend to fail for lack of compliance given the high number of sessions needed; the second has technical difficulties such as material manipulation and overfilling. With both techniques, the root development is interrupted leaving the tooth with a fragile root structure, a poor crown-to-root ratio, periodontal breakdown, and high risk of fracture, compromising long-term prognosis of the tooth. New scientific literature has described a procedure that allows complete root development of these specific teeth. This regenerative endodontic procedure (REP) proposes the use of a combination of antimicrobials and irrigants, no canal walls instrumentation, induced apical bleeding to form a blood clot and a tight seal into the root canal to promote healing. MTA is the most used material to perform this seal, but updated guidelines advise the use of other bioactive endodontic cements that incorporate calcium and silicate in their compositions. They share most of their characteristics with MTA but claim to have fewer drawbacks with regards to manipulation and aesthetics. The purpose of the present article is to review pertinent literature and to describe the clinical procedures protocol with its variations, and their clinical application.
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Orti V, Collart-Dutilleul PY, Piglionico S, Pall O, Cuisinier F, Panayotov I. Pulp Regeneration Concepts for Nonvital Teeth: From Tissue Engineering to Clinical Approaches. TISSUE ENGINEERING. PART B, REVIEWS 2018; 24:419-442. [PMID: 29724156 DOI: 10.1089/ten.teb.2018.0073] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Following the basis of tissue engineering (Cells-Scaffold-Bioactive molecules), regenerative endodontic has emerged as a new concept of dental treatment. Clinical procedures have been proposed by endodontic practitioners willing to promote regenerative therapy. Preserving pulp vitality was a first approach. Later procedures aimed to regenerate a vascularized pulp in necrotic root canals. However, there is still no protocol allowing an effective regeneration of necrotic pulp tissue either in immature or mature teeth. This review explores in vitro and preclinical concepts developed during the last decade, especially the potential use of stem cells, bioactive molecules, and scaffolds, and makes a comparison with the goals achieved so far in clinical practice. Regeneration of pulp-like tissue has been shown in various experimental conditions. However, the appropriate techniques are currently in a developmental stage. The ideal combination of scaffolds and growth factors to obtain a complete regeneration of the pulp-dentin complex is still unknown. The use of stem cells, especially from pulp origin, sounds promising for pulp regeneration therapy, but it has not been applied so far for clinical endodontics, in case of necrotic teeth. The gap observed between the hope raised from in vitro experiments and the reality of endodontic treatments suggests that clinical success may be achieved without external stem cell application. Therefore, procedures using the concept of cell homing, through evoked bleeding that permit to recreate a living tissue that mimics the original pulp has been proposed. Perspectives for pulp tissue engineering in the near future include a better control of clinical parameters and pragmatic approach of the experimental results (autologous stem cells from cell homing, controlled release of growth factors). In the coming years, this therapeutic strategy will probably become a clinical reality, even for mature necrotic teeth.
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Affiliation(s)
- Valérie Orti
- LBN, Université de Montpellier , Montpellier, France
| | | | | | - Orsolya Pall
- LBN, Université de Montpellier , Montpellier, France
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Oktay EA, Ersahan S, Gokyay S. Effect of intracanal medicaments used in endodontic regeneration on the push-out bond strength of a calcium-phosphate-silicate-based cement to dentin. Pak J Med Sci 2018; 34:310-315. [PMID: 29805399 PMCID: PMC5954370 DOI: 10.12669/pjms.342.14630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objective: To evaluate the effects of various endodontic regeneration agents on the push-out bond strength of Endosequence Root Repair Material (ERRM) to root-canal dentin. Methods: Fifty single-rooted human teeth were selected and instrumented to obtain a standard internal diameter of 1.5 mm. Specimens were randomly divided into four experimental groups and treated with an intracanal medicament [calcium hydroxide (CH), double antibiotic paste (DAP), triple antibiotic paste (TAP), TAP with amoxicillin (mTAP)] and a non-treated control group. Medicaments were removed after three weeks, and ERRM was applied to all specimens. The coronal portion of each root was then sliced into 2-mm-thick parallel transverse sections (2 slices per tooth, n=20 slices per group), and a push-out test was used to measure the bond strength of ERRM to dentin. Data were analyzed using Bonferroni-corrected Mann-Whitney tests, with the level of significance set at p<0.05. Results: The push-out bond strength of the CH group was significantly higher than that of the TAP, DAP and mTAP groups (p< 0.005). Furthermore, the bond strength of the control group was higher than the bond strength of both the DAP and mTAP groups. Conclusion: The use of CH in clinical practice may help improve the adhesion of ERRM to dentin.
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Affiliation(s)
- Elif Aybala Oktay
- Elif Aybala Oktay, Department of Restorative Dentistry, Faculty of Dentistry, Health Sciences University, Ankara, Turkey
| | - Seyda Ersahan
- Seyda Ersahan, Department of Endodontics, Faculty of Dentistry, Medipol University, Istanbul, Turkey
| | - Selcuk Gokyay
- Selcuk Gokyay, Department of Endodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
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Lee JY, Kersten DD, Mines P, Beltran TA. Regenerative Endodontic Procedures among Endodontists: A Web-based Survey. J Endod 2017; 44:250-255. [PMID: 29229459 DOI: 10.1016/j.joen.2017.09.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 09/10/2017] [Accepted: 09/22/2017] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The protocols that endodontists implement for regenerative endodontic procedures (REPs) are unknown. The aim of this study was to examine current REP protocols among practicing endodontists in the United States. METHODS A Web-based survey was sent to 4060 active members of the American Association of Endodontists (AAE). A total of 850 participants completed the survey, representing a 20.9% response rate. RESULTS Responses indicated 60% reported having performed REPs; most performed 1 to 3 per year. The most commonly selected source (60.8%) for the clinical protocol was the "AAE Clinical Considerations for a Regenerative Procedure." Time constraints were the most common reason why 92.4% of respondents did not report their REP cases to the AAE.org database; additionally, 15.5% were unaware of it. Almost half (49.8%) of the participants reported they would attempt an REP on a patient of any age. The most commonly used irrigants were >3% sodium hypochlorite at the first appointment and EDTA at the scaffold formation appointment. As the intracanal medicament, 52.2% used calcium hydroxide, whereas 23.5% used triple antibiotic paste. At the scaffold formation appointment, 77.1% used a local anesthetic without a vasoconstrictor, and 94.3% used a blood clot as the scaffold. Mineral trioxide aggregate was the coronal barrier most often selected. Considering factors most likely to encourage the use of REPs in the future, 79.8% reported the availability of good candidates followed by 40.1% who desired better evidence. CONCLUSIONS Based on the results of this survey, REP protocols appear to be heterogeneous and do not strictly conform to the "AAE Clinical Considerations for a Regenerative Procedure."
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Affiliation(s)
- Jonathan Y Lee
- United States Army Endodontic Residency Program, Fort Bragg, North Carolina; Uniformed Services University of the Health Sciences, Bethesda, Maryland.
| | - Daniel D Kersten
- United States Army Endodontic Residency Program, Fort Bragg, North Carolina; Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Pete Mines
- United States Army Endodontic Residency Program, Fort Bragg, North Carolina; Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Thomas A Beltran
- Department of Clinical Investigation, Womack Army Medical Center, Fort Bragg, North Carolina
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Lin LM, Kahler B. A review of regenerative endodontics: current protocols and future directions. J Istanb Univ Fac Dent 2017; 51:S41-S51. [PMID: 29354308 PMCID: PMC5750827 DOI: 10.17096/jiufd.53911] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 10/10/2017] [Indexed: 12/15/2022] Open
Abstract
This review outlines the biological basis and clinical
protocols currently used in regenerative endodontic
procedures (REPs) and discuss future directions in pulp
regeneration approaches. The treatment of immature teeth
with REPs has been described as a ‘paradigm shift’ as
there is the potential for further root maturation. Clinically,
REPs involve disinfection of the root canal system without
damaging the endogenous stem cell potential present in
the apical papilla and other tissues. These stems cells are
introduced into the root canal space by inducing a blood
clot followed by placement of an intracanal barrier to
prevent microleakage. The biological concept of REPs
involves the triad of stem cells, scaffold and signalling
molecules. Currently, repair rather than true regeneration
of the ‘pulp-dentine complex’ is achieved and further root
maturation is variable. However, may clinicians consider
the treatment of teeth with REPs as the optimal treatment
approach for immature teeth with pulp necrosis.
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Affiliation(s)
- Louis M Lin
- Department of Endodontics New York University College of Dentistry 345 East 24th Street New York, NY 10010 USA
| | - Bill Kahler
- School of Dentistry The University of Queensland Oral Health Centre 288 Herston Road, Corner Bramston Terrace and Herston Road Herston QLD 4006 Australia
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Radiographic, Histologic, and Biomechanical Evaluation of Combined Application of Platelet-rich Fibrin with Blood Clot in Regenerative Endodontics. J Endod 2017; 43:2034-2040. [DOI: 10.1016/j.joen.2017.07.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 07/27/2017] [Accepted: 07/28/2017] [Indexed: 11/19/2022]
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Timmerman A, Parashos P. Bleaching of a Discolored Tooth with Retrieval of Remnants after Successful Regenerative Endodontics. J Endod 2017; 44:93-97. [PMID: 29079055 DOI: 10.1016/j.joen.2017.08.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 07/31/2017] [Accepted: 08/30/2017] [Indexed: 01/29/2023]
Abstract
INTRODUCTION This report presents the retrieval of remnants from a discolored mandibular right second premolar (tooth #29) of a 17-year-old female after a successful regenerative endodontic procedure (REP). METHODS The REP was performed in October 2011. Coronal discoloration became of great concern to the patient at a review visit in 2016. A cone-beam computed tomographic scan was taken to investigate the formation of hard tissues within the root canal as well as a region of no calcified tissue formation. During internal bleaching of tooth #29, a black material with particulate inclusions was retrieved and examined histopathologically. RESULTS Five years after the REP, there was complete periapical healing, hard tissue formation within the root canal, and complete maturation of the root apex. A hard tissue bridge was noted at the cementoenamel junction when the pulp chamber of #29 was reaccessed. The remnants retrieved from the pulp chamber were confirmed to be partly mineral trioxide aggregate (MTA). A normal tooth color was achieved after 3 weeks of internal bleaching. CONCLUSIONS MTA remnants within the pulp chamber contributed to the tooth discoloration and appear to have obstructed hard tissue formation. A matrix of oxidized regenerated cellulose seems not to hinder tissue regeneration and is resorbed by these tissues. Other materials with color stability should be selected as coronal barriers for REPs to avoid a potential adverse effect of the MTA on the REP outcome and discoloration.
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Affiliation(s)
- Aovana Timmerman
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Parashos
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia.
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Nicoloso GF, Pötter IG, Rocha RDO, Montagner F, Casagrande L. A comparative evaluation of endodontic treatments for immature necrotic permanent teeth based on clinical and radiographic outcomes: a systematic review and meta-analysis. Int J Paediatr Dent 2017; 27:217-227. [PMID: 27529749 DOI: 10.1111/ipd.12261] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Dental trauma and deep caries are frequent findings in children and adolescents that may lead to pulp necrosis in young permanent teeth. As a consequence, the root stops its development, and managing these immature teeth becomes challenging due to the presence of open apexes and fragile dentinal walls. AIM We aimed to carry out a systematic review including a meta-analysis to compare the endodontic treatments available in the management of immature necrotic permanent teeth and determine which one provides the best clinical and radiographic outcomes. DESIGN The literature was screened via PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials databases until August 2015 to select randomized clinical trials that compared at least two different treatments regarding immature necrotic permanent teeth comprising clinical and radiographic success as outcome. Two reviewers independently performed the screening and evaluation of the articles. A total of 648 studies were retrieved from the databases, in which only 14 were selected to full-text analysis by the appliance of inclusion criteria. After the exclusion criteria, the remaining seven studies had their data extracted and assessed for bias risk. Pooled-effect estimates were obtained comparing clinical and radiographic success rates among MTA Versus other treatments. RESULTS Evaluation of clinical (Z = 2.32, P = 0.02, OR = 5.37, 95% CI: 1.29-22.23, I = 0%) and radiographic (Z = 2.45, P = 0.01, OR = 4.31, 95% CI: 1.34-13.82, I = 0%) outcomes favored the MTA (control group) when compared to other endodontic treatments (P < 0.05). No evidence of heterogeneity was detected among the studies (I < 50%), whereas a moderate risk of bias was identified in five of them. CONCLUSIONS Although almost all of the identified studies presented moderate risk of bias, MTA apexification seems to produce overall better clinical and radiographic success rates among the endodontic treatment available in immature necrotic permanent teeth.
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Affiliation(s)
- Gabriel Ferreira Nicoloso
- Specialist in Pediatric Dentistry, Federal University of Rio Grande do Sul - UFRGS, Porto Alegre, RS, Brazil
| | - Isabel Garcia Pötter
- Specialist in Pediatric Dentistry, Federal University of Rio Grande do Sul - UFRGS, Porto Alegre, RS, Brazil
| | | | - Francisco Montagner
- Department of Conservative Dentistry, Federal University of Rio Grande do Sul - UFRGS, Porto Alegre, RS, Brazil
| | - Luciano Casagrande
- Department of Surgery and Orthopedics, Federal University of Rio Grande do Sul - UFRGS, Porto Alegre, RS, Brazil
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Deniz Sungur D, Aksel H, Purali N. Effect of a Low Surface Tension Vehicle on the Dentinal Tubule Penetration of Calcium Hydroxide and Triple Antibiotic Paste. J Endod 2017; 43:452-455. [DOI: 10.1016/j.joen.2016.10.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/09/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
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Timmerman A, Parashos P. Delayed Root Development by Displaced Mineral Trioxide Aggregate after Regenerative Endodontics: A Case Report. J Endod 2017; 43:252-256. [DOI: 10.1016/j.joen.2016.10.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 09/29/2016] [Accepted: 10/10/2016] [Indexed: 02/05/2023]
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Abstract
The primary goal of conventional endodontic treatment is prevention and/or elimination of apical periodontitis for both mature permanent teeth and immature teeth with an open apex. Besides these goals, the objectives of endodontic treatment of immature teeth include preservation of pulp vitality and often further root maturation. Robust criteria for outcome assessment are an essential determinant for any measure of treatment success for both mature and immature teeth.
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Affiliation(s)
- Nadia Chugal
- Section of Endodontics, UCLA School of Dentistry, CHS A3-075, 10833 Le Conte Avenue, Los Angeles, CA 90095-1668, USA.
| | - Sanjay M Mallya
- Section of Oral and Maxillofacial Radiology, UCLA School of Dentistry, CHS 53-068B, Los Angeles, CA 90095-1668, USA
| | - Bill Kahler
- School of Dentistry, The University of Queensland Oral Health Centre, 288 Herston Road, Corner Bramston Terrace & Herston Road, Herston, Queensland 4006, Australia
| | - Louis M Lin
- Department of Endodontics, New York University College of Dentistry, 345 East 24th Street, New York, NY 10010, USA
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Alagl A, Bedi S, Hassan K, AlHumaid J. Use of platelet-rich plasma for regeneration in non-vital immature permanent teeth: Clinical and cone-beam computed tomography evaluation. J Int Med Res 2017; 45:583-593. [PMID: 28415948 PMCID: PMC5536665 DOI: 10.1177/0300060517692935] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective This study was performed to assess the clinical and radiological outcomes of a revascularization procedure in immature teeth with apical periodontitis using platelet-rich plasma (PRP). The PRP protocol and conventional revascularization protocol, which used a blood clot as the scaffold, were compared. Methods Thirty non-vital immature permanent teeth were randomly categorized into two groups. After disinfecting the root canal space with triple antibiotic paste (1:1:1 ciprofloxacin, metronidazole, and cefaclor), a tissue scaffold was created using either PRP or a blood clot (control) and covered with white mineral trioxide aggregate. All cases were followed up clinically and radiographically for 12 months. Differences in bone density, root length, and lesion size were calculated using preoperative and postoperative computed tomography images. The means of the differences in individual parameters in the blood clot and PRP groups were compared using the Mann–Whitney U test. Results After 5 months, sensitivity tests (cold and electric pulp tests) elicited a delayed positive response in 23 sites. At 12 months, cone-beam computed tomography revealed resolution or a decrease in lesion size and an increase in bone density in all 30 (100%) teeth. Additionally, continued root development was observed in 22 (73%) teeth and early root growth was observed in the test group (mineral trioxide aggregate with PRP). Conclusions The results of this study suggest that PRP can serve as a successful scaffold for regenerative endodontic treatment. With the exception of a significant increase in root length, the results of treatment with PRP were not significantly different from those of the conventional protocol using a blood clot as the scaffold.
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Affiliation(s)
- Adel Alagl
- 1 Division of Periodontics, Department of Preventive Dental Sciences, College of Dentistry, University of Dammam, Dammam, Saudi Arabia
| | - Sumit Bedi
- 2 Division of Paediatric Dentistry, Department of Preventive Dental Sciences, College of Dentistry, University of Dammam, Dammam, Saudi Arabia
| | - Khalid Hassan
- 1 Division of Periodontics, Department of Preventive Dental Sciences, College of Dentistry, University of Dammam, Dammam, Saudi Arabia
| | - Jehan AlHumaid
- 2 Division of Paediatric Dentistry, Department of Preventive Dental Sciences, College of Dentistry, University of Dammam, Dammam, Saudi Arabia
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Saghiri MA, Asatourian A, Garcia-Godoy F, Sheibani N. Effect of biomaterials on angiogenesis during vital pulp therapy. Dent Mater J 2016; 35:701-709. [PMID: 27546854 DOI: 10.4012/dmj.2015-332] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This review intended to provide an overview of the effects of dental materials, used in dentin-pulp complex and dental pulp regeneration, on angiogenesis processes during regenerative endodontic procedures. An electronic search was performed in PubMed and MEDLINE databases via OVID using the keywords mentioned in the PubMed and MeSH headings for English language published articles from January 2005-April 2014 that evaluated the angiogenic properties of different dental materials used in regenerative endodontic procedures. Of the articles identified in an initial search, only 40 articles met the inclusion criteria set for this review. Vital pulp therapy materials might have positive effects on angiogenesis events, while most of the canal irrigating solutions and antibiotic pastes have anti-angiogenic activity except for EDTA. Future clinical studies will be helpful in defining the mechanisms of action for dental materials that promote or inhibit angiogenesis events at applied areas.
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Affiliation(s)
- Mohammad Ali Saghiri
- Departments of Ophthalmology and Visual Science and Biomedical Engineering, University of Wisconsin, School of Medicine and Public Health
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Lolato A, Bucchi C, Taschieri S, Kabbaney AE, Fabbro MD. Platelet concentrates for revitalization of immature necrotic teeth: a systematic review of the clinical studies. Platelets 2016; 27:383-92. [DOI: 10.3109/09537104.2015.1131255] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Alessandra Lolato
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milano, Italia
- IRCCS Istituto Ortopedico Galeazzi, Università degli Studi di Milano, Milano, Italia
| | - Cristina Bucchi
- Facultad de Odontología, CICO Research Center, Universidad de La Frontera, Temuco, Chile
| | - Silvio Taschieri
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milano, Italia
- IRCCS Istituto Ortopedico Galeazzi, Università degli Studi di Milano, Milano, Italia
| | - Ahmed El Kabbaney
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milano, Italia
- Conservative Dentistry and Endodontic Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Massimo Del Fabbro
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milano, Italia
- IRCCS Istituto Ortopedico Galeazzi, Università degli Studi di Milano, Milano, Italia
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Bezgin T, Sönmez H. Review of current concepts of revascularization/revitalization. Dent Traumatol 2015; 31:267-73. [DOI: 10.1111/edt.12177] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2015] [Indexed: 01/31/2023]
Affiliation(s)
- Tuğba Bezgin
- Faculty of Dentistry; Department of Pediatric Dentistry; Ankara University; Ankara Turkey
| | - Hayriye Sönmez
- Faculty of Dentistry; Department of Pediatric Dentistry; Ankara University; Ankara Turkey
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Dudeja PG, Grover S, Srivastava D, Dudeja KK, Sharma V. Pulp Revascularization- It's your Future Whether you Know it or Not? J Clin Diagn Res 2015; 9:ZR01-4. [PMID: 26023665 DOI: 10.7860/jcdr/2015/10149.5768] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 09/18/2014] [Indexed: 01/09/2023]
Abstract
Pulpal regeneration after tooth injury is not easy to accomplish. In teeth with immature apices and exposed vital pulp tissue, partial or complete pulpotomy is indicated to preserve pulpal function and allow continued root development. In many cases, injury causes loss of pulp vitality and arrested root development leading to a tooth with poor crown root ratio, a root with very thin walls, an open blunderbuss apex and development of apical pathosis. The ideal treatment in such cases would be to obtain further root development and thickening of dentinal walls by stimulating the regeneration of a functional pulp dentin complex. This outcome has been observed after reimplantation in avulsed immature permanent teeth but has been thought impossible in a necrotic infected tooth. This case series evaluates the efficacy of revascularization procedure in immature, non vital permanent teeth. Pulp regeneration was attempted in four patients at Department of Conservative Dentistry, ESIC Dental College, New Delhi using blood clotting approach. The cases were treated and followed up regularly at regular intervals ranging from 6 months to 3 years to assess the treatment response clinically and radiographically. The patients remained clinically asymptomatic with three out of four patients even responding positively to pulp responsiveness tests. Radiographic examination also revealed increased root formation and thickening of dentinal walls. It was concluded that the triad of a disinfected canal, a matrix (blood clot) in to which new tissue could grow and an effective coronal seal produced the desirable environment for successful revascularization.
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Affiliation(s)
- Pooja Gupta Dudeja
- Associate Professor, Department of Conservative Dentistry, ESIC Dental College and Hospital , Sector 15, Rohini, Delhi, India
| | - Shibani Grover
- Professor and Head, Department of Conservative Dentistry, ESIC Dental College and Hospital , Sector 15, Rohini, Delhi, India
| | - Dhirendra Srivastava
- Professor and Dean, Department of Oral and Maxillofacial Surgery, ESIC Dental College and Hospital , Sector 15, Rohini, Delhi, India
| | - Krishan Kumar Dudeja
- Formerly Professor, Department of Prosthodontics, Krishna Dental College , Mohan Nagar, Ghaziabad India
| | - Vivek Sharma
- Assistant Professor, Department of Conservative Dentistry, ESIC Dental College and Hospital , Sector 15, Rohini, Delhi, India
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Nerness AZ, Ehrlich Y, Spolnik K, Platt JA, Yassen GH. Effect of triple antibiotic paste with or without ethylenediaminetetraacetic acid on surface loss and surface roughness of radicular dentine. Odontology 2015; 104:170-5. [DOI: 10.1007/s10266-014-0191-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 12/15/2014] [Indexed: 10/24/2022]
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Yassen GH, Eckert GJ, Platt JA. Effect of intracanal medicaments used in endodontic regeneration procedures on microhardness and chemical structure of dentin. Restor Dent Endod 2014; 40:104-12. [PMID: 25984471 PMCID: PMC4432252 DOI: 10.5395/rde.2015.40.2.104] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 11/03/2014] [Indexed: 11/18/2022] Open
Abstract
Objectives This study was performed to investigate the effects of different intracanal medicaments on chemical structure and microhardness of dentin. Materials and Methods Fifty human dentin discs were obtained from intact third molars and randomly assigned into two control groups and three treatment groups. The first control group received no treatment. The second control group (no medicament group) was irrigated with sodium hypochlorite (NaOCl), stored in humid environment for four weeks and then irrigated with ethylenediaminetetraacetic acid (EDTA). The three treatment groups were irrigated with NaOCl, treated for four weeks with either 1 g/mL triple antibiotic paste (TAP), 1 mg/mL methylcellulose-based triple antibiotic paste (DTAP), or calcium hydroxide [Ca(OH)2] and finally irrigated with EDTA. After treatment, one half of each dentin disc was subjected to Vickers microhardness (n = 10 per group) and the other half was used to evaluate the chemical structure (phosphate/amide I ratio) of treated dentin utilizing attenuated total reflection Fourier transform infrared spectroscopy (n = 5 per group). One-way ANOVA followed by Fisher's least significant difference were used for statistical analyses. Results Dentin discs treated with different intracanal medicaments and those treated with NaOCl + EDTA showed significant reduction in microhardness (p < 0.0001) and phosphate/amide I ratio (p < 0.05) compared to no treatment control dentin. Furthermore, dentin discs treated with TAP had significantly lower microhardness (p < 0.0001) and phosphate/amide I ratio (p < 0.0001) compared to all other groups. Conclusions The use of DTAP or Ca(OH)2 medicaments during endodontic regeneration may cause significantly less microhardness reduction and superficial demineralization of dentin compared to the use of TAP.
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Affiliation(s)
- Ghaeth Hamdon Yassen
- Department of Restorative Dentistry, Division of Dental Biomaterials, Indiana University School of Dentistry, Indianapolis, IN, USA
| | - George Joseph Eckert
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jeffrey Allen Platt
- Department of Restorative Dentistry, Division of Dental Biomaterials, Indiana University School of Dentistry, Indianapolis, IN, USA
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Kamocki K, Nör JE, Bottino MC. Dental pulp stem cell responses to novel antibiotic-containing scaffolds for regenerative endodontics. Int Endod J 2014; 48:1147-56. [PMID: 25425048 DOI: 10.1111/iej.12414] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 11/20/2014] [Indexed: 11/30/2022]
Abstract
AIM To evaluate both the drug-release profile and the effects on human dental pulp stem cells' (hDPSC) proliferation and viability of novel bi-mix antibiotic-containing scaffolds intended for use as a drug delivery system for root canal disinfection prior to regenerative endodontics. METHODOLOGY Polydioxanone (PDS)-based fibrous scaffolds containing both metronidazole (MET) and ciprofloxacin (CIP) at selected ratios were synthesized via electrospinning. Fibre diameter was evaluated based on scanning electron microscopy (SEM) images. Pure PDS scaffolds and a saturated CIP/MET solution (i.e. 50 mg of each antibiotic in 1 mL) (hereafter referred to as DAP) served as both negative (nontoxic) and positive (toxic) controls, respectively. High-performance liquid chromatography (HPLC) was performed to investigate the amount of drug(s) released from the scaffolds. WST-1(®) proliferation assay was used to evaluate the effect of the scaffolds on cell proliferation. LIVE/DEAD(®) assay was used to qualitatively assess cell viability. Data obtained from drug release and proliferation assays were statistically analysed at the 5% significance level. RESULTS A burst release of CIP and MET was noted within the first 24 h, followed by a sustained maintenance of the drug(s) concentration for 14 days. A concentration-dependent trend was noticed upon hDPSCs' exposure to all CIP-containing scaffolds, where increasing the CIP concentration resulted in reduced cell proliferation (P < 0.05) and viability. In groups exposed to pure MET or pure PDS scaffolds, no changes in proliferation were observed. CONCLUSIONS Synthesized antibiotic-containing scaffolds had significantly lower effects on hDPSCs proliferation when compared to the saturated CIP/MET solution (DAP).
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Affiliation(s)
- K Kamocki
- Department of Restorative Dentistry, Division of Dental Biomaterials, Indiana University School of Dentistry (IUSD), Indianapolis, IN, USA
| | - J E Nör
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - M C Bottino
- Department of Restorative Dentistry, Division of Dental Biomaterials, Indiana University School of Dentistry (IUSD), Indianapolis, IN, USA
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Bezgin T, Yilmaz AD, Celik BN, Kolsuz ME, Sonmez H. Efficacy of platelet-rich plasma as a scaffold in regenerative endodontic treatment. J Endod 2014; 41:36-44. [PMID: 25459571 DOI: 10.1016/j.joen.2014.10.004] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 09/21/2014] [Accepted: 10/07/2014] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Current research is concerned with discovering better scaffolds for use in regenerative endodontic treatment. This study aimed to clinically and radiographically evaluate the efficacy of platelet-rich plasma (PRP) used as a scaffold in regenerative endodontic treatment and compare it with that of a conventional blood clot (BC) scaffold. METHODS A total of 20 necrotic, single-rooted immature teeth were randomly distributed into 2 groups. After disinfecting the root canal space with triple antibiotic paste (1:1:1 ciprofloxacin, metronidazole, and cefaclor), a tissue scaffold was created by using either PRP or BC and covered with white mineral trioxide aggregate. Clinical and radiographic follow-up examinations were performed once every 3 months during an 18-month period. Differences in root area were calculated from preoperative and postoperative radiographs. Fisher exact and Mann-Whitney U tests were used to evaluate differences between groups, with P value <.05 considered to be statistically significant. RESULTS All 20 teeth were clinically asymptomatic during 18-month follow-up period; however, 1 tooth in the BC group exhibited periapical pathosis and was judged radiographically unsuccessful. Complete apical closure was observed in a mean of 8.1 months in the PRP group compared with 9 months in the BC group. The PRP group exhibited 9.86% increase in root area, compared with 12.6% increase in the BC group. The difference in success rates between the groups was not statistically significant (P > .05). CONCLUSIONS PRP successfully created a scaffold for regenerative endodontic treatment; however, treatment outcomes did not differ significantly between PRP and conventional BC scaffold.
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Affiliation(s)
- Tugba Bezgin
- Department of Pedodontics, Faculty of Dentistry, Ankara University, Ankara, Turkey.
| | - Ayca Dilara Yilmaz
- Molecular Biology Laboratory, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Burcu Nihan Celik
- Department of Pedodontics, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Mehmet Eray Kolsuz
- Department of Maxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Hayriye Sonmez
- Department of Pedodontics, Faculty of Dentistry, Ankara University, Ankara, Turkey
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40
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Management of 2 Teeth Diagnosed with Dens Invaginatus with Regenerative Endodontics and Apexification in the Same Patient: A Case Report and Review. J Endod 2014; 40:725-31. [DOI: 10.1016/j.joen.2013.10.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 10/06/2013] [Accepted: 10/18/2013] [Indexed: 12/15/2022]
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41
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Law AS. Considerations for regeneration procedures. J Endod 2014; 39:S44-56. [PMID: 23439044 DOI: 10.1016/j.joen.2012.11.019] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 10/20/2012] [Accepted: 11/06/2012] [Indexed: 01/09/2023]
Abstract
When pulp tissue becomes necrotic in immature teeth, the prognosis of the teeth is compromised. Disinfection of the root(s) presents several challenges including difficulties in cleaning and shaping large canals with open apices, obturation of canals with open apices, and potential root fractures caused by thin and/or weakened root walls. Regenerative endodontic procedures may increase the prognosis of the compromised immature tooth by re-establishment of a functional pulp tissue that fosters continued root development and immune competency. This article reviews the literature related to and discuss considerations for regenerative endodontic procedures and how these procedures may increase the prognosis for immature teeth with necrotic pulp tissue.
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Affiliation(s)
- Alan S Law
- The Dental Specialists, 8650 Hudson Boulevard, Lake Elmo, MN 55042, USA.
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Hargreaves KM, Diogenes A, Teixeira FB. Treatment options: biological basis of regenerative endodontic procedures. J Endod 2013; 39:S30-43. [PMID: 23439043 PMCID: PMC3589799 DOI: 10.1016/j.joen.2012.11.025] [Citation(s) in RCA: 199] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 11/12/2012] [Accepted: 11/12/2012] [Indexed: 12/14/2022]
Abstract
Dental trauma occurs frequently in children and often can lead to pulpal necrosis. The occurrence of pulpal necrosis in the permanent but immature tooth represents a challenging clinical situation because the thin and often short roots increase the risk of subsequent fracture. Current approaches for treating the traumatized immature tooth with pulpal necrosis do not reliably achieve the desired clinical outcomes, consisting of healing of apical periodontitis, promotion of continued root development, and restoration of the functional competence of pulpal tissue. An optimal approach for treating the immature permanent tooth with a necrotic pulp would be to regenerate functional pulpal tissue. This review summarizes the current literature supporting a biological rationale for considering regenerative endodontic treatment procedures in treating the immature permanent tooth with pulp necrosis.
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Affiliation(s)
- Kenneth M Hargreaves
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA.
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