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Widbiller M, Knüttel H, Meschi N, Durán-Sindreu Terol F. Effectiveness of endodontic tissue engineering in treatment of apical periodontitis: A systematic review. Int Endod J 2023; 56 Suppl 3:533-548. [PMID: 35699668 DOI: 10.1111/iej.13784] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Regenerative endodontics has evolved in recent years with tissue engineering concepts in particular appearing promising. Endodontic tissue engineering (ETE) describes the various approaches based on the orthograde introduction of scaffolds or biomaterials (with or without cells) into the root canal to achieve pulp tissue regeneration. There are currently no systematic reviews investigating whether ETE is a suitable method for the treatment of endodontic disease in both mature and immature permanent teeth. OBJECTIVES The purpose of this systematic review was to determine the effectiveness of ETE in permanent teeth with pulp necrosis in comparison with conventional endodontic treatment. METHODS We searched MEDLINE, Embase and the Cochrane Library for published reports as well as Google Scholar for grey literature up to November 2021. Included were studies of patients with permanent immature or mature teeth and pulp necrosis with or without signs of apical periodontitis (P) comparing ETE (I) with calcium hydroxide apexification, apical plug and root canal treatment (C) in terms of tooth survival, pain, tenderness, swelling, need for medication (analgesics and antibiotics), radiographic evidence of reduction in apical lesion size, radiographic evidence of normal periodontal ligament space, function (fracture and restoration longevity), the need for further intervention, adverse effects (including exacerbation, restoration integrity, allergy and discolouration), oral health-related quality of life (OHRQoL), presence of sinus tract and response to sensibility testing (O). An observation period of at least 12 months was mandatory (T) and the number of patients in human experimental studies or longitudinal observational studies had to be at least 20 (10 in each arm) at the end (S). Risk of bias was appraised using the Cochrane risk-of-bias (RoB 2) tool. Two authors independently screened the records, assessed full texts for eligibility and evaluated risk of bias. Heterogeneity of outcomes and limited body of evidence did not allow for meta-analysis. RESULTS Two randomized clinical trials investigating cell transplantation approaches with a total of 76 participants (40 treated immature teeth and 36 treated mature teeth) were included for qualitative analysis. Both studies had moderate concerns in terms of risk of bias. Due to the lack of homogeneity a meta-analysis was not possible. Tooth survival for ETE, root canal treatment and apexification was 100% after 12 months. Teeth treated with ETE showed a higher number of cases with positive pulpal responses to sensitivity tests and with blood perfusion compared with root canal treatment or apexification. DISCUSSION This systematic review highlights that there is limited evidence for ETE approaches. Even though the results of this review suggest a high survival with ETE in mature and immature teeth, there is a moderate risk of bias due to methodological limitations in the included studies, so the overall results should be interpreted with caution. Lack of a robust control group was a common problem during literature screening, and outcomes besides dental survival were reported inconsistently. Future clinical trials need to address methodical as well as assessment concerns and report long-term results. CONCLUSION The benefits and high survival rates reported for ETE techniques suggest that this procedure might be an alternative to conventional procedures for permanent teeth with pulpal necrosis. However, more appropriate studies are needed to derive clinical recommendations. REGISTRATION PROSPERO (CRD42021266350).
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Affiliation(s)
- Matthias Widbiller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
| | - Helge Knüttel
- University Library, University of Regensburg, Regensburg, Germany
| | - Nastaran Meschi
- Department of Oral Health Sciences, BIOMAT - Biomaterials Research Group, KU Leuven and Dentistry, University Hospitals Leuven, Leuven, Belgium
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Meschi N, Palma PJ, Cabanillas-Balsera D. Effectiveness of revitalization in treating apical periodontitis: A systematic review and meta-analysis. Int Endod J 2023; 56 Suppl 3:510-532. [PMID: 35579093 DOI: 10.1111/iej.13778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Revitalization procedures primarily aim to eliminate clinical symptoms and heal periapical lesions. OBJECTIVES The objective of the study was to elucidate the effectiveness of revitalization in treating apical periodontitis in necrotic mature and immature permanent teeth based on the following PICO question: In patients with permanent immature or mature teeth and pulp necrosis with or without signs of apical periodontitis (P) what is the effectiveness of revitalization (I) in comparison with calcium hydroxide apexification, apical plug and root canal treatment (C) in terms of tooth survival, pain, tenderness, swelling, need for medication (analgesics and antibiotics), radiographic evidence of reduction of apical lesion size, radiographic evidence of normal periodontal ligament space, radiographic evidence of increased root thickness and length (not for mature teeth), tooth function (fracture and restoration longevity), need for further intervention, adverse effects (including exacerbation, restoration integrity, allergy and discolouration), oral health-related quality of life (OHRQoL), presence of sinus tract and response to sensibility testing (O). (T) = Defined as a minimum of 1 year and maximum of as long as possible for all outcome measures, except 'pain, tenderness, swelling, need for medication (analgesics)', which is a minimum of 7 days and maximum of 3 months and OHRQoL which is minimum of 6 months and a maximum of as long as possible. METHODS Three databases (PubMed, Embase and Cochrane Library) were searched for human, experimental and observational studies in English, complemented with hand search, until 31/10/2021. Studies recruiting teeth with pulp necrosis (with/without apical periodontitis), with minimum 10 teeth/arm at the end of the study and with a follow-up of at least 1 year, were included. Records without an abstract and a full text were excluded. The qualitative analysis of the included (non-) randomized controlled clinical trials was performed with the Revised Cochrane risk-of-bias tools (RoB 2 and ROBINS-I). Meta-analysis for survival and success (including a subgroup analysis for mature/immature permanent teeth) was performed using the Mantel-Haenszel method. The certainty of evidence was assessed using GRADE (Grades of Recommendation, Assessment, Development and Evaluation). RESULTS From the 365 identified records, five met the inclusion criteria. The 12 months survival rate was 100% for all (im)mature permanent teeth in all groups (3 studies). The success rate at 12 months was 100% for immature permanent teeth for I and C (1 study), however, reduced to 92% and 80% for mature teeth in I and C respectively (1 study, p > .05). The risk of bias for the most critical outcome (survival) was high for two studies and low for one. For the critical outcome success, all assessed studies were highly biased. Meta-analyses provided pooled relative risk with no statistically significant difference between I and C for both survival (RR = 1.00, 95%CI = 0.96-1.04, p = 1.00) and success (RR = 1.06; 95%CI = 0.83-1.35, p = .66). The evidence level for survival was kept 'low' and for success was downgraded to 'very low' due to inconsistency and imprecision. DISCUSSION The survival and success rates were favourable in all included studies and for all groups; however, these outcomes are not reliable due to the low certainty level. Clinically, the most reported adverse event was tooth discolouration, hence the application of bismuth oxide containing calcium silicate cements should be avoided in revitalization. Radiographically, caution is needed when assessing periapical bone healing and further root development with periapical radiographs, due to multifactorial inaccuracies of this imaging technique. Methodological and assessment concerns need to be addressed in future clinical trials. Long-term results are necessary for studies reporting revitalization of mature permanent teeth, as they seem to be experimental so far. CONCLUSIONS No robust evidence was discovered to support that revitalization is effective to treat apical periodontitis in (im)mature permanent teeth. The success and survival rates of revitalized and fully pulpectomized (im)mature permanent teeth did not differ significantly. REGISTRATION Prospero: CRD42021262466.
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Affiliation(s)
- Nastaran Meschi
- Department of Oral Health Sciences, Endodontology, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Paulo J Palma
- Center for Innovation and Research in Oral Sciences (CIROS) I Institute of Endodontic, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Daniel Cabanillas-Balsera
- Department of Stomatology, Section of Endodontics, School of Dentistry, University of Seville, Seville, Spain
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EzEldeen M, Pedano De Piero MNS, Xu L, Driesen RB, Wyatt J, Van Gorp G, Meschi N, Van Meerbeek B, Lambrichts I, Jacobs R. Multimodal Imaging of Dental Pulp Healing Patterns following Tooth Autotransplantation And Regenerative Endodontic Treatment. J Endod 2023:S0099-2399(23)00324-2. [PMID: 37315781 DOI: 10.1016/j.joen.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Understanding the healing process of dental pulp after tooth autotransplantation (TAT) and regenerative endodontic treatment (RET) of immature teeth is important both clinically and scientifically. This study aimed to characterize the pattern of dental pulp healing in human teeth that underwent TAT and RET using state-of-the-art imaging techniques. MATERIALS AND METHODS This study examined four human teeth, two premolars that underwent TAT and two central incisors that received RET. The premolars were extracted after one year (case 1) and two years (case 2) due to ankylosis, while the central incisors were extracted after three years (cases 3 and 4) for orthodontic reasons. Nanofocus x-ray computed tomography was used to image the samples before being processed for histological and immunohistochemical analysis. Laser scanning confocal second harmonic generation imaging (SHG) was used to examine the patterns of collagen deposition. A maturity-matched premolar was included as a negative control for the histological and SHG analysis. RESULTS Analysis of the four cases revealed different patterns of dental pulp healing. Similarities were observed in the progressive obliteration of the root canal space. However, a striking loss of typical pulpal architecture was observed in the TAT cases, while a pulp-like tissue was observed in one of the RET cases. Odontoblast-like cells were observed in cases 1 and 3. CONCLUSION This study provided insights into the patterns of dental pulp healing after TAT and RET. The SHG imaging sheds light on the patterns of collagen deposition during reparative dentin formation.
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Affiliation(s)
- Mostafa EzEldeen
- OMFS IMPATH Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium; KU Leuven (University of Leuven), Department of Oral Health Sciences, KU Leuven and Paediatric Dentistry and Special Dental Care, University Hospitals Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium.
| | - Mariano N Simon Pedano De Piero
- KU Leuven (University of Leuven), Department of Oral Health Sciences, Endodontology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Lianyi Xu
- OMFS IMPATH Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium; Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Ronald B Driesen
- Biomedical Research Institute, Hasselt University, Campus Diepenbeek, Agoralaan Building C, B-3590 Diepenbeek, Belgium
| | - Jan Wyatt
- KU Leuven (University of Leuven), Department of Oral Health Sciences, KU Leuven and Paediatric Dentistry and Special Dental Care, University Hospitals Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium
| | - Gertrude Van Gorp
- KU Leuven (University of Leuven), Department of Oral Health Sciences, KU Leuven and Paediatric Dentistry and Special Dental Care, University Hospitals Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium
| | - Nastaran Meschi
- Section of Endodontology, Department of Oral Health Sciences, Ghent University, C. Heymanslaan 10/P8, 9000 Ghent, Belgium
| | - Bart Van Meerbeek
- KU Leuven (University of Leuven), Department of Oral Health Sciences, BIOMAT - Biomaterials Research group & UZ Leuven, University Hospitals Leuven, Dentistry, Kapucijnenvoer 33, 3000 Leuven, Belgium
| | - Ivo Lambrichts
- Biomedical Research Institute, Hasselt University, Campus Diepenbeek, Agoralaan Building C, B-3590 Diepenbeek, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium; Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
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Camilleri J, Atmeh A, Li X, Meschi N. Present status and future directions: Hydraulic materials for endodontic use. Int Endod J 2022; 55 Suppl 3:710-777. [PMID: 35167119 PMCID: PMC9314068 DOI: 10.1111/iej.13709] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/11/2022] [Accepted: 02/13/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Hydraulic materials are used in Endodontics due to their hydration characteristics namely the formation of calcium hydroxide when mixing with water and also because of their hydraulic properties. These materials are presented in various consistencies and delivery methods. They are composed primarily of tricalcium and dicalcium silicate, and also include a radiopacifier, additives and an aqueous or a non-aqueous vehicle. Only materials whose primary reaction is with water can be classified as hydraulic. OBJECTIVES Review of the classification of hydraulic materials by Camilleri and the literature pertaining to specific uses of hydraulic cements in endodontics namely intra-coronal, intra-radicular and extra-radicular. Review of the literature on the material properties linked to specific uses providing the current status of these materials after which future trends and gaps in knowledge could be identified. METHODS The literature was reviewed using PUBMED, and for each clinical use, the in vitro properties such as physical, chemical, biological and antimicrobial characteristics and clinical data were extracted and evaluated. RESULTS A large number of publications were retrieved for each clinical use and these were grouped depending on the property type being investigated. CONCLUSIONS The hydraulic cements have made a difference in clinical outcomes. The main shortcoming is the poor testing methodologies employed which provide very limited information and also inhibits adequate clinical translation. Furthermore, the clinical protocols need to be updated to enable the materials to be employed effectively.
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Affiliation(s)
- Josette Camilleri
- School of DentistryCollege of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
| | - Amre Atmeh
- Hamdan Bin Mohammed College of Dental Medicine (HBMCDM)Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU)DubaiUnited Arab Emirates
| | - Xin Li
- Department of Oral Health SciencesBIOMAT – Biomaterials Research GroupKU Leuven and DentistryUniversity Hospitals LeuvenLeuvenBelgium
| | - Nastaran Meschi
- Department of Oral Health SciencesBIOMAT – Biomaterials Research GroupKU Leuven and DentistryUniversity Hospitals LeuvenLeuvenBelgium
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Meschi N, EzEldeen M, Garcia AET, Lahoud P, Van Gorp G, Coucke W, Jacobs R, Vandamme K, Teughels W, Lambrechts P. Regenerative Endodontic Procedure of Immature Permanent Teeth with Leukocyte and Platelet-rich Fibrin: A Multicenter Controlled Clinical Trial. J Endod 2021; 47:1729-1750. [PMID: 34400199 DOI: 10.1016/j.joen.2021.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The aim of this nonrandomized, multicenter controlled clinical trial was to evaluate the impact of leukocyte-platelet-rich fibrin (LPRF) on regenerative endodontic procedures (REPs) of immature permanent teeth in terms of periapical bone healing (PBH) and further root development (RD). METHODS Healthy patients between 6-25 years with an inflamed or necrotic immature permanent tooth were included and divided between the test (= REP + LPRF) and control (= REP-LPRF) group depending on their compliance and the clinical setting (university hospital or private practice). After receiving REP ± LPRF, the patients were recalled after 3, 6, 12, 24, and 36 months. At each recall session, the teeth were clinically and radiographically (by means of a periapical radiograph [PR]) evaluated. A cone-beam computed tomographic (CBCT) imaging was taken preoperatively and 2 and 3 years postoperatively. PBH and RD were quantitatively and qualitatively assessed. RESULTS Twenty-nine teeth with a necrotic pulp were included, from which 23 (9 test and 14 control) were analyzed. Three teeth in the test group had a flare-up reaction in the first year after REP. Except for 2 no shows, all the analyzed teeth survived up to 3 years after REP, and, in case of failure, apexification preserved them. Complete PBH was obtained in 91.3% and 87% of the cases based on PR qualitative and quantitative evaluation, respectively, with no significant difference between the groups with respect to the baseline. The PR quantitative change in RD at the last recall session with respect to the baseline was not significant (all P values > .05) in both groups. The qualitative assessment of the type of REP root healing was nonuniform. In the test group, 55.6% of the teeth presented no RD and no apical closure. Only 50% of the 14 teeth assessed with CBCT imaging presented complete PBH. Regarding volumetric measurements on RD 3 years after REP for the change with respect to the baseline in root hard tissue volume, mean root hard tissue thickness, and apical area, the control group performed significantly in favor of RD than the test group (P = .03, .003, and 0.05 respectively). For the volumetric change 3 years after REP with respect to the baseline in root length and maximum root hard tissue thickness, no significant difference (P = .72 and .4, respectively) was found between the groups. The correlation between the PR and CBCT variables assessing RD was weak (root lengthening) to very weak (root thickening). CONCLUSIONS REP-LPRF seems to be a viable treatment option to obtain PBH and aid further RD of necrotic immature permanent teeth. Caution is needed when evaluating REP with PR.
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Affiliation(s)
- Nastaran Meschi
- Department of Oral Health Sciences, Endodontology, KU Leuven and Dentistry, University Hospitals Leuven, Leuven, Belgium; Department of Oral Health Sciences, BIOMAT-Biomaterials Research Group, KU Leuven and Dentistry, Leuven, Belgium.
| | - Mostafa EzEldeen
- OMFS IMPATH-Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Andres Eduardo Torres Garcia
- Department of Oral Health Sciences, Endodontology, KU Leuven and Dentistry, University Hospitals Leuven, Leuven, Belgium; OMFS IMPATH-Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Pierre Lahoud
- OMFS IMPATH-Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Gertrude Van Gorp
- Department of Oral Health Sciences, Endodontology, KU Leuven and Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Wim Coucke
- Freelance Statistical Consultant, Heverlee, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH-Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Katleen Vandamme
- Department of Oral Health Sciences, Restorative Dentistry, KU Leuven and Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Wim Teughels
- Department of Oral Health Sciences, Periodontology, KU Leuven and Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Paul Lambrechts
- Department of Oral Health Sciences, Endodontology, KU Leuven and Dentistry, University Hospitals Leuven, Leuven, Belgium; Department of Oral Health Sciences, BIOMAT-Biomaterials Research Group, KU Leuven and Dentistry, Leuven, Belgium
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Meschi N, Hilkens P, Van Gorp G, Strijbos O, Mavridou A, Cadenas de Llano Perula M, Lambrichts I, Verbeken E, Lambrechts P. Regenerative Endodontic Procedures Posttrauma: Immunohistologic Analysis of a Retrospective Series of Failed Cases. J Endod 2019; 45:427-434. [PMID: 30833096 DOI: 10.1016/j.joen.2019.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 12/14/2018] [Accepted: 01/08/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Regenerative endodontic procedures (REP) are a novel treatment modality to restore the function of necrotic pulp tissue via stimulation or transplantation of stem cells into the root canal. This study aimed to investigate the immunohistologic outcome of 3 extracted teeth because of sequelae of trauma and unsatisfactory REP outcomes. METHODS Three immature permanent maxillary central incisors of 3 female patients (6-9 years) were extracted 5.5-22 months after REP. Additionally, 1 sound permanent immature central maxillary incisor of 1 of the included patients was extracted for orthodontic reasons. The teeth were immunohistologically stained with Masson's trichrome, neurofilament (NF), pan cytokeratin, dentin sialophosphoprotein, and Gram+/-. RESULTS The REP-teeth presented intracanalar vascularized connective/mineralized reparative tissue (RT), which was less organized than the pulp tissue of the sound tooth. Moderate to considerable calcification was observed below the Portland cement used during REP. In 1 case, the RT was NF+; in the 2 other cases, the periodontal ligament and apical granuloma/papilla were NF+. All teeth were Gram+/- negative; nevertheless, inflammatory cells were present in 2 cases. The pan cytokeratin and dentin sialophosphoprotein stainings were not specific enough for 2 cases. CONCLUSIONS This immunohistologic study of failed REP cases resulted in bacteria-free intracanalar RT and biomaterial-induced calcification. Nevertheless, the presence of inflammatory cells revealed a persistent inflammation. Hence, the clinical and radiographic signs were decisive for tooth survival and multidisciplinary outcome determination.
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Affiliation(s)
- Nastaran Meschi
- Department of Oral Health Sciences, Endodontology, Katholieke Universiteit Leuven, Leuven, Belgium; Biomaterials, BIOMAT, Leuven, Belgium.
| | - Petra Hilkens
- Laboratory of Morphology, Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Gertrude Van Gorp
- Department of Oral Health Sciences, Endodontology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Olaf Strijbos
- Department of Oral Health Sciences, Endodontology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Athina Mavridou
- Department of Oral Health Sciences, Endodontology, Katholieke Universiteit Leuven, Leuven, Belgium; Biomaterials, BIOMAT, Leuven, Belgium
| | | | - Ivo Lambrichts
- Laboratory of Morphology, Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Eric Verbeken
- Department of Translational Cell and Tissue Research, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Paul Lambrechts
- Department of Oral Health Sciences, Endodontology, Katholieke Universiteit Leuven, Leuven, Belgium; Biomaterials, BIOMAT, Leuven, Belgium
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Meschi N, EzEldeen M, Torres Garcia AE, Jacobs R, Lambrechts P. A Retrospective Case Series in Regenerative Endodontics: Trend Analysis Based on Clinical Evaluation and 2- and 3-dimensional Radiology. J Endod 2018; 44:1517-1525. [DOI: 10.1016/j.joen.2018.06.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 06/09/2018] [Accepted: 06/15/2018] [Indexed: 12/17/2022]
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Meschi N, Fieuws S, Vanhoenacker A, Strijbos O, Van der Veken D, Politis C, Lambrechts P. Root-end surgery with leucocyte- and platelet-rich fibrin and an occlusive membrane: a randomized controlled clinical trial on patients’ quality of life. Clin Oral Investig 2018. [DOI: 10.1007/s00784-018-2343-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Curvers F, Meschi N, Vanhoenacker A, Strijbos O, Van Mierlo M, Lambrechts P. Ultrasound Assessment of Bone Healing after Root-end Surgery: Echoes Back to Patient's Safety. J Endod 2017; 44:32-37. [PMID: 29079054 DOI: 10.1016/j.joen.2017.08.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/20/2017] [Accepted: 08/26/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The aim of this study was to present ultrasound imaging (UI) techniques as promising and safe tools for the follow-up of root-end surgery (RES) in vivo. METHODS The study included 8 patients who underwent RES. All were followed up using UI at 1 week, 1 month, 2 months, 3 months, and 6 months (if necessary) after RES. The bony crypt was defined on the ultrasound image, and the following observations were made during follow-up: cortical bone interruption and surface area measurement of the residual echoic bony crypt image. RESULTS In all cases, the hypoechoic image became hyperechoic, indicating gradual bone healing of the crypt. Compared with baseline, at 3 months a remaining cortical opening of 51.2% (±12.6%) and a bony crypt surface area of 24.3% (±10.8%) was detected for all patients. For 50% of the patients, the echographic follow-up ended at 3 months because the ultrasound waves could no longer enter the bony crypt. For 4 patients who attended the 6-month recall, a remaining cortical disruption of 43.2% (±9.9%) and a bony crypt surface area of 17.2% (±7%) compared with the baseline was noted. CONCLUSIONS UI is a promising follow-up tool for RES. It helps clinicians understand the initial stages of bone healing, allows close healing monitoring, and is radiation free.
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Affiliation(s)
- Frederik Curvers
- Department of Oral Health Sciences, KU Leuven, University of Leuven, University Hospitals Leuven, Leuven, Belgium.
| | - Nastaran Meschi
- Department of Oral Health Sciences, KU Leuven, University of Leuven, University Hospitals Leuven, Leuven, Belgium.
| | - Anke Vanhoenacker
- Department of Oral and Maxillofacial Surgery, KU Leuven, University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Olaf Strijbos
- Department of Oral Health Sciences, KU Leuven, University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Maarten Van Mierlo
- Department of Oral Health Sciences, KU Leuven, University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Paul Lambrechts
- Department of Oral Health Sciences, KU Leuven, University of Leuven, University Hospitals Leuven, Leuven, Belgium
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Castro AB, Meschi N, Temmerman A, Pinto N, Lambrechts P, Teughels W, Quirynen M. Regenerative potential of leucocyte- and platelet-rich fibrin. Part B: sinus floor elevation, alveolar ridge preservation and implant therapy. A systematic review. J Clin Periodontol 2017; 44:225-234. [PMID: 27891638 PMCID: PMC5347939 DOI: 10.1111/jcpe.12658] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2016] [Indexed: 11/21/2022]
Abstract
AIM To analyse the effect of leucocyte- and platelet-rich fibrin (L-PRF) on bone regeneration procedures and osseointegration. MATERIALS AND METHODS An electronic and hand search was conducted in three databases (MEDLINE, EMBASE and Cochrane). Only randomized clinical trials, written in English where L-PRF was applied in bone regeneration and implant procedures, were selected. No follow-up restrictions were applied. RESULTS A total of 14 articles were included and processed. Three subgroups were created depending on the application: sinus floor elevation (SFE), alveolar ridge preservation and implant therapy. In SFE, for a lateral window as well as for the trans-alveolar technique, histologically faster bone healing was reported when L-PRF was added to most common xenografts. L-PRF alone improved the preservation of the alveolar width, resulting in less buccal bone resorption compared to natural healing. In implant therapy, better implant stability over time and less marginal bone loss were observed when L-PRF was applied. Meta-analyses could not be performed due to the heterogeneity of the data. CONCLUSIONS Despite the lack of strong evidence found in this systematic review, L-PRF might have a positive effect on bone regeneration and osseointegration.
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Affiliation(s)
- Ana B. Castro
- Department of Oral Health Sciences, PeriodontologyKU Leuven & DentistryUniversity Hospitals LeuvenLeuvenBelgium
| | - Nastaran Meschi
- Department of Oral Health Sciences, EndodontologyKU Leuven & DentistryUniversity Hospitals LeuvenLeuvenBelgium
| | - Andy Temmerman
- Department of Oral Health Sciences, PeriodontologyKU Leuven & DentistryUniversity Hospitals LeuvenLeuvenBelgium
| | - Nelson Pinto
- Department of Oral Health Sciences, PeriodontologyKU Leuven & DentistryUniversity Hospitals LeuvenLeuvenBelgium
- Faculty of DentistryPostgraduate Implant ProgramUniversity of the AndesSantiagoChile
| | - Paul Lambrechts
- Department of Oral Health Sciences, EndodontologyKU Leuven & DentistryUniversity Hospitals LeuvenLeuvenBelgium
| | - Wim Teughels
- Department of Oral Health Sciences, PeriodontologyKU Leuven & DentistryUniversity Hospitals LeuvenLeuvenBelgium
| | - Marc Quirynen
- Department of Oral Health Sciences, PeriodontologyKU Leuven & DentistryUniversity Hospitals LeuvenLeuvenBelgium
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Castro AB, Meschi N, Temmerman A, Pinto N, Lambrechts P, Teughels W, Quirynen M. Regenerative potential of leucocyte- and platelet-rich fibrin. Part A: intra-bony defects, furcation defects and periodontal plastic surgery. A systematic review and meta-analysis. J Clin Periodontol 2016; 44:67-82. [PMID: 27783851 PMCID: PMC5248642 DOI: 10.1111/jcpe.12643] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2016] [Indexed: 12/20/2022]
Abstract
Aim To analyse the regenerative potential of leucocyte‐ and platelet‐rich fibrin (L‐PRF) during periodontal surgery. Materials and Methods An electronic and hand search were conducted in three databases. Only randomized clinical trials were selected and no follow‐up limitation was applied. Pocket depth (PD), clinical attachment level (CAL), bone fill, keratinized tissue width (KTW), recession reduction and root coverage (%) were considered as outcome. When possible, meta‐analysis was performed. Results Twenty‐four articles fulfilled the inclusion and exclusion criteria. Three subgroups were created: intra‐bony defects (IBDs), furcation defects and periodontal plastic surgery. Meta‐analysis was performed in all the subgroups. Significant PD reduction (1.1 ± 0.5 mm, p < 0.001), CAL gain (1.2 ± 0.6 mm, p < 0.001) and bone fill (1.7 ± 0.7 mm, p < 0.001) were found when comparing L‐PRF to open flap debridement (OFD) in IBDs. For furcation defects, significant PD reduction (1.9 ± 1.5 mm, p = 0.01), CAL gain (1.3 ± 0.4 mm, p < 0.001) and bone fill (1.5 ± 0.3 mm, p < 0.001) were reported when comparing L‐PRF to OFD. When L‐PRF was compared to a connective tissue graft, similar outcomes were recorded for PD reduction (0.2 ± 0.3 mm, p > 0.05), CAL gain (0.2 ± 0.5 mm, p > 0.05), KTW (0.3 ± 0.4 mm, p > 0.05) and recession reduction (0.2 ± 0.3 mm, p > 0.05). Conclusions L‐PRF enhances periodontal wound healing.
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Affiliation(s)
- Ana B. Castro
- Department of Oral Health Sciences, PeriodontologyKU Leuven & Dentistry, University Hospitals LeuvenLeuvenBelgium
| | - Nastaran Meschi
- Department of Oral Health Sciences, EndodontologyKU Leuven & Dentistry, University Hospitals LeuvenLeuvenBelgium
| | - Andy Temmerman
- Department of Oral Health Sciences, PeriodontologyKU Leuven & Dentistry, University Hospitals LeuvenLeuvenBelgium
| | - Nelson Pinto
- Department of Oral Health Sciences, PeriodontologyKU Leuven & Dentistry, University Hospitals LeuvenLeuvenBelgium
- Faculty of DentistryPostgraduate Implant ProgramUniversity of the AndesSantiagoChile
| | - Paul Lambrechts
- Department of Oral Health Sciences, EndodontologyKU Leuven & Dentistry, University Hospitals LeuvenLeuvenBelgium
| | - Wim Teughels
- Department of Oral Health Sciences, PeriodontologyKU Leuven & Dentistry, University Hospitals LeuvenLeuvenBelgium
| | - Marc Quirynen
- Department of Oral Health Sciences, PeriodontologyKU Leuven & Dentistry, University Hospitals LeuvenLeuvenBelgium
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Abstract
The current literature was reviewed to determine the impact of autologous platelet concentrates (APCs) on endodontic healing. All types of clinical study designs concerning any kind of endodontic treatment involving the application of APCs were included. Two independent reviewers searched three databases (PubMed, Embase, and Cochrane Library) for studies, complemented by hand search, until 16/1/2016. From the 423 identified records, 48 articles met the inclusion criteria. Selected randomized controlled clinical trials (RCTs) underwent Cochrane Collaboration's risk-of-bias assessment and data extraction. Only two RCTs showed low risk of bias. There was considerable heterogeneity between the RCTs with regard to the type of therapy, type of APCs, assessment method, and study quality, and therefore the data could not be analyzed quantitatively. The included case reports/series and non-randomized comparative studies underwent qualitative analysis with the revised Methodological Index for Non-Randomized Studies (MINORS) and data extraction. The two comparative non-randomized studies scored qualitatively high, though the MINORS-scores of the case series and reports were dispersed. APCs were involved in five endodontic treatment modalities, namely apexification, regenerative endodontic procedures, pulpotomy, apical surgery, and treatment of endo-perio/perio-endo lesions. APCs seem to accelerate postoperative bone healing, augment the patients' postoperative quality of life, aid further root development, and support maintenance/regaining of pulp vitality. No adverse events were reported. APCs in endodontic treatments seem to contribute to the healing of soft and hard tissues, though there is a lack of long-term high quality clinical trials and standardized treatment protocols.
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Affiliation(s)
- Nastaran Meschi
- a Department of Oral Health Sciences, Endodontology , KU Leuven & Dentistry, University Hospitals Leuven , Leuven , Belgium
| | - Ana B Castro
- b Department of Oral Health Sciences , Periodontology, KU Leuven & Dentistry, University Hospitals Leuven , Leuven , Belgium
| | - Katleen Vandamme
- c Department of Oral Health Sciences , Restorative Dentistry, KU Leuven & Dentistry, University Hospitals Leuven , Leuven , Belgium
| | - Marc Quirynen
- b Department of Oral Health Sciences , Periodontology, KU Leuven & Dentistry, University Hospitals Leuven , Leuven , Belgium
| | - Paul Lambrechts
- a Department of Oral Health Sciences, Endodontology , KU Leuven & Dentistry, University Hospitals Leuven , Leuven , Belgium
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Galler KM, Krastl G, Simon S, Van Gorp G, Meschi N, Vahedi B, Lambrechts P. European Society of Endodontology position statement: Revitalization procedures. Int Endod J 2016; 49:717-23. [DOI: 10.1111/iej.12629] [Citation(s) in RCA: 186] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- K. M. Galler
- Department of Conservative Dentistry and Periodontology; University Hospital; Regensburg Germany
| | - G. Krastl
- Department of Conservative Dentistry and Periodontology; University of Würzburg; Würzburg Germany
| | - S. Simon
- Department of Oral Biology and Endodontics; University of Paris Diderot (Paris 7); Paris France
| | - G. Van Gorp
- Department of Oral Health Sciences, KU Leuven and Dentistry; University Hospitals Leuven; Leuven Belgium
| | - N. Meschi
- Department of Oral Health Sciences, KU Leuven and Dentistry; University Hospitals Leuven; Leuven Belgium
| | | | - P. Lambrechts
- Department of Oral Health Sciences, KU Leuven and Dentistry; University Hospitals Leuven; Leuven Belgium
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Meschi N, Hilkens P, Lambrichts I, Van den Eynde K, Mavridou A, Strijbos O, De Ketelaere M, Van Gorp G, Lambrechts P. Regenerative endodontic procedure of an infected immature permanent human tooth: an immunohistological study. Clin Oral Investig 2015; 20:807-14. [DOI: 10.1007/s00784-015-1555-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 07/28/2015] [Indexed: 11/27/2022]
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Hilkens P, Meschi N, Lambrechts P, Bronckaers A, Lambrichts I. Dental Stem Cells in Pulp Regeneration: Near Future or Long Road Ahead? Stem Cells Dev 2015; 24:1610-22. [PMID: 25869156 DOI: 10.1089/scd.2014.0510] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Although regenerative endodontic procedures have yielded an impressive body of favorable outcomes, the treatment of necrotic immature permanent teeth in particular remains to be a challenge. Recent advances in dental stem cell (DSC) research have gained increasing insight in their regenerative potential and prospective use in the formation of viable dental tissues. Numerous studies have already reported successful dental pulp regeneration following application of dental pulp stem cells, stem cells from the apical papilla, or dental follicle precursor cells in different in vivo models. Next to responsive cells, dental tissue engineering also requires the support of an appropriate scaffold material, ranging from naturally occurring polymers to treated dentin matrix components. However, the routine use and banking of DSCs still holds some major challenges, such as culture-associated differences, patient-related variability, and the effects of culture medium additives. Only in-depth evaluation of these problems and the implementation of standardized models and protocols will effectively lead to better alternatives for patients who no longer benefit from current treatment protocols.
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Affiliation(s)
- Petra Hilkens
- 1 Laboratory of Morphology, Biomedical Research Institute (BIOMED), Hasselt University , Diepenbeek, Belgium
| | - Nastaran Meschi
- 2 Department of Oral Health Sciences, KU Leuven and Dentistry, University Hospitals Leuven , Leuven, Belgium
| | - Paul Lambrechts
- 2 Department of Oral Health Sciences, KU Leuven and Dentistry, University Hospitals Leuven , Leuven, Belgium
| | - Annelies Bronckaers
- 1 Laboratory of Morphology, Biomedical Research Institute (BIOMED), Hasselt University , Diepenbeek, Belgium
| | - Ivo Lambrichts
- 1 Laboratory of Morphology, Biomedical Research Institute (BIOMED), Hasselt University , Diepenbeek, Belgium
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