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Uyar DS, Alacam A. Evaluation of partial pulpotomy treatment in cariously exposed immature permanent molars: Randomized controlled trial. Niger J Clin Pract 2021; 24:1511-1519. [PMID: 34657018 DOI: 10.4103/njcp.njcp_686_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background and Aims This study aimed to assess the outcomes of partial pulpotomy treatments using different biocompatible materials which were Biodentine®, mineral trioxide aggregate (MTA), and calcium hydroxide (CH) in cariously exposed pulp tissue in immature permanent molars. Materials and Methods Fifty-four teeth of 50 patients, which had cariously pulp exposures were randomly divided into Biodentine®, MTA, and CH groups for partial pulpotomy treatments and finally restored with stainless steel crowns at the same appointment. Clinical and radiographical success was evaluated by the absence of any clinical and radiographical signs and symptoms for 12 months. Also, Image J was used for the quantitative assessment of length developments for mesial and distal roots. P value of less than 0.05 was considered statistically significant. Results Partial pulpotomy treatments showed high overall success rate (87%). On the other hand, Biodentine and MTA showed higher success rates compared to CH without any statistical significance (P = 0.09). Besides, mesial and distal root lengths displayed a continuous and significant increase in each group at sixth month follow-up (P = 0.01; P = 0.03). Conclusions Favorable results demonstrated that Biodentine, MTA, and CH might be recommended as suitable agents for partial pulpotomy treatment in cariously exposed immature molars with clinical diagnosis of normal pulp or reversible pulpitis.
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Affiliation(s)
- D Sakaryali Uyar
- Department of Pediatric Dentistry, Faculty of Dentistry, Başkent University, Ankara, Turkey
| | - A Alacam
- Department of Pediatric Dentistry, Faculty of Dentistry, Gazi University, Ankara, Turkey
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Leite ML, Soares DG, Anovazzi G, Filipe Koon Wu M, Bordini EAF, Hebling J, DE Souza Costa CA. Bioactivity effects of extracellular matrix proteins on apical papilla cells. J Appl Oral Sci 2021; 29:e20210038. [PMID: 34495108 PMCID: PMC8425894 DOI: 10.1590/1678-7757-2021-0038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/19/2021] [Indexed: 01/27/2023] Open
Abstract
Potent signaling agents stimulate and guide pulp tissue regeneration, especially in endodontic treatment of teeth with incomplete root formation.
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Affiliation(s)
- Maria Luísa Leite
- Universidade Estadual Paulista - UNESP, Faculdade de Odontologia de Araraquara, Departamento de Materiais Odontológicos e Prótese, Araraquara, SP, Brasil
| | - Diana Gabriela Soares
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Dentística, Endodontia e Materiais Odontológicos, Bauru, SP, Brasil
| | - Giovana Anovazzi
- Universidade Estadual Paulista - UNESP, Faculdade de Odontologia de Araraquara, Departamento de Morfologia e Clínica Infantil, Araraquara, SP, Brasil
| | - Mon Filipe Koon Wu
- Universidade Estadual Paulista - UNESP, Faculdade de Odontologia de Araraquara, Departamento de Fisiologia e Patologia, Araraquara, SP, Brasil
| | - Ester Alves Ferreira Bordini
- Universidade Estadual Paulista - UNESP, Faculdade de Odontologia de Araraquara, Departamento de Materiais Odontológicos e Prótese, Araraquara, SP, Brasil
| | - Josimeri Hebling
- Universidade Estadual Paulista - UNESP, Faculdade de Odontologia de Araraquara, Departamento de Morfologia e Clínica Infantil, Araraquara, SP, Brasil
| | - Carlos Alberto DE Souza Costa
- Universidade Estadual Paulista - UNESP, Faculdade de Odontologia de Araraquara, Departamento de Fisiologia e Patologia, Araraquara, SP, Brasil
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The effect of changing apical foramen diameter on regenerative potential of mature teeth with necrotic pulp and apical periodontitis. Clin Oral Investig 2021; 26:1843-1853. [PMID: 34480644 DOI: 10.1007/s00784-021-04159-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/21/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim of the present study was to evaluate the regenerative potential of permanent necrotic mature teeth with different apical foramen diameters in comparison to conventional endodontic treatment. METHODS Pulp necrosis and periapical pathosis were induced in premolars (144 roots) in six mongrel dogs. The infected teeth were divided into six groups; conventional root canal treatment (RCT) group prepared up to apical preparation sizes #F3 ProTaper file, regenerative endodontic therapy (RET) groups; groups RET-F3, RET-F4, and RET-F5 where regenerative endodontic procedures were applied after apical preparation up to sizes #F3, F4, and F5 ProTaper file, respectively, control groups; and positive (P) and negative (N) groups included infected and healthy teeth respectively. Each group (12 teeth with 24 roots each) was further subdivided into two subgroups (6 teeth with 12 roots each) according to the evaluation periods 1 and 3 months; each group was equally randomized in the upper and lower jaws during each evaluation period. RESULTS The inflammatory cell counts for the RCT group were statistically significantly higher than that of all RET groups at the first period and only significantly higher than RET-F5 at the second period. The enlargement of the apical foramen to #F5 showed no statistically significant difference with #F4 regarding the inflammatory cell count, tissue in-growth inside the root canal, and percentage of bone resorption. The tissue formed after RET was not true pulp tissue and is considered tissue repair with connective tissue, dilated blood vessels, and cementum-like structures. CONCLUSION: Increasing the apical size diameter was associated with less inflammatory cell count, less percentage of bone resorption, more tissue ingrowth, and more percentage of new hard tissue formation inside root canal. The minimum apical diameter that should be enlarged for RET is 0.4 mm. CLINICAL RELEVANCE RET could be used as an alternative procedure to RCT for the treatment of mature teeth with necrotic pulp and apical periodontitis.
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Shaik I, Tulli M, Unnam P, Karunakaran S, Vaddi DS, Jabeen R, Tiwari RVC. Regenerative Endodontic Therapy in the Management of Nonvital Immature Permanent teeth: A Systematic Review and Meta-analysis. J Pharm Bioallied Sci 2021; 13:S36-S42. [PMID: 34447039 PMCID: PMC8375786 DOI: 10.4103/jpbs.jpbs_807_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 12/31/2022] Open
Abstract
This meta-analysis is intended to evaluate the reliability of evidences published in current regenerative endodontic publications in a critical way. This meta-analysis is used to summarize and analyze the various clinical and radiographic findings associated with nonvital immature permanent teeth which have been treated with regenerative endodontic techniques. We also intend to significantly evaluate the worth of facts provided in the previous published literature. A structured electronic search by authors was undertaken in August 2020 using MEDLINE and PubMed search engine. The chosen parameters studied in this systematic review were presented in flowcharts and were summarized. We observed a good accomplishment rates in terms of survival of the treated tooth and also in resolution of any associated pathology in the apical areas; on contrary, our results in relation to apex closure along with constant root development, our findings from various studies were quiet variable. Regenerative endodontic procedures are constantly being restructured and enhanced to benefit present-day dentistry in all likely ways. Still, many factors that are important for the success of regenerative endodontic treatment outcomes still remain unexplained. There are still numerous gaps in our expertise at the present stage of this study.
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Affiliation(s)
- Izaz Shaik
- DMD Student, Rutgers School of Dental Medicine, Newark, New Jersey, USA
| | - Malti Tulli
- Dental Surgeon, Guru Nanak Dev Dental College and Research Institutes, Sunam, Punjab, India
| | - Priyanka Unnam
- Dental Surgeon, Narayana Dental College and Hospital, Nellore, Tamil Nadu, India
| | - Sangeetha Karunakaran
- Dental Surgeon, Sri Ramakrishna Dental College and Hospital, Coimbatore, Tamil Nadu, India
| | - Durga Susmitha Vaddi
- Dental Surgeon, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
| | - Rafiya Jabeen
- Dental Surgeon, AME'S Dental College, Raichur, Karnataka, India
| | - Rahul Vinay Chandra Tiwari
- Department of OMFS, Narsinhbhai Patel Dental College and Hospital, Sankalchand Patel University, Visnagar, Gujarat, India
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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] [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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Sponchiado-Júnior EC, de Andrade Vieira W, Frozoni M, Herkrath FJ, de-Jesus-Soares A. CONSORT Compliance in Randomized Clinical Trials of Regenerative Endodontic treatments of Necrotic Immature Teeth. A Scoping Review. J Endod 2021; 47:1751-1766. [PMID: 34352304 DOI: 10.1016/j.joen.2021.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION This study aimed to investigate methodological quality of clinical trials in regenerative endodontics and its compliance with the CONSORT statement. METHODS An electronic search was performed in eight electronic databases. Only clinical trials whose participants underwent regenerative endodontic treatment on necrotic permanent immature teeth were included. Quality assessment was performed using the Cochrane Collaboration's Risk of Bias Tool (RoB, version 2.0). Compliance of articles with the CONSORT guidelines was assessed by a tool with scales: 0 = no description, 1 = deficient, and 2 = adequate description, totaling a maximum score of 32 points. The Mann-Whitney and Kruskal-Wallis tests were used to compare the scores between journals, studies, country, income levels, and publication periods. Spearman correlation analyses were performed between CONSORT compliance scores and 2019 journal CiteScore values, publication year, and quality assessment. RESULTS Twenty studies were included. The average CONSORT compliance score was 20.95 (±6.19). The better reported items were the description of the interventions performed in the trials (100%), followed by the description of the number of patients analyzed, losses and exclusions (90%) and the hypothesis tested (85%). Within the 20 studies, 3 articles were classified as "low risk of bias," 8 studies were classified as "some concerns" and 9 studies were considered "high risk of bias". Studies carried out in countries with higher income levels presented higher CONSORT scores. Significant moderate correlations were found between the CONSORT score and the percentage of risk of bias in low-risk domains (rs = 0.63, 95%CI = 0.31 to 0.94, p = 0.003) and the overall risk of bias categories (rs = 0.76, 95%CI = 0.54 to 0.98, p = 0.001). CONCLUSIONS The adequacy of reporting based on the CONSORT checklist items of regenerative endodontic trials was low with a moderate to high risk of bias.
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Affiliation(s)
- Emílio Carlos Sponchiado-Júnior
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas, Piracicaba, SP, Brazil; Division of Endodontics, Dental School, Federal University of Amazonas, Manaus, Amazonas, Brazil.
| | - Walbert de Andrade Vieira
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas, Piracicaba, SP, Brazil
| | - Marcos Frozoni
- São Leopoldo Mandic School of Dentistry, Campinas, São Paulo, Brazil
| | | | - Adriana de-Jesus-Soares
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas, Piracicaba, SP, Brazil
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Cerqueira-Neto ACCL, Prado MC, Pereira AC, Oliveira ML, Vargas-Neto J, Gomes BPFA, Ferraz CCR, Almeida JFA, de-Jesus-Soares A. Clinical and Radiographic Outcomes of Regenerative Endodontic Procedures in Traumatized Immature Permanent Teeth: Interappointment Dressing or Single-Visit? J Endod 2021; 47:1598-1608. [PMID: 34310980 DOI: 10.1016/j.joen.2021.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/20/2021] [Accepted: 07/16/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION More data are needed before affirming that single-visit approaches are effective and safe for regenerative endodontic procedures (REPs). This study compared clinical and radiographic outcomes of REPs between interappointment dressing or single-visit protocols. METHODS Twenty young patients presenting traumatized immature teeth with pulp necrosis were divided into 2 groups. Teeth were submitted to 6% sodium hypochlorite and 2% chlorhexidine irrigation and to 17% EDTA use before blood clot induction. In the interappointment dressing group (n = 11), calcium hydroxide was used with 2% chlorhexidine gel for 21 days before scaffold induction. In the single-visit group (n = 9), the scaffold was induced during the only appointment. Patients were followed up for 24 months. Primary, secondary, and tertiary outcomes were assessed by 3 independent evaluators. Preoperative and follow-up radiographs were assessed for quantitative measurements of the apical diameter, root width, root length, and cervical barrier placement and compared between groups using the t test or Mann-Whitney U test. Categoric variables were assessed with the G test and the Fisher exact test and continuous variables with the Mann-Whitney U test. Statistical significance was set at 5%. RESULTS One tooth showed persistence of infection. No difference was observed in cervical barrier placement (P > .05); between groups regarding primary, secondary, and tertiary outcomes (P > .05); and in parameters of quantitative radiographic outcomes (P > .05). CONCLUSIONS Completing REPs with an interappointment dressing or a single-visit protocol presented similar clinical and radiographic outcomes. A single-visit protocol of REPs using 6% sodium hypochlorite, 2% chlorhexidine, and 17% EDTA permitted satisfactory outcomes in necrotic immature permanent teeth.
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Affiliation(s)
- Ana Carolina C L Cerqueira-Neto
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School - State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - Marina C Prado
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School - State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - Andréa C Pereira
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School - State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - Matheus L Oliveira
- Department of Oral Diagnosis, Oral Radiology Division, Piracicaba Dental School - State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - Júlio Vargas-Neto
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School - State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - Brenda P F A Gomes
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School - State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - Caio C R Ferraz
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School - State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - José Flávio A Almeida
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School - State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - Adriana de-Jesus-Soares
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School - State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil.
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External Root Resorption Management of an Avulsed and Reimplanted Central Incisor: A Case Report. Dent J (Basel) 2021; 9:dj9060072. [PMID: 34208510 PMCID: PMC8233981 DOI: 10.3390/dj9060072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 02/06/2023] Open
Abstract
Background: Avulsion and reimplantation of permanent teeth represent a major challenge in terms of treatment and long-term prognosis. The present study reported clinical management of external root resorption of an avulsed and reimplanted maxillary central incisor. Case report: A 9-year-old boy reported an uncomplicated crown fracture and avulsion of tooth 11 and complicated crown fracture of tooth 21 due to trauma. Reimplantation of element 11 was obtained within 30 min post-trauma and 3 days after both elements were diagnosed with necrotic pulp. In addition, tooth 11 showed early external root resorption. Both elements underwent endodontic treatment and root closure with apical plug using calcium-silicate-based cement. At 6-month follow-up root resorption appeared to be arrested. Twenty-four months after trauma the clinical results were stable, although signs and symptoms of ankylosis were observed. Conclusions: An immediate endodontic approach and use of calcium-silicate-based cement seemed to contrast the progression of root resorption of an avulsed and reimplanted central incisor after 24 months of follow-up.
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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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Cui D, Yu S, Zhou X, Liu Y, Gan L, Pan Y, Zheng L, Wan M. Roles of Dental Mesenchymal Stem Cells in the Management of Immature Necrotic Permanent Teeth. Front Cell Dev Biol 2021; 9:666186. [PMID: 34095133 PMCID: PMC8170050 DOI: 10.3389/fcell.2021.666186] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/06/2021] [Indexed: 02/05/2023] Open
Abstract
Dental caries and trauma always lead to pulp necrosis and subsequent root development arrest of young permanent teeth. The traditional treatment, apexification, with the absence of further root formation, results in abnormal root morphology and compromises long-term prognosis. Regeneration endodontics procedures (REPs) have been developed and considered as an alternative strategy for management of immature permanent teeth with pulpal necrosis, including cell-free and cell-based REPs. Cell-free REPs, including revascularization and cell homing with molecules recruiting endogenous mesenchymal stem cells (MSCs), have been widely applied in clinical treatment, showing optimistic periapical lesion healing and continued root development. However, the regenerated pulp-dentin complex is still absent in these cases. Dental MSCs, as one of the essentials of tissue engineering, are vital seed cells in regenerative medicine. Dental MSC-based REPs have presented promising potential with pulp-dentin regeneration in large animal studies and clinical trials via cell transplantation. In the present review, we summarize current understanding of the biological basis of clinical treatments for immature necrotic permanent teeth and the roles of dental MSCs during this process and update the progress of MSC-based REPs in the administration of immature necrotic permanent teeth.
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Affiliation(s)
- Dixin Cui
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Sihan Yu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xin Zhou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Ying Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lu Gan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yue Pan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Liwei Zheng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Mian Wan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Andrei M, Vacaru RP, Coricovac A, Ilinca R, Didilescu AC, Demetrescu I. The Effect of Calcium-Silicate Cements on Reparative Dentinogenesis Following Direct Pulp Capping on Animal Models. Molecules 2021; 26:molecules26092725. [PMID: 34066444 PMCID: PMC8125639 DOI: 10.3390/molecules26092725] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/03/2021] [Accepted: 05/03/2021] [Indexed: 12/11/2022] Open
Abstract
Dental pulp vitality is a desideratum for preserving the health and functionality of the tooth. In certain clinical situations that lead to pulp exposure, bioactive agents are used in direct pulp-capping procedures to stimulate the dentin-pulp complex and activate reparative dentinogenesis. Hydraulic calcium-silicate cements, derived from Portland cement, can induce the formation of a new dentin bridge at the interface between the biomaterial and the dental pulp. Odontoblasts are molecularly activated, and, if necessary, undifferentiated stem cells in the dental pulp can differentiate into odontoblasts. An extensive review of literature was conducted on MedLine/PubMed database to evaluate the histological outcomes of direct pulp capping with hydraulic calcium-silicate cements performed on animal models. Overall, irrespective of their physico-chemical properties and the molecular mechanisms involved in pulp healing, the effects of cements on tertiary dentin formation and pulp vitality preservation were positive. Histological examinations showed different degrees of dental pulp inflammatory response and complete/incomplete dentin bridge formation during the pulp healing process at different follow-up periods. Calcium silicate materials have the ability to induce reparative dentinogenesis when applied over exposed pulps, with different behaviors, as related to the animal model used, pulpal inflammatory responses, and quality of dentin bridges.
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Affiliation(s)
- Mihai Andrei
- Division of Embryology, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Boulevard, 050474 Bucharest, Romania; (M.A.); (R.P.V.); (A.C.)
| | - Raluca Paula Vacaru
- Division of Embryology, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Boulevard, 050474 Bucharest, Romania; (M.A.); (R.P.V.); (A.C.)
| | - Anca Coricovac
- Division of Embryology, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Boulevard, 050474 Bucharest, Romania; (M.A.); (R.P.V.); (A.C.)
| | - Radu Ilinca
- Division of Biophysics, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Boulevard, 050474 Bucharest, Romania;
| | - Andreea Cristiana Didilescu
- Division of Embryology, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Boulevard, 050474 Bucharest, Romania; (M.A.); (R.P.V.); (A.C.)
- Correspondence: ; Tel.: +40-722536798
| | - Ioana Demetrescu
- Department of General Chemistry, University Politehnica Bucharest, Spl. Independentei 313, 060042 Bucharest, Romania;
- Academy of Romanian Scientists, 3 Ilfov, 050044 Bucharest, Romania
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Anthrayose P, Nawal RR, Yadav S, Talwar S, Yadav S. Effect of revascularisation and apexification procedures on biomechanical behaviour of immature maxillary central incisor teeth: a three-dimensional finite element analysis study. Clin Oral Investig 2021; 25:6671-6679. [PMID: 33899155 DOI: 10.1007/s00784-021-03953-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/19/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study aimed to assess the effects of revascularisation and apexification procedures on biomechanical behaviour of immature teeth using 3-dimensional finite element analysis (3D FEA). MATERIALS AND METHODS Five 3D FEA permanent maxillary incisor models were developed from CBCT scans and available literature data: Model MT: Mature tooth, Model IT: Immature tooth (Cvek's stage 3), Model AT: Apexified tooth-mineral trioxide aggregate (MTA) apexification, Model RTB: Revascularised tooth with blood, and Model RTS: Revascularised tooth with supplementary scaffold. Using FEA, a masticatory load of 240N at 120° was simulated, and the Von Mises and maximum principal stresses within the models were evaluated. Failure index (FI) and weakening% were also calculated for each model. RESULTS On dentinal stress analysis, model MT (96.16MPa) and IT (158.38MPa) had lowest and highest stress values, respectively. Among the experimental groups, model RTS (131.12MPa) had lower stresses than AT (136.33MPa) and RTB (133.7MPa), with no significant difference among the three. Peak dentinal stresses in all the models were observed in the cervical third of the root and near the apical opening in model IT. The extent of high dentinal stress area in model RTB and RTS was lesser than that of AT. The FI and weakening% values were highest for model AT followed by RTB and RTS, among the experimental groups. However, all these treatments strengthened an immature tooth by more than 20%. CONCLUSIONS AT, RTB, and RTS treatments lowered the stress values and risk of fracture in immature teeth with no significant difference among the three groups. CLINICAL RELEVANCE Stress distribution evaluation following revascularisation/apexification was essential, with potential to influence clinical decision-making. MTA apexification and revascularisation with blood clot/supplementary scaffold lowered the stresses in immature teeth, with no significant difference among the three.
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Affiliation(s)
- Persis Anthrayose
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, MAMC Complex, Bahadur Shah Zafar Marg, New Delhi, 110002, India
| | - Ruchika Roongta Nawal
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, MAMC Complex, Bahadur Shah Zafar Marg, New Delhi, 110002, India
| | - Seema Yadav
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, MAMC Complex, Bahadur Shah Zafar Marg, New Delhi, 110002, India
| | - Sangeeta Talwar
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, MAMC Complex, Bahadur Shah Zafar Marg, New Delhi, 110002, India.
| | - Sudha Yadav
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, MAMC Complex, Bahadur Shah Zafar Marg, New Delhi, 110002, India
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Leite ML, Soares DG, Anovazzi G, Anselmi C, Hebling J, de Souza Costa CA. Fibronectin-loaded Collagen/Gelatin Hydrogel Is a Potent Signaling Biomaterial for Dental Pulp Regeneration. J Endod 2021; 47:1110-1117. [PMID: 33887309 DOI: 10.1016/j.joen.2021.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Guided tissue regeneration has been considered a promising biological strategy to replace conventional endodontic therapies of teeth with incomplete root formation. Therefore, in the present study, a collagen/gelatin hydrogel either containing dosages of fibronectin (FN), or not, was developed and assessed concerning their bioactive and chemotactic potential on human apical papilla cells (hAPCs). METHODS Hydrogels were prepared by varying the ratio of collagen and gelatin (Col/Gel; v/v), and used to establish the following groups: Collagen (positive control); Col/Gel 4:6; Col/Gel 6:4; Col/Gel 8:2. The viability, adhesion, and spreading of cells seeded on the hydrogels were evaluated. Different concentrations of FN (0, 5, or 10 μg/mL) were incorporated into the best formulation of the collagen/gelatin hydrogel selected. Then, the hAPCs seeded on the biomaterials were assessed concerning the cell migration, viability, adhesion and spreading, and gene expression of ITGA5, ITGAV, COL1A1, and COL3A1. RESULTS The Col/Gel 8:2 group exhibited better cell viability, adhesion and spreading in comparison with Control. Higher values of hAPC migration, viability, adhesion, spreading and gene expression of pulp regeneration markers were found, the higher the concentration was of FN incorporated into the collagen/gelatin hydrogel. CONCLUSION Collagen/gelatin hydrogel with 10 μg/mL of FN had potent bioactive and chemotactic effects on cultured hAPCs.
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Affiliation(s)
- Maria Luísa Leite
- Department of Dental Materials and Prosthodontics, Araraquara School of Dentistry, Univ. Estadual Paulista - UNESP, Araraquara, SP, Brazil
| | - Diana Gabriela Soares
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Giovana Anovazzi
- Departament of Orthodontics and Pediatric Dentistry, Araraquara School of Dentistry, São Paulo State University (Unesp), Araraquara, SP, Brazil
| | - Caroline Anselmi
- Departament of Orthodontics and Pediatric Dentistry, Araraquara School of Dentistry, São Paulo State University (Unesp), Araraquara, SP, Brazil
| | - Josimeri Hebling
- Departament of Orthodontics and Pediatric Dentistry, Araraquara School of Dentistry, São Paulo State University (Unesp), Araraquara, SP, Brazil
| | - Carlos Alberto de Souza Costa
- Department of Physiology and Pathology, Araraquara School of Dentistry, São Paulo State University (Unesp), Araraquara, SP, Brazil.
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Clinical and Radiographic Outcomes of Immature Teeth Treated with Different Treatment Protocols of Regenerative Endodontic Procedures: A Retrospective Cohort Study. J Clin Med 2021; 10:jcm10081600. [PMID: 33918937 PMCID: PMC8069309 DOI: 10.3390/jcm10081600] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/27/2021] [Accepted: 04/07/2021] [Indexed: 12/18/2022] Open
Abstract
Regenerative endodontic procedure (REP) is a progressive treatment modality for immature permanent teeth with necrotic pulp. The ambiguousness about the predictability of REP outcome in relation to complete disinfection of the root canal system and the occurrence of discoloration still exists. The aim of this retrospective study was to analyze two treatment protocols on clinical success rate, radiographic root development and the occurrence of discoloration. Eighteen patients were treated by a single operator by either treatment protocol according to the American Association of Endodontists (AAEP, n = 9) or a modified protocol (MP, n = 9) with the use of 5% sodium hypochlorite and sandblasting. Patients were followed up after 3, 6, 9, 12, 18 and 24 months and clinical success, radiographic root development and the occurrence of discoloration were assessed. The clinical success of MP was significantly higher in two years follow-up (p = 0.015), but the change in radiographic root area was higher for AAEP (p = 0.017) and the occurrence of discoloration was higher in AAEP (p = 0.029). The use of 5% sodium hypochlorite for a longer period of time leads to a higher success rate. The sandblasting of the access cavity reduces the occurrence of discoloration.
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Glynis A, Foschi F, Kefalou I, Koletsi D, Tzanetakis GN. Regenerative Endodontic Procedures for the Treatment of Necrotic Mature Teeth with Apical Periodontitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Endod 2021; 47:873-882. [PMID: 33811981 DOI: 10.1016/j.joen.2021.03.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Regenerative endodontic procedures (REPs) are intended to repair and regenerate part of the pulp-dentin complex. The aim of this study was to systematically appraise the existing evidence on the effectiveness of REPs on mature teeth with pulp necrosis and apical periodontitis. METHODS Electronic database and hand searches were performed on 8 databases of published and unpublished literature from inception to January 3, 2021, for the identification of randomized controlled trials (RCTs) or prospective clinical trials. The related key words included "regenerative," "pulp revascularization," "revitalization procedure," and "necrotic mature teeth." A random effects meta-analysis was conducted assessing success as the main outcome treatment. Risk of bias was assessed through the Cochrane Risk of Bias 2.0 tool, and the quality of the evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Of the 337 initial hits, 4 RCTs were eligible for inclusion, whereas 3 were included in the quantitative synthesis. Overall, there was no difference in the relative risk for a successful/unsuccessful treatment outcome between REPs or conventional treatment (3 studies, relative risk = 1.03; 95% confidence interval, 0.92-1.15; P = .61; heterogeneity I2 = 0.0%, P = .53; prediction interval = 0.51-2.09). Risk of bias ranged from low to raising some concerns, whereas the quality of the evidence was graded as moderate. CONCLUSIONS Based on moderate-quality evidence, REPs appear as a viable treatment alternative for mature necrotic teeth with periapical lesions at present. Furthermore, well-designed RCTs might also provide confirmatory evidence in this respect while also framing a backbone for standardization of the therapeutic protocol of REPs.
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Affiliation(s)
| | - Federico Foschi
- Department of Endodontics, Faculty of Dentistry, Oral and Craniofacial Sciences, Guy's Dental Hospital, London, United Kingdom; Department of Therapeutic Dentistry, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Despina Koletsi
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Giorgos N Tzanetakis
- Department of Endodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
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Singh H, Rathee K, Kaur A, Miglani N. Pulp Regeneration in an Immature Maxillary Central Incisor Using Hyaluronic Acid Hydrogel. Contemp Clin Dent 2021; 12:94-98. [PMID: 33967547 PMCID: PMC8092086 DOI: 10.4103/ccd.ccd_149_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/18/2020] [Accepted: 07/18/2020] [Indexed: 11/21/2022] Open
Abstract
Pulp regenerative procedure is one of the treatment options for endodontically involved immature permanent teeth. The regenerative endodontic procedure was performed in a child of 9 years. After thorough canal disinfection using triple antibiotic paste for 21 days, bleeding was induced from the apex to provide for the stem cells. After that hyaluronic acid (HA) hydrogel was introduced into the canal space to act as injectable scaffold for pulp regeneration. This was followed by mineral trioxide aggregate placement to provide tight seal from the coronal aspect. Later, the tooth was restored with composite restoration. This approach offers the clinicians great opportunity to physiologically strengthen the immature root walls. The present report presents a regenerative endodontic procedure with HA hydrogel for a traumatized central incisor with arrested root development. The continued root development in the present case suggests that this treatment option may be able to resume the root maturation process in immature teeth with open apices.
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Affiliation(s)
- Harveen Singh
- Department of Periodontics, Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India
| | - Kirti Rathee
- Department of Conservative and Endodontics, Inderprastha Dental College and Hospital, Ghaziabad, Uttar Pradesh, India
| | - Amandeep Kaur
- Department of Periodontics, Maharaja Ganga Singh Dental College and Research Centre, Sri Ganganagar, Rajasthan, India
| | - Neha Miglani
- Demonstrator, J.N. Kapoor DAV Centenary Dental College, Yamunanagar, Haryana, India
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Mayya A, Bhandary S, Kolakemar A, George AM. Management of necrotic immature permanent maxillary incisors using a modified technique of revascularisation. BMJ Case Rep 2021; 14:14/3/e240203. [PMID: 33731387 PMCID: PMC7978076 DOI: 10.1136/bcr-2020-240203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The management of necrotic immature permanent teeth has always been a challenge to endodontists. Various treatment modalities have been tried and tested for achieving a successful outcome. Revascularisation is one among these treatment options, which is gaining widespread attention among endodontists. The growing body of evidence demonstrating the success of revascularisation has led to different variations of this treatment option. Clinicians have over time used different scaffolds such as blood clot, collagen, platelet-rich fibrin (PRF) and platelet-rich plasma for revascularisation. This case report outlines the management of immature maxillary central incisors with pulp necrosis and large periapical lesions in a 19-year-old female patient with a modified technique of revascularisation by combining PRF and blood clot. At the end of 12 months, the patient was completely asymptomatic along with regression of the periapical lesions.
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Affiliation(s)
- Arun Mayya
- Conservative Dentistry and Endodontics, Srinivas Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Shruti Bhandary
- Conservative Dentistry and Endodontics, AJ Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Advith Kolakemar
- Conservative Dentistry and Endodontics, AJ Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Ann Mary George
- Oral and Maxillofacial Surgery, Manipal University College Malaysia, Melaka, Malaysia
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Lin LM, Huang GTJ, Sigurdsson A, Kahler B. Clinical cell-based versus cell-free regenerative endodontics: clarification of concept and term. Int Endod J 2021; 54:887-901. [PMID: 33389773 DOI: 10.1111/iej.13471] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 12/17/2022]
Abstract
There is no consensus on the true meaning of clinical regenerative endodontics, and there is confusion over the concept and the term. Commonly used terms include revitalization and revascularization. The clinical methods for endodontic revitalization procedures and the tissue engineering concept differ depending on whether there is exogenous delivery of cells - called cell therapy, or not. Here, in this review, the difference is clarified by emphasizing the correct terminology: cell-free versus cell-based regenerative endodontic therapy (CF-RET versus CB-RET). The revitalization procedures practised clinically do not fit into the modern tissue engineering concepts of pulp regeneration but can be categorized as CF-RET. The modern tissue engineering concept in pulp regeneration is a CB-RET, which so far is at the clinical trial stage. However, histological examination of teeth following regenerative endodontic treatments reveals healing with repair derived from stem cells that originate from the periodontal, bone and other tissues. The aim of regenerative endodontics is regeneration of the pulp-dentine complex. This review discusses why CF-RET is unlikely to regenerate a pulp-dentine complex with current protocols. The American Association of Endodontists and the European Society of Endodontology have not yet recommended autologous stem cell transplantation (CB-RERT) which aspires for regeneration. Therefore, an understanding of the concept, term, difficulties and differences in current protocols is important for the clinician. However, rather than being discouraged that ideal regeneration has not been achieved to date, repair can be an acceptable outcome in clinical regenerative endodontics as it has also been accepted in medicine. Repair should also be considered in the context that resolution of the clinical signs/symptoms of pulp necrosis/apical periodontitis is generally reliably obtained in clinical regenerative endodontics.
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Affiliation(s)
- L M Lin
- College of Dentistry, New York University, New York, NY, USA
| | - G T-J Huang
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN, USA
| | - A Sigurdsson
- College of Dentistry, New York University, New York, NY, USA
| | - B Kahler
- School of Dentistry, University of Queensland, Brisbane, Australia
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Nawal RR, Utneja S, Sharma V, Yadav S, Talwar S. Long-term follow-up of traumatized immature necrotic permanent teeth treated with regenerative endodontic protocol using platelet-rich fibrin: A prospective case series. J Conserv Dent 2021; 23:417-421. [PMID: 33623247 PMCID: PMC7883791 DOI: 10.4103/jcd.jcd_460_20] [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: 09/09/2020] [Revised: 09/23/2020] [Accepted: 10/05/2020] [Indexed: 11/04/2022] Open
Abstract
The purpose of this prospective case series was to report the long-term clinical and radiographic outcomes of regenerative endodontic procedures (REP) using platelet-rich fibrin (PRF), in traumatized immature permanent teeth with necrotic pulps. Six immature necrotic permanent maxillary central incisors from six patients were treated with REP supplemented with PRF. Patients were recalled at 6, 12, 18, 24, 36, 48, and 60 months. Radiographic changes in the radiographic root area (RRA), apical diameter, root thickness, and root length were quantified. Clinically, tooth survival in terms of tooth retention in the arch and absence of any sign and symptoms of endodontic pathology were noted. All the teeth survived and met the clinical criteria for success throughout the follow-up period. Follow-up radiographs at 5 years revealed complete resolution of the periapical lesions in all patients and the average apical diameter decrease was 30.96%. An average increase of 13.18% for root length, 40.20% for root thickness, and 26.35% for RRA were noted.
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Affiliation(s)
- Ruchika Roongta Nawal
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Shivani Utneja
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Vivek Sharma
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Sudha Yadav
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Sangeeta Talwar
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
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What is the best long-term treatment modality for immature permanent teeth with pulp necrosis and apical periodontitis? Eur Arch Paediatr Dent 2021; 22:311-340. [PMID: 33420674 PMCID: PMC8213569 DOI: 10.1007/s40368-020-00575-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/17/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate and assess the current knowledge about apexification and regenerative techniques as a meaningful treatment modality and to map the scientific evidence for the efficacy of both methods for the management of traumatised immature teeth with pulp necrosis and apical periodontitis. METHODS This systematic review searched five databases: PubMed, Web of Science, Cochrane Library, Ovid (Medline), and Embase. Published articles written in English were considered for inclusion. The following keywords were used: Regenerative endodontic treatment OR regenerat* OR revital* OR endodontic regeneration OR regenerative endodontics OR pulp revascularization OR revasculari* OR 'traumatized immature teeth'. Only peer-reviewed studies with a study size of at least 20 cases followed up for 24 months were included. Eligibility assessment was performed independently in a blinded manner by three reviewers and disagreements were resolved by consensus. Subgroup analyses were performed on three clinical outcomes: survival, success, and continued root development. RESULTS Seven full texts out of 1359 citations were included and conventional content analysis was performed. Most of the identified citations were case reports and case series. CONCLUSIONS In the present systematic review, the qualitative analysis revealed that both regenerative and apexification techniques had equal rates of success and survival and proved to be effective in the treatment of immature necrotic permanent teeth. Endodontic regenerative techniques appear to be superior to apexification techniques in terms of stimulation of root maturation, i.e. root wall thickening and root lengthening. Knowledge gaps were identified regarding the treatment and follow-up protocols for both techniques.
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Leite ML, Soares DG, Anovazzi G, Mendes Soares IP, Hebling J, de Souza Costa CA. Development of fibronectin-loaded nanofiber scaffolds for guided pulp tissue regeneration. J Biomed Mater Res B Appl Biomater 2020; 109:1244-1258. [PMID: 33381909 DOI: 10.1002/jbm.b.34785] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/28/2020] [Accepted: 12/08/2020] [Indexed: 01/26/2023]
Abstract
Fibronectin (FN)-loaded nanofiber scaffolds were developed and assessed concerning their bioactive potential on human apical papilla cells (hAPCs). First, random (NR) and aligned (NA) nanofiber scaffolds of polycaprolactone (PCL) were obtained by electrospinning technique and their biological properties were evaluated. The best formulations of NR and NA were loaded with 0, 5, or 10 μg/ml of FN and their bioactivity was assessed. Finally, FN-loaded NR and NA tubular scaffolds were prepared and their chemotactic potential was analyzed using an in vitro model to mimic the pulp regeneration of teeth with incomplete root formation. All scaffolds tested were cytocompatible. However, NR and NA based on 10% PCL promoted the highest hAPCs proliferation, adhesion and spreading. Polygonal and elongated cells were observed on NR and NA, respectively. The higher the concentration of FN added to the scaffolds, greater cell migration, viability, proliferation, adhesion and spreading, as well as collagen synthesis and gene expression (ITGA5, ITGAV, COL1A1, COL3A1). In addition, tubular scaffolds with NA loaded with FN (10 μg/ml) showed the highest chemotactic potential on hAPCs. It was concluded that FN-loaded NA scaffolds may be an interesting biomaterial to promote hAPCs-mediated pulp regeneration of endodontically compromised teeth with incomplete root formation.
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Affiliation(s)
- Maria Luísa Leite
- Department of Dental Materials and Prosthodontics, Araraquara School of Dentistry, Universidade Estadual Paulista, Araraquara, Brazil
| | - Diana Gabriela Soares
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, Sao Paulo University, Bauru, Brazil
| | - Giovana Anovazzi
- Departament of Orthodontics and Pediatric Dentistry, Araraquara School of Dentistry, São Paulo State University, Araraquara, Brazil
| | - Igor Paulino Mendes Soares
- Department of Dental Materials and Prosthodontics, Araraquara School of Dentistry, Universidade Estadual Paulista, Araraquara, Brazil
| | - Josimeri Hebling
- Departament of Orthodontics and Pediatric Dentistry, Araraquara School of Dentistry, São Paulo State University, Araraquara, Brazil
| | - Carlos Alberto de Souza Costa
- Department of Physiology and Pathology, Araraquara School of Dentistry, São Paulo State University, Araraquara, Brazil
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Alenazy MS, Al-Nazhan S, Mosadomi HA. Histologic, Radiographic, and Micro-Computed Tomography Evaluation of Experimentally Enlarged Root Apices in Dog Teeth with Apical Periodontitis after Regenerative Treatment. Curr Ther Res Clin Exp 2020; 94:100620. [PMID: 34306261 PMCID: PMC8296077 DOI: 10.1016/j.curtheres.2020.100620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/21/2020] [Accepted: 12/05/2020] [Indexed: 01/09/2023] Open
Abstract
Background Blood clot (BC) and platelet-rich fibrin (PRF) has been successfully used to biologically treat immature roots. It is nowadays considered the treatment of choice. Objective This study aimed to determine the ability of PRF and BC scaffolds to enhance regeneration of disinfected root canals and healing of apical periodontitis within experimentally enlarged canal apices of dog teeth. Methods Forty-eight root canals in 28 mandibular premolars from 4 healthy adult dogs were experimentally infected and developed apical periodontitis. The teeth were randomly divided into a control (untreated) group, a disinfection only group, a group that received disinfection and a BC scaffold, and a group that received disinfection and a BC + PRF scaffold. Healing of the apical radiolucency was evaluated by conventional radiography, micro-computed tomography, and histology after 3 months. The data were analyzed by χ2 test. Results Healing was achieved in 49% of roots as seen on radiograph and 43% as seen on micro-computed tomography. There was no significant between-group difference in the presence or absence of periapical radiolucency in the mesial roots when seen on conventional images (P = 0.255), but there was a significant difference in the distal roots (P = 0.001); similarly, on micro-computed tomography, there was no significant between-group difference in the mesial roots (P = 0.174) but there was a significant difference in the distal roots (P = 0.001). Histologically, apical closure was significantly not greater in the BC + PRF scaffold group than in the BC scaffold group (P = 0.001). Conclusions A mix of BC + PRF scaffold did not improve tissue regeneration in experimentally enlarged dog teeth. (Curr Ther Res Clin Exp. 2021; 82:XXX–XXX) © 2021 Elsevier HS Journals, Inc.
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Affiliation(s)
- Mohammed S Alenazy
- East of Riyadh Dental center-Second Health Cluster, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Saad Al-Nazhan
- Division of Endodontics, Department of Restorative Dentistry, College of Dentistry, Riyadh Elm University, Riyadh, Kingdom of Saudi Arabia
| | - Hezekiah A Mosadomi
- Division of Oral Diagnostic Sciences, Department of Oral and Maxillofacial Pathology, College of Dentistry, Riyadh Elm University, Riyadh, Kingdom of Saudi Arabia
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Abbass MMS, El-Rashidy AA, Sadek KM, Moshy SE, Radwan IA, Rady D, Dörfer CE, Fawzy El-Sayed KM. Hydrogels and Dentin-Pulp Complex Regeneration: From the Benchtop to Clinical Translation. Polymers (Basel) 2020; 12:E2935. [PMID: 33316886 PMCID: PMC7763835 DOI: 10.3390/polym12122935] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023] Open
Abstract
Dentin-pulp complex is a term which refers to the dental pulp (DP) surrounded by dentin along its peripheries. Dentin and dental pulp are highly specialized tissues, which can be affected by various insults, primarily by dental caries. Regeneration of the dentin-pulp complex is of paramount importance to regain tooth vitality. The regenerative endodontic procedure (REP) is a relatively current approach, which aims to regenerate the dentin-pulp complex through stimulating the differentiation of resident or transplanted stem/progenitor cells. Hydrogel-based scaffolds are a unique category of three dimensional polymeric networks with high water content. They are hydrophilic, biocompatible, with tunable degradation patterns and mechanical properties, in addition to the ability to be loaded with various bioactive molecules. Furthermore, hydrogels have a considerable degree of flexibility and elasticity, mimicking the cell extracellular matrix (ECM), particularly that of the DP. The current review presents how for dentin-pulp complex regeneration, the application of injectable hydrogels combined with stem/progenitor cells could represent a promising approach. According to the source of the polymeric chain forming the hydrogel, they can be classified into natural, synthetic or hybrid hydrogels, combining natural and synthetic ones. Natural polymers are bioactive, highly biocompatible, and biodegradable by naturally occurring enzymes or via hydrolysis. On the other hand, synthetic polymers offer tunable mechanical properties, thermostability and durability as compared to natural hydrogels. Hybrid hydrogels combine the benefits of synthetic and natural polymers. Hydrogels can be biofunctionalized with cell-binding sequences as arginine-glycine-aspartic acid (RGD), can be used for local delivery of bioactive molecules and cellularized with stem cells for dentin-pulp regeneration. Formulating a hydrogel scaffold material fulfilling the required criteria in regenerative endodontics is still an area of active research, which shows promising potential for replacing conventional endodontic treatments in the near future.
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Affiliation(s)
- Marwa M. S. Abbass
- Oral Biology Department, Faculty of Dentistry, Cairo University, Cairo 11562, Egypt; (M.M.S.A.); (S.E.M.); (I.A.R.); (D.R.)
- Stem Cells and Tissue Engineering Research Group, Faculty of Dentistry, Cairo University, Cairo 11562, Egypt; (A.A.E.-R.); (K.M.S.)
| | - Aiah A. El-Rashidy
- Stem Cells and Tissue Engineering Research Group, Faculty of Dentistry, Cairo University, Cairo 11562, Egypt; (A.A.E.-R.); (K.M.S.)
- Biomaterials Department, Faculty of Dentistry, Cairo University, Cairo 11562, Egypt
| | - Khadiga M. Sadek
- Stem Cells and Tissue Engineering Research Group, Faculty of Dentistry, Cairo University, Cairo 11562, Egypt; (A.A.E.-R.); (K.M.S.)
- Biomaterials Department, Faculty of Dentistry, Cairo University, Cairo 11562, Egypt
| | - Sara El Moshy
- Oral Biology Department, Faculty of Dentistry, Cairo University, Cairo 11562, Egypt; (M.M.S.A.); (S.E.M.); (I.A.R.); (D.R.)
- Stem Cells and Tissue Engineering Research Group, Faculty of Dentistry, Cairo University, Cairo 11562, Egypt; (A.A.E.-R.); (K.M.S.)
| | - Israa Ahmed Radwan
- Oral Biology Department, Faculty of Dentistry, Cairo University, Cairo 11562, Egypt; (M.M.S.A.); (S.E.M.); (I.A.R.); (D.R.)
- Stem Cells and Tissue Engineering Research Group, Faculty of Dentistry, Cairo University, Cairo 11562, Egypt; (A.A.E.-R.); (K.M.S.)
| | - Dina Rady
- Oral Biology Department, Faculty of Dentistry, Cairo University, Cairo 11562, Egypt; (M.M.S.A.); (S.E.M.); (I.A.R.); (D.R.)
- Stem Cells and Tissue Engineering Research Group, Faculty of Dentistry, Cairo University, Cairo 11562, Egypt; (A.A.E.-R.); (K.M.S.)
| | - Christof E. Dörfer
- Clinic for Conservative Dentistry and Periodontology, School of Dental Medicine, Christian Albrechts University, 24105 Kiel, Germany;
| | - Karim M. Fawzy El-Sayed
- Stem Cells and Tissue Engineering Research Group, Faculty of Dentistry, Cairo University, Cairo 11562, Egypt; (A.A.E.-R.); (K.M.S.)
- Clinic for Conservative Dentistry and Periodontology, School of Dental Medicine, Christian Albrechts University, 24105 Kiel, Germany;
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University, Cairo 11562, Egypt
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Ong TK, Lim GS, Singh M, Fial AV. Quantitative Assessment of Root Development after Regenerative Endodontic Therapy: A Systematic Review and Meta-Analysis. J Endod 2020; 46:1856-1866.e2. [DOI: 10.1016/j.joen.2020.08.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/07/2020] [Accepted: 08/13/2020] [Indexed: 12/15/2022]
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Sallam NM, El Kalla IH, Wahba AH, Salama NM. Clinical and radiographic evaluation of platelet-rich fibrin for revascularization of necrotic immature permanent teeth: A controlled clinical trial. PEDIATRIC DENTAL JOURNAL 2020. [DOI: 10.1016/j.pdj.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pereira AC, Oliveira ML, Cerqueira-Neto ACCL, Vargas-Neto J, Nagata JY, Gomes BPFA, Ferraz CCR, de Almeida JFA, de-Jesus-Soares A. Outcomes of traumatised immature teeth treated with apexification or regenerative endodontic procedure: a retrospective study. AUST ENDOD J 2020; 47:178-187. [PMID: 33094527 DOI: 10.1111/aej.12447] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/22/2020] [Accepted: 09/15/2020] [Indexed: 11/30/2022]
Abstract
This study compares the clinical success rate and continued radiographic root development of apexification and regenerative endodontic procedure in traumatised immature permanent teeth, and proposes a method to evaluate apical convergence, namely apical angle. Clinical and radiological data were collected from 44 treated teeth (22 with apexification and 22 with regenerative endodontic procedure). The preoperative and follow-up periapical radiographs were analysed to calculate the percentage changes in root length, root width, apical diameter and apical angle. The success rates for complete healing with apexification and regenerative endodontic procedure were 86.36% and 95.45%, respectively. Radiographically, regenerative endodontic procedure showed significantly greater percentage changes in root width only (P < 0.05). Apexification and regenerative endodontic procedure provide satisfactory outcomes concerning clinical success rates. Continued root development in regenerative endodontic procedure was similar to apexification, except for root width. Apical angle allowed us to assess the convergence of the root canal walls.
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Affiliation(s)
- Andrea Cardoso Pereira
- Endodontics Division, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - Matheus Lima Oliveira
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - Ana Carolina C L Cerqueira-Neto
- Endodontics Division, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - Júlio Vargas-Neto
- Endodontics Division, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - Juliana Yuri Nagata
- Department of Dentistry, Endodontics Area, Federal University of Sergipe - UFS, Lagarto, SE, Brazil
| | - Brenda P F A Gomes
- Endodontics Division, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - Caio Cezar Randi Ferraz
- Endodontics Division, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - José Flávio Affonso de Almeida
- Endodontics Division, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - Adriana de-Jesus-Soares
- Endodontics Division, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas - UNICAMP, Piracicaba, SP, Brazil
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Clinical and Molecular Microbiological Evaluation of Regenerative Endodontic Procedures in Immature Permanent Teeth. J Endod 2020; 46:1448-1454. [DOI: 10.1016/j.joen.2020.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/17/2020] [Accepted: 07/04/2020] [Indexed: 11/17/2022]
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El Halaby HM, Abu-Seida AM, Fawzy MI, Farid MH, Bastawy HA. Evaluation of the regenerative potential of dentin conditioning and naturally derived scaffold for necrotic immature permanent teeth in a dog model. Int J Exp Pathol 2020; 101:264-276. [PMID: 32985739 DOI: 10.1111/iep.12372] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 06/29/2020] [Accepted: 07/26/2020] [Indexed: 02/05/2023] Open
Abstract
This study evaluated the outcome of partial exposure of dentin matrix to ethylenediaminetetraacetic acid (EDTA) and application of platelet-rich fibrin (PRF) scaffold on regeneration of necrotic immature permanent teeth in a dog model. The present study was carried out on 216 permanent immature roots in nine mongrel dogs aged 6-9 months. Pulp necrosis and periapical pathosis were induced in 180 roots. These roots were divided into five equal groups (36 roots each) according to the treatment protocol: group I: blood clot; group II: 17% EDTA solution and blood clot; group III: PRF; group IV: 17% EDTA solution and PRF; and group V: without treatment (positive control). The negative control group (group VI) represented 36 untouched normal roots for normal maturation. The groups were followed up for 1, 2 and 3 months (subgroups). Maturation of the roots was monitored by radiography and histopathology. All data were statistically analysed. Group IV exhibited the highest increase in root length and thickness, decrease in apical diameter, the highest score of vital tissue infiltration and least inflammatory scores. There was a significant difference regarding the increase in root length and thickness and decrease in apical diameter in all subgroups of the experimental and negative control groups (P ≤ .05). PRF has a better regenerative potential than the blood clot during treatment of immature permanent teeth with necrotic pulp. Inclusion of 17% EDTA solution as a final irrigation enhances the regenerative potential of both PRF and blood clot.
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Affiliation(s)
- Hisham M El Halaby
- Department of Endodontics, Faculty of Dental Medicine, Assiut University, Assiut, Egypt
| | - Ashraf M Abu-Seida
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | - Mervat I Fawzy
- Department of Endodontics, Faculty of Dental Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Mona H Farid
- Department of Oral Biology, Faculty of Dental Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Hagar A Bastawy
- Department of Endodontics, Faculty of Dental Medicine for Girls, Al-Azhar University, Cairo, Egypt.,Endodontic Department, Faculty of Dentistry, King Abdulaziz University (KAU), Jeddah, Saudi Arabia
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Jun JH, Chun KA, Kum KY, Lee W, Shon WJ, Yoo YJ, Baek SH. Effect of mineral trioxide aggregate plug location on root development in regenerative endodontic procedure. Odontology 2020; 109:411-421. [PMID: 32980911 DOI: 10.1007/s10266-020-00556-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/11/2020] [Indexed: 11/29/2022]
Abstract
This retrospective study investigated the effect of mineral trioxide aggregate (MTA) plug location on treatment outcome and root maturation after regenerative endodontic procedures (REP) in immature permanent teeth. Thirty-three roots (n = 33) in cohort that underwent REP consistently according to AAE guideline were included to trace radiographic changes for the root and canal dimensions. Based on intraoral radiographs, roots were divided into two groups depending on the location of MTA plug within whole root length: coronal group (n = 14), within the upper half; apical group (n = 19), within the lower half. Periapical radiographs were standardized to assess treatment outcomes and root maturation including root development stages and digital measurements on the change ratios of root length, apex width, radiographic root area (RRA), modified RRA (mRRA), and periapical rarefaction area. The data were statistically analysed using the Mann-Whitney test. The patients' average age was 11 years and 10 months, with no significant between-group difference in sex. Premolars were the most prevalent tooth type (62.1%), followed by incisiors and molars. Pre-existing symptoms and signs subsided within 6 months in all cases. The teeth showed similar radiographic root development in both groups (P > 0.05). However, mRRA increase ratio was significantly higher in apical group than that in coronal group at early (< 6 months) and late (< 24 months) periods of follow-up (P < 0.05). Significant changes of root development stage were observed at early period for apical group and at late period for coronal group (P < 0.05). All the observed cases showed continuing root development after REP. Significant changes in root developments occurred at different follow-up periods according to the location of MTA plugs.
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Affiliation(s)
- Joon-Hee Jun
- Department of Conservative Dentistry, Dental Research Institute, Seoul National University School of Dentistry, Daehak-ro 101, Jongro-Gu, Seoul, 03080, Republic of Korea
| | - Kyung-A Chun
- Department of Conservative Dentistry, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Kee-Yeon Kum
- Department of Conservative Dentistry, Dental Research Institute, Seoul National University School of Dentistry, Daehak-ro 101, Jongro-Gu, Seoul, 03080, Republic of Korea
- National Dental Care Center for Persons with Special Cares, Seoul, Republic of Korea
| | - WooCheol Lee
- Department of Conservative Dentistry, Dental Research Institute, Seoul National University School of Dentistry, Daehak-ro 101, Jongro-Gu, Seoul, 03080, Republic of Korea
| | - Won-Jun Shon
- Department of Conservative Dentistry, Dental Research Institute, Seoul National University School of Dentistry, Daehak-ro 101, Jongro-Gu, Seoul, 03080, Republic of Korea
| | - Yeon-Jee Yoo
- Department of Comprehensive Treatment Center, Seoul National University Dental Hospital, Daehak-ro, 101, Jongro-Gu, Seoul, 03080, Republic of Korea.
| | - Seung-Ho Baek
- Department of Conservative Dentistry, Dental Research Institute, Seoul National University School of Dentistry, Daehak-ro 101, Jongro-Gu, Seoul, 03080, Republic of Korea.
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Pereira AC, Oliveira MLD, Cerqueira-Neto ACCL, Gomes BPFA, Ferraz CCR, Almeida JFAD, Marciano MA, DE-Jesus-Soares A. Treatment outcomes of pulp revascularization in traumatized immature teeth using calcium hydroxide and 2% chlorhexidine gel as intracanal medication. J Appl Oral Sci 2020; 28:e20200217. [PMID: 32997087 PMCID: PMC7518246 DOI: 10.1590/1678-7757-2020-0217] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/17/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Pulp revascularization is an effective treatment for immature necrotic teeth. Calcium hydroxide has been used in pulp revascularization as an intracanal medication due to its antimicrobial action and the non-exhibition of crown discoloration and cytotoxicity for stem cells from the apical papilla. Our study aimed to investigate the clinical success and quantitative radiographic changes of root development in immature traumatized teeth using calcium hydroxide plus 2% chlorhexidine gel as intracanal medication. METHODOLOGY In this retrospective study, 16 patients were treated with a standardized pulp revascularization protocol. Calcium hydroxide and 2% chlorhexidine gel were manipulated in a 1:1 (v/v) ratio and inserted into root canals with Lentulo spirals (Dentsply Maillefer, Baillaigues, Switzerland). Patients were followed up for a period from 9 to 36 months for the evaluation of clinical and radiological data. Radiographic measurements of root length, root width, apical diameter, and MTA placement from the apex were quantified using software ImageJ. Wilcoxon test and t-test were used, according to nonparametric or parametric data, respectively, for changes over time in root length, root width, and apical diameter. RESULTS Fifteen teeth survived during the follow-up period (93.75%) and met the criteria for clinical success. Although the changes seem to be very small in many cases, significant increases in the average root length (14.28%, p<0.0001), root width (8.12%, p=0.0196), and decrease in apical diameter (48.37%, p=0.0007) were observed. MTA placement from the apex and age at the time of treatment was not significantly associated with the quantitative radiographic outcomes. CONCLUSIONS Pulp revascularization in traumatized immature teeth treated with calcium hydroxide plus 2% chlorhexidine gel as intracanal medication had high success and survival rates, showing periodontal healing and resolution of signs and symptoms. However, concerning the continued root development, the outcomes can still be considered unpredictable.
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Affiliation(s)
- Andrea Cardoso Pereira
- Universidade Estadual Campinas - UNICAMP. Faculdade de Odontologia de Piracicaba. Departamento de Odontologia Restauradora, área de Endodontia. Piracicaba, SP, Brasil
| | - Matheus Lima de Oliveira
- Universidade Estadual Campinas - UNICAMP. Faculdade de Odontologia de Piracicaba. Departamento de Diagnóstico Oral, área de Radiologia Oral, Piracicaba, SP, Brasil
| | - Ana Carolina C L Cerqueira-Neto
- Universidade Estadual Campinas - UNICAMP. Faculdade de Odontologia de Piracicaba. Departamento de Odontologia Restauradora, área de Endodontia. Piracicaba, SP, Brasil
| | - Brenda P F A Gomes
- Universidade Estadual Campinas - UNICAMP. Faculdade de Odontologia de Piracicaba. Departamento de Odontologia Restauradora, área de Endodontia. Piracicaba, SP, Brasil
| | - Caio Cezar Randi Ferraz
- Universidade Estadual Campinas - UNICAMP. Faculdade de Odontologia de Piracicaba. Departamento de Odontologia Restauradora, área de Endodontia. Piracicaba, SP, Brasil
| | - José Flávio Affonso de Almeida
- Universidade Estadual Campinas - UNICAMP. Faculdade de Odontologia de Piracicaba. Departamento de Odontologia Restauradora, área de Endodontia. Piracicaba, SP, Brasil
| | - Marina Angélica Marciano
- Universidade Estadual Campinas - UNICAMP. Faculdade de Odontologia de Piracicaba. Departamento de Odontologia Restauradora, área de Endodontia. Piracicaba, SP, Brasil
| | - Adriana DE-Jesus-Soares
- Universidade Estadual Campinas - UNICAMP. Faculdade de Odontologia de Piracicaba. Departamento de Odontologia Restauradora, área de Endodontia. Piracicaba, SP, Brasil
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81
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Bogen G, Ricucci D. Mineral trioxide aggregate apexification: a 20-year case review. AUST ENDOD J 2020; 47:335-342. [PMID: 32896968 DOI: 10.1111/aej.12442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/03/2020] [Accepted: 08/09/2020] [Indexed: 12/31/2022]
Abstract
Apexification strategies in traumatised non-vital immature permanent teeth can promote root-end closure and continued root development. However, traumatic injuries may compromise the integrity of generative cells of the apical papilla responsible for root maturation. This report describes the long-term treatment outcome of mineral trioxide aggregate (MTA) apexification managed with late-term surgical intervention. A seven-year-old male reported with swelling and suppuration associated with a traumatised maxillary left central incisor (#21). After palliative treatment and MTA apexification procedures, the incisor demonstrated normal function during a 14.5-year period with radiographic evidence of atypical radicular elongation. Seventeen years after initial treatment, the patient presented with mid-plate buccal swelling and surgical treatment was completed involving root resection, biopsy of a spherical mineralised tissue specimen and placement of MTA root-end filling. Periapical healing and normal tooth function was evident at the 20-year review.
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Affiliation(s)
- George Bogen
- School of Dentistry, University of Queensland, Brisbane, QLD, Australia
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83
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Tzanetakis GN, Giannakoulas DG, Papanakou S, Gizani S, Lygidakis N. Regenerative endodontic therapy of immature permanent molars with pulp necrosis: a cases series and a literature review. Eur Arch Paediatr Dent 2020; 22:515-525. [PMID: 32677019 DOI: 10.1007/s40368-020-00550-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/30/2020] [Indexed: 02/08/2023]
Abstract
AIM To present the application and the outcome of the regenerative endodontic therapy (RET) in a series of symptomatic immature mandibular molars with pulp necrosis and apical periodontitis and to review the relevant literature for the documentation of the procedure as a potential treatment option. METHODS Three young male patients were referred with pain in the left mandibular region resulting from pulp necrosis and apical periodontitis of the first permanent molar. Regenerative endodontic approach was performed for the complete resolution of the lesions and the thickening of the apical root canal walls. The databases of Medline, Pubmed and Google Scholar were also searched for articles in which a regenerative approach has been undertaken for the endodontic management of immature permanent molars with pulp necrosis and apical periodontitis. RESULTS Follow-up examinations showed that the teeth remained functional without any signs or symptoms. Final radiographic examination at 12, 18 and 36 months, respectively, revealed complete resolution of the lesions and complete apical closure in the two out of three cases. The search of the literature revealed the existence of only 25 clinical articles in which necrotic immature molars were treated by the regenerative approach. The total number of the treated teeth were 46. CONCLUSIONS Regenerative endodontic approach may be applied in posterior non-vital molar teeth with a possible favorable outcome. However, the literature support for the documentation of the procedure as a predictable and reproducible treatment option in posterior immature molar teeth is at present limited.
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Affiliation(s)
- G N Tzanetakis
- Department of Endodontics, Dental School, University of Athens, Greece Private, 421B Mesogeion Ave., Agia Paraskevi, 15343, Athens, Greece.
| | - D G Giannakoulas
- Department of Endodontics, Dental School, University of Athens, Greece Private, 421B Mesogeion Ave., Agia Paraskevi, 15343, Athens, Greece
| | - S Papanakou
- Department of Paediatric Dentistry, Dental School, University of Athens, Greece Private, Athens, Greece
| | - S Gizani
- Department of Paediatric Dentistry, Dental School, University of Athens, Greece Private, Athens, Greece
| | - N Lygidakis
- Department of Paediatric Dentistry, Dental School, University of Athens, Greece Private, Athens, Greece
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Mittmann CW, Kostka E, Ballout H, Preus M, Preissner R, Karaman M, Preissner S. Outcome of revascularization therapy in traumatized immature incisors. BMC Oral Health 2020; 20:207. [PMID: 32664918 PMCID: PMC7362656 DOI: 10.1186/s12903-020-01193-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/09/2020] [Indexed: 11/25/2022] Open
Abstract
Background The aim of this retrospective analysis was to evaluate the clinical and radiological outcome of revascularization therapy in traumatized permanent incisors to determine whether this approach could be implemented into clinical routine. Methods A total of 16 traumatized incisors (either avulsion or severe luxation/intrusion) with open apices (> 1 mm) that underwent revascularization following a standardized protocol were analyzed with a mean follow-up of 22 months. Radiographs and clinical parameters (such as root length, pulp space, dentin wall width, apical foramen, alveolar bone loss, ankylosis/mobility, supra−/infraposition, discoloration, probing depth) were compared pre- and postoperatively and statistically analyzed. Results Over the follow-up period, 81.3% of the teeth survived revascularization and regained sensitivity, while 18.7% failed, as they had to be extracted due to serious root resorption. Regarding radiographic outcomes a significant difference could only be found in the decrease of apical foramina (p = 0.04). The other parameters showed no significant difference between pre- and postoperative measurements. More than half of the teeth (56.3%) developed root resorptions and 31.3% displayed signs of ankylosis and 92.9% developed discolorations during follow-up. However, 85.7% of the teeth maintained the bone level and outcomes of mobility showed a significant solidification. Conclusions Revascularization is a promising approach for the treatment of immature incisors to regain sensitivity and to enhance apical closure and at least to maintain alveolar bone in terms of a socket preservation. Further studies have to be performed to determine ideal conditions (type of trauma, age, width of apical foramen) for a revascularization.
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Affiliation(s)
- Carolina W Mittmann
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Assmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Eckehard Kostka
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Assmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Husam Ballout
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Assmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Mareike Preus
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Assmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Robert Preissner
- Institute of Physiology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Philippstrasse 12, 10115, Berlin, Germany
| | - Murat Karaman
- Institute of Physiology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Philippstrasse 12, 10115, Berlin, Germany
| | - Saskia Preissner
- Department Oral, Maxillary and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin. Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
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Regenerative Endodontic Therapy in the Management of Immature Necrotic Permanent Dentition: A Systematic Review. ScientificWorldJournal 2020; 2020:7954357. [PMID: 32765197 PMCID: PMC7374232 DOI: 10.1155/2020/7954357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/22/2020] [Accepted: 06/27/2020] [Indexed: 12/25/2022] Open
Abstract
Materials and Methods The electronic databases PubMed and Google Scholar were used to search the literature for relevant studies after applying specific inclusion and exclusion criteria. Studies that fulfilled both the inclusion and exclusion criteria were included in this systematic review. The search was conducted by two independent reviewers following the PRISMA guidelines. Results Only 46 studies that fulfilled both the inclusion and exclusion criteria, which were conducted within the last 10 years, were included in this systematic review. These studies investigated different aspects of regenerative endodontic therapy including different types of scaffolds, intracanal medications, pulpal space/barriers, root maturation stage, follow-up duration, and updated studies on their use in the management of immature necrotic permanent teeth. Conclusions This review concluded the compiled data observed that endodontic regenerative therapy was more efficient in treating immature necrotic permanent teeth and offered a greater advantage that should lead to wider acceptance among endodontists for effective results compared to different treatment options. However, more clinical trials with a standardized protocol and defined clinical, radiographic, and histopathological outcomes with longer follow-up periods are warranted.
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Rizk HM, Salah AL-Deen MS, Emam AA. Pulp Revascularization/Revitalization of Bilateral Upper Necrotic Immature Permanent Central Incisors with Blood Clot vs Platelet-rich Fibrin Scaffolds-A Split-mouth Double-blind Randomized Controlled Trial. Int J Clin Pediatr Dent 2020; 13:337-343. [PMID: 33149405 PMCID: PMC7586471 DOI: 10.5005/jp-journals-10005-1788] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Clinical and radiographic evaluation of the regeneration of bilateral necrotic upper permanent central incisors with open apex using blood clot (BC) and platelet-rich fibrin (PRF) scaffolds. TRIAL DESIGN Split-mouth double-blind parallel arm randomized controlled clinical trial. MATERIALS AND METHODS Randomization and blinding: The study started with 15 patients with bilateral necrotic upper permanent central incisors with open apex. Computer-generated tables were used to allocate treatments. The two maxillary central incisors were randomly assigned to either the control (BC scaffold) or the examined (PRF scaffold) groups. Participants: Thirteen patients aged 8-14 years fulfilled the study requirements. Follow-up was performed for 3, 6, 9, and 12 months. Standardized radiographs were collected each 3 months, and difference in measurements was calculated using Image J software. Primary outcomes measured were sinus/fistula formation, pain complaint, mobility grade, and swelling presence/absence. Radiographic: Root length elongation and increase in root thickness. Secondary outcomes were sensibility test and crown color change. Radiographic: Change in bone density and apical diameter. Radiographs that were standardized used during the follow-up time, and occurred changes were calculated using Image J software. RESULTS One patient was lost during follow-up; therefore, 24 treated teeth were analyzed, they showed 100% success rate. Platelet-rich fibrin teeth displayed a statistically significant growth in radiographic root length and width, increased periapical bone density, and a reduction in apical diameter when compared with BC. At the end of the follow-up period, all treated teeth were negative to sensibility test. Blood clot displayed greater crown discoloration in comparison to PRF group. CONCLUSION For teeth with open apex and necrotic pulp, revascularization using PRF is an appropriate substitute to BC. HOW TO CITE THIS ARTICLE Rizk HM, Salah AL-Deen MS, Emam AA. Pulp Revascularization/Revitalization of Bilateral Upper Necrotic Immature Permanent Central Incisors with Blood Clot vs Platelet-rich Fibrin Scaffolds-A Split-mouth Double-blind Randomized Controlled Trial. Int J Clin Pediatr Dent 2020;13(4):337-343.
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Affiliation(s)
- Hazim Mohamed Rizk
- Department of Pediatric Dentistry, Faculty of Dentistry, Suez Canal University, Ismailia, Egypt
| | | | - Asmaa Aly Emam
- Department of Pediatric Dentistry, Faculty of Dentistry, Suez Canal University, Ismailia, Egypt
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87
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Rizk HM, Salah Al-Deen MSM, Emam AA. Comparative evaluation of Platelet Rich Plasma (PRP) versus Platelet Rich Fibrin (PRF) scaffolds in regenerative endodontic treatment of immature necrotic permanent maxillary central incisors: A double blinded randomized controlled trial. Saudi Dent J 2020; 32:224-231. [PMID: 32647469 PMCID: PMC7336024 DOI: 10.1016/j.sdentj.2019.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/09/2019] [Accepted: 09/12/2019] [Indexed: 10/29/2022] Open
Abstract
OBJECTIVES The research aims to assess the regenerative potential of Platelet Rich Plasma (PRP) versus Platelet Rich Fibrin (PRF) scaffolds in immature permanent maxillary central incisors with necrotic pulps, clinically and radiographically. TRIAL DESIGN Double blinded parallel randomized controlled trial was implemented to identify the results. SUBJECT & METHODS The proposed study was conducted among 30 patients with maxillary necrotic permanent immature central incisors but only 26 patients fulfilled the study requirements. Group I was treated with PRP and Group II with PRF scaffolds. Follow up has been done every 3 months for one year. Primary outcomes were measured clinically: Pain, Mobility, Swelling, and Sinus/fistula. Radiographically: increase root length and width. Secondary outcomes were clinically: Discoloration and Sensibility test. Radiographically: increase in bone density measurements and decrease in apical diameter. Standardized radiographs were collected during the follow up period, and radiographic changes were measured by using Image J software. Statistical analysis was performed on 25 patients who had completed the study. RESULTS All 25 patients' teeth were survived during the 12-month follow-up period. PRP showed marginal increase in radiographic root length and width, periapical bone density and a decrease in apical diameter. No statistical significant differences were observed when it was compared with PRF. The teeth which were treated did not respond to sensibility test at the end of the study. PRF displayed statistical significant higher amount of crown discoloration when compared to PRP group. CONCLUSIONS For necrotic immature teeth, revascularization using PRP is an appropriate alternative to PRF and showed excellent 12-months prognosis.
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Affiliation(s)
- Hazim Mohamed Rizk
- Pediatric Dentistry, Preventive & Dental Public Health Department, Faculty of Dentistry, Suez Canal University, Egypt
| | | | - Asmaa Aly Emam
- Pediatric Dentistry, Preventive & Dental Public Health Department, Faculty of Dentistry, Suez Canal University, Egypt
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Chrepa V, Joon R, Austah O, Diogenes A, Hargreaves KM, Ezeldeen M, Ruparel NB. Clinical Outcomes of Immature Teeth Treated with Regenerative Endodontic Procedures-A San Antonio Study. J Endod 2020; 46:1074-1084. [PMID: 32560972 DOI: 10.1016/j.joen.2020.04.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/03/2020] [Accepted: 04/21/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Factors that influence clinical outcomes for regenerative endodontic procedures (REPs) are unknown. This retrospective study aimed to assess tooth healing, root development, pulp vitality, and esthetics post-REPs and categorize them into clinician- and patient-centered outcomes. Furthermore, this study identified significant predictors affecting such outcomes. METHODS Immature permanent teeth diagnosed with pulp necrosis treated with REPs between 2008 and 2018 with a minimum of 1-year follow-up were included. Outcomes included success and survival rates, changes in root development using 2-dimensional radiographic root area (RRA) and 3-dimensional measurements, pulp vitality, and tooth discoloration. Predictor variables of success included age, sex, etiology of pulp necrosis (PN), type of medicament, sodium hypochlorite (NaOCl) concentration, type of biomaterial used over the blood clot, and preoperative apical diagnosis. Statistical analyses included Cox proportional hazard analyses and generalized regression models. RESULTS Fifty-one teeth with an average of 2.1 years of follow-up satisfied the criteria. The survival rate was 92%. The success rate was 84.3% with age, etiology of PN, type of medicament, and NaOCl concentration being significant predictors of failure. Root development occurred in 91.4% of cases with age, sex, etiology of PN, type of medicament, NaOCl concentration, and apical diagnosis being significant predictors for RRA change. Positive pulp sensibility responses were associated with greater RRA change, and, finally, the type of biomaterial was a significant predictor for tooth discoloration after treatment. CONCLUSIONS REPs provide a high survival rate. Patient and clinical factors may affect outcomes, and this knowledge may help to define the criteria for optimal treatment planning of REPs.
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Affiliation(s)
- Vanessa Chrepa
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Ruchika Joon
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Obadah Austah
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Anibal Diogenes
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Kenneth M Hargreaves
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - 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
| | - Nikita B Ruparel
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
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ElSheshtawy AS, Nazzal H, El Shahawy OI, El Baz AA, Ismail SM, Kang J, Ezzat KM. The effect of platelet-rich plasma as a scaffold in regeneration/revitalization endodontics of immature permanent teeth assessed using 2-dimensional radiographs and cone beam computed tomography: a randomized controlled trial. Int Endod J 2020; 53:905-921. [PMID: 32249441 DOI: 10.1111/iej.13303] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/26/2020] [Indexed: 12/20/2022]
Abstract
AIM To assess the outcomes of platelet-rich plasma as a scaffold in regenerative/revitalization endodontics (RET) using cone beam computed tomography (CBCT) and 2-dimensional radiographs. METHODOLOGY Twenty-six healthy patients with mean age of 12.66 ± 4.47, and immature permanent anterior teeth with necrotic pulps, were randomly allocated to two groups, whereby RET was performed using platelet-rich plasma (PRP, test group) and blood clot (BLC, control group). Changes in root length (RL), root dentinal thickness (RDT), apical foramen width (AFW) and radiographic root area (RRA), were assessed using both radiographic methods, whilst changes in periapical area diameter (PAD) were assessed using CBCT, over a period of 12 months. T-test and chi-square/Fisher's exact tests were used to compare continuous and categorical data between BLC and PRP groups, respectively. Changes in RL, RDT, AFW, RRA and PAD were examined by comparing the two groups (PRP versus BLC) using multilevel modelling, considering the clustering effect of repeated measures of several teeth originating from the same participant. RESULTS Changes in RL, RDT, AFW, RRA and PAD, over time, were found to be significant for both groups. There was, however, no difference between the RET techniques (PRP versus BLC), using both radiographic and CBCT methods. The results of both assessment techniques (CBCT and 2-dimensional radiographic methods) were highly consistent (overall ICC ranged between 0.80 and 0.94). In addition, a significant effect of baseline PAD was found on RL, RRA and AD at 12 months (RL effect = -0.68, P < 0.001; RRA effect = -1.91, P = 0.025; AD effect = 0.08, P = 0.024). CONCLUSION The current study highlights successful and comparable clinical and radiographic outcomes of RET techniques using PRP and BLC. Standardized and calibrated 2-dimensional radiographic assessment was as effective as CBCT in assessing RET outcomes; therefore, the routine use of CBCT in RET is not recommended. Although an effect of baseline periapical lesion diameter on root development outcomes, at 12 months, were observed, more studies are recommended in order to assess such an effect.
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Affiliation(s)
- A S ElSheshtawy
- Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - H Nazzal
- Paediatric Dentistry Section, Hamad Dental Center, Hamad Medical Corporation, Doha, Qatar
| | - O I El Shahawy
- Department of Pediatric Dentistry, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - A A El Baz
- Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - S M Ismail
- Department of Endodontics, The National Research Center, Cairo, Egypt
| | - J Kang
- Department of Oral Biology, School of Dentistry, University of Leeds, Leeds, UK
| | - K M Ezzat
- Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
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90
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Evaluation of the Bactericidal Activity of a Hyaluronic Acid-Vehicled Clarithromycin Antibiotic Mixture by Confocal Laser Scanning Microscopy. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10080761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Confocal laser scanning microscopy (CLSM) was used to evaluate the antibacterial effect and depth of action of a novel clarithromycin-containing triple antibiotic mixture, which was proposed for root canal disinfection in dental pulp regeneration. A previous study reported that this mixture had no tooth discoloration effects in vitro. After infection with Enterococcus faecalis for 3 weeks, the dentinal tubules in the cylindrical root specimens were exposed to different antibiotic mixtures: ciprofloxacin, metronidazole and minocycline (3-MIX); ciprofloxacin, metronidazole and clarithromycin (3-MIXC) and ciprofloxacin and metronidazole (2-MIX). Each antibiotic formulation was mixed with macrogol (MG) or hyaluronic acid (HA) vehicles. CLSM and viability staining were used to quantitatively analyze the mean depth of the antibacterial effect and the proportions of dead and live bacteria inside the dentinal tubules. The 3-MIX and 3-MIXC demonstrated a similar depth of action. The mean proportion of dead bacteria was similar in the 3-MIX and 3-MIXC groups, and both were statistically higher than that of 2-MIX (p = 0.014). Each antibiotic mixture showed a higher bactericidal efficacy if conveyed with HA, compared to MG (3-MIX, p = 0.019; 3-MIXC, p = 0.013 and 2-MIX, p = 0.0125). The depth of action and the antibacterial efficacy of 3-MIXC seemed comparable with 3-MIX.
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91
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Abuelniel GM, Duggal MS, Kabel N. A comparison of MTA and Biodentine as medicaments for pulpotomy in traumatized anterior immature permanent teeth: A randomized clinical trial. Dent Traumatol 2020; 36:400-410. [DOI: 10.1111/edt.12553] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 02/15/2020] [Accepted: 02/16/2020] [Indexed: 12/20/2022]
Affiliation(s)
| | | | - Nihal Kabel
- Misr University for Sciences and Technology 6th of October City Egypt
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92
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Revitalisation endodontic treatment of traumatised immature teeth: a prospective long-term clinical study. Eur Arch Paediatr Dent 2019; 21:587-596. [PMID: 31808111 PMCID: PMC7518998 DOI: 10.1007/s40368-019-00501-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/28/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Continuation of root development following revitalisation endodontics (RET) has been shown to be unpredictable with lower success rates in traumatised teeth. This study reports the outcomes for RET in traumatised teeth over a review period of 4 years. METHODS A prospective uncontrolled study, where RET was performed on traumatised upper immature anterior teeth with necrotic pulps in 15 children (mean age = 8.3 years), was conducted. Patients were reviewed at 3, 9, 12, 24, and 48 months, where clinical and radiographic assessments were performed. At the last review appointment, patients and parents answered questions assessing their perception and acceptance of tooth colour change over time. McNemar's Exact test and linear mixed model assessment were used to assess changes in pulpal electrical response and radiographic evidence of continuation of root development over time, respectively. RESULTS There was 83.3% healing with no significant changes in EPT responses, and no significant changes in root lengths, while significant changes in root widths (p < 0.05) and root apex widths (p < 0.001) were found over time. Twenty-five percent of patients and 33% of parents felt that there were changes in tooth colour following RET over time. CONCLUSION Within the limitations of this study, traumatised teeth treated using RET showed no significant root lengthening, however, acceptable periapical healing, slow thickening of root dentinal walls, and rapid development of apical closure were evident over a period of 43 months. Using Portland cement and omitting minocycline, did not eliminate crown colour change following RET.
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94
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Fouad AF. Microbiological aspects of traumatic injuries. Dent Traumatol 2019; 35:324-332. [PMID: 31125490 DOI: 10.1111/edt.12494] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 05/21/2019] [Indexed: 12/11/2022]
Abstract
After traumatic injuries to teeth, microorganisms may invade the compromised pulp tissue and initiate pulp infection and periapical inflammation. In addition to bone resorption that typically accompanies pulp necrosis, root resorption frequently occurs. Root resorption has several variants that may occur shortly after the trauma or at a later stage. The pathological changes seen after traumatic injuries to teeth are invariably linked to the presence of microbial irritants. The presence of bacterial biofilms in the dental pulp space can be treated with regenerative or therapeutic endodontic procedures. However, necrosis of periodontal ligament is usually terminal for the tooth involved. In this review, the sources of bacteria after traumatic injuries are discussed. The types and role of microorganisms involved in the pathogenesis of endodontic pathosis after traumatic injuries are presented, and contemporary approaches for the management of these conditions are reviewed. Contemporary antimicrobial strategies are discussed. The rationale for the use of systemic and topical antimicrobials is presented. Finally, novel approaches to the use of antimicrobial therapies, particularly in regenerative procedures, are reviewed.
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Affiliation(s)
- Ashraf F Fouad
- Department of Endodontics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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95
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Zaccara IM, Jardine AP, Mestieri LB, Quintana RM, Jesus L, Moreira MS, Grecca FS, Martins MD, Kopper PMP. Influence of photobiomodulation therapy on root development of rat molars with open apex and pulp necrosis. Braz Oral Res 2019; 33:e084. [PMID: 31460610 DOI: 10.1590/1807-3107bor-2019.vol33.0084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/25/2019] [Indexed: 02/21/2023] Open
Abstract
This study aimed to evaluate the role of photobiomodulation (PBM) in apexification and apexogenesis of necrotic rat molars with an open apex. Rat molars were exposed to the oral environment for 3 weeks. Canals were rinsed with 2.5% NaOCl and 17% EDTA, filled with antibiotic paste and sealed. After 7 days, canals were rinsed and divided into six groups (n=6): mineral trioxide aggregate (MTA); blood clot (BC); human dental pulp stem cells (hDPSC); MTA+PBM; BC+PBM; and hDPSC+PBM. In hDPSC groups, a 1% agarose gel scaffold was used. Two groups were not exposed: healthy tooth+PBM (n = 6), healthy tooth (n = 3); and one was exposed throughout the experiment: necrotic tooth (n = 3). In PBM groups, irradiation was performed with aluminum gallium indium phosphide (InGaAlP) diode laser for 30 days within 24-h intervals. After that, the specimens were processed for histological and immunohistochemical analyses. Necrotic tooth showed greater neutrophil infiltrate (p < 0.05). Necrotic tooth, healthy tooth, and healthy tooth+PBM groups showed absence of a thin layer of fibrous condensation in the periapical area. All the other groups stimulated the formation of a thicker layer of fibers (p < 0.05). All groups formed more mineralized tissue than necrotic tooth (p < 0.05). PBM associated with MTA, BC, or hDPSC formed more mineralized tissue (p < 0.05). MTA+PBM induced apexification (p < 0.05). Rabbit polyclonal anti-bone sialoprotein (BSP) antibody confirmed the histological findings of mineralized tissue formation, and hDPSC groups exhibited higher percentage of BSP-positive cells. It can be concluded that PBM improved apexification and favored apexogenesis in necrotic rat molars with an open apex.
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Affiliation(s)
- Ivana Maria Zaccara
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Graduate program, Porto Alegre, RS, Brazil
| | | | - Letícia Boldrin Mestieri
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Graduate program, Porto Alegre, RS, Brazil
| | - Ramiro Martins Quintana
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Graduate program, Porto Alegre, RS, Brazil
| | - Luciano Jesus
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Graduate program, Porto Alegre, RS, Brazil
| | | | - Fabiana Soares Grecca
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Graduate program, Porto Alegre, RS, Brazil
| | - Manoela Domingues Martins
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Graduate program, Porto Alegre, RS, Brazil
| | - Patrícia Maria Poli Kopper
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Graduate program, Porto Alegre, RS, Brazil
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El-Tayeb MM, Abu-Seida AM, El Ashry SH, El-Hady SA. Evaluation of antibacterial activity of propolis on regenerative potential of necrotic immature permanent teeth in dogs. BMC Oral Health 2019; 19:174. [PMID: 31387578 PMCID: PMC6685241 DOI: 10.1186/s12903-019-0835-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 06/27/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This study evaluated the antibacterial efficiency and ability of propolis to promote regeneration of immature permanent non-vital dogs' teeth. METHODS Ninety six immature permanent premolars teeth in 6 mongrel dogs were divided randomly into: experimental teeth (N = 72) and control teeth (N = 24). Periapical pathosis was induced in all experimental and positive control teeth. Experimental teeth were classified according to the used intra-canal medication into: group I (N = 36), propolis paste was used and group II (N = 36), triple antibiotic paste (TAP) was used. Bacteriologic samplings were collected before and after exposure to intra-canal medicaments. After the disinfection period (3 weeks), revascularization was induced in all experimental teeth. Each group was subdivided according to the root canal orifice plug into: subgroup A (N = 18), propolis paste was used and subgroup B (N = 18), mineral trioxide aggregates (MTA) was used. Each subgroup was further subdivided according to the evaluation period into 3 subdivisions (6 teeth each): subdivision 1; after 2 weeks, subdivision 2; after one month and subdivision 3; after 2 months. Positive control group had 12 teeth with induced untreated periapical pathosis. Negative control group had 12 untouched sound teeth. All teeth were evaluated with radiography and histology. The bacteriologic and radiographic data were analyzed using repeated measures ANOVA and post-hoc Tukey tests. The histologic data were analyzed using Kruskal-Wallis test, Mann-Whitney U test with Bonferroni's adjustment and Chi-square test. The significance level was set at P ≤ .05. RESULTS There was no significant difference in the antibacterial effectiveness between TAP and propolis groups (P > .05). In all subdivisions, there was no significant difference between the experimental groups in terms of increase in root length and dentin thickness, decrease in apical closure, new hard tissue formation, vital tissue formation inside the pulp canal and apical closure scores (P > .05). CONCLUSION Propolis can be comparable with TAP as a disinfection treatment option in regenerative endodontic. As a root canal orifice plug after revascularization of necrotic immature permanent teeth in dogs, propolis induces a progressive increase in root length and dentin thickness and a decrease in apical diameter similar to those of MTA.
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Affiliation(s)
- M. M. El-Tayeb
- Department of Endodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - A. M. Abu-Seida
- Department of Surgery, Anesthesiology & Radiology, Faculty of Veterinary Medicine, Cairo University, Giza Square, Giza, PO: 12211 Egypt
| | - S. H. El Ashry
- Department of Endodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - S. A. El-Hady
- Department of Microbiology & Immunology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Rizk HM, AL-Deen MSS, Emam AA. Regenerative Endodontic Treatment of Bilateral Necrotic Immature Permanent Maxillary Central Incisors with Platelet-rich Plasma versus Blood Clot: A Split Mouth Double-blinded Randomized Controlled Trial. Int J Clin Pediatr Dent 2019; 12:332-339. [PMID: 31866720 PMCID: PMC6898871 DOI: 10.5005/jp-journals-10005-1656] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
AIM Clinical and radiographic assessment of the regenerative potential of bilateral immature permanent maxillary central incisors with necrotic pulps using blood clot (BC) and platelet-rich plasma (PRP) scaffolds. TRIAL DESIGN This is a split mouth double-blinded parallel randomized controlled clinical trial. SUBJECTS AND METHODS Randomization and blinding: the study started with 15 patients with bilateral maxillary immature permanent central incisors with necrotic pulp. The two upper bilateral central incisors were randomly assigned to either the control (BC scaffold) group I or examined (PRP scaffold) group II. Participant: 13 patients aged 8-14 years fulfilled the study requirements. A follow-up was done for 3, 6, 9, and 12 months. Standardized radiographs were collected during the follow-up period, and radiographic changes were measured using Image J software. Primary outcome measured were clinical: pain, mobility, swelling, and sinus/fistula. Radiographic outcome included increased root length and increase in root thickness. Secondary outcomes were clinical: discoloration and sensibility test. Radiographic outcome included an increase in bone density measurements and a decrease in apical diameter. Standardized radiographs were collected during the follow-up period, and radiographic changes were measured using Image J software. RESULTS All 26 treated teeth survived during the 12-month follow-up period with 100% success rate. PRP-treated teeth showed a statistically significant increase in radiographic root length, width, periapical bone density, and a decrease in apical diameter when compared with BC. At the end of 12 months, all treated teeth did not respond to the sensibility test. BC displayed a significantly higher amount of crown discoloration compared to the PRP group. CONCLUSION For necrotic immature teeth, regenerative endodontic treatment using PRP is a desirable alternative to BC and shows excellent 12-months prognosis. HOW TO CITE THIS ARTICLE Rizk HM, AL-Deen MSS, et al. Regenerative Endodontic Treatment of Bilateral Necrotic Immature Permanent Maxillary Central Incisors with Platelet-rich Plasma versus Blood Clot: A Split Mouth Double-blinded Randomized Controlled Trial. Int J Clin Pediatr Dent 2019;12(4):332-339.
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Affiliation(s)
- Hazim Mohamed Rizk
- Preventive and Dental Public Health Department, Faculty of Dentistry, Suez Canal University, Egypt
| | | | - Asmaa Aly Emam
- Preventive and Dental Public Health Department, Faculty of Dentistry, Suez Canal University, Egypt
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Aly MM, Taha SEED, El Sayed MA, Youssef R, Omar HM. Clinical and radiographic evaluation of Biodentine and Mineral Trioxide Aggregate in revascularization of non-vital immature permanent anterior teeth (randomized clinical study). Int J Paediatr Dent 2019; 29:464-473. [PMID: 30702789 DOI: 10.1111/ipd.12474] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 12/12/2018] [Accepted: 01/24/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To asses clinically and radiographically the effect of using two types of coronal plug materials in revascularization of non-vital immature teeth. METHODS A total of 26 necrotic immature permanent anterior teeth were enrolled for pulp revascularization using a double antibiotic mix for root canal disinfection. They were randomly divided into the following based on coronal plug materials used: Biodentine (Group I) and white Mineral Trioxide Aggregate (Group II; n = 13). Clinical and radiographic assessments were performed after 3, 6, 9, and 12 months. RESULTS When comparing the overall clinical successes and percentage of increase in root length between the two groups, there was no statistically significant difference (P > 0.05). There was a significant difference in the distribution of discoloration between the two groups. One case was reported in Group I, and seven cases were reported in Group II (P = 0.01). CONCLUSIONS Both Biodentine and Mineral Trioxide Aggregate were successful clinically regarding the resolution of signs and symptoms associated with the necrotic teeth.
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Affiliation(s)
- Mariam Mohsen Aly
- Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Cairo University, Giza, Egypt
| | - Sherine Ezz El-Din Taha
- Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Cairo University, Giza, Egypt
| | - Manal Ahmed El Sayed
- Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Cairo University, Giza, Egypt
| | - Randa Youssef
- Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Cairo University, Giza, Egypt
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Bottino MC, Albuquerque MTP, Azabi A, Münchow EA, Spolnik KJ, Nör JE, Edwards PC. A novel patient-specific three-dimensional drug delivery construct for regenerative endodontics. J Biomed Mater Res B Appl Biomater 2019; 107:1576-1586. [PMID: 30281899 PMCID: PMC6447484 DOI: 10.1002/jbm.b.34250] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/15/2018] [Accepted: 09/09/2018] [Indexed: 12/13/2022]
Abstract
Evoked bleeding (EB) clinical procedure, comprising a disinfection step followed by periapical tissue laceration to induce the ingrowth of undifferentiated stem cells from the periodontal ligament and alveolar bone, is currently the only regenerative-based therapeutic approach to treating pulp tissue necrosis in undeveloped (immature) permanent teeth approved in the United States. Yet, the disinfection step using antibiotic-based pastes leads to cytotoxic, warranting a biocompatible strategy to promote root canal disinfection with no or minimal side-effects to maximize the regenerative outcomes. The purpose of this investigation was to develop a tubular three-dimensional (3D) triple antibiotic-eluting construct for intracanal drug delivery. Morphological (scanning electron microscopy), chemical (Fourier transform infrared spectroscopy), and mechanical (tensile testing) characteristics of the polydioxanone-based triple antibiotic-eluting fibers were assessed. The antimicrobial properties of the tubular 3D constructs were determined in vitro and in vivo using an infected (Actinomyces naeslundii) dentin tooth slice model and a canine method of periapical disease, respectively. The in vitro data indicated significant antimicrobial activity and the ability to eliminate bacterial biofilm inside dentinal tubules. In vivo histological findings demonstrated that, using the EB procedure, the tubular 3D triple antibiotic-eluting construct allowed the formation of an appropriate environment that led to apex closure and the ingrowth of a thin layer of osteodentin-like tissue into the root canal. Taken together, these findings indicate that our novel drug delivery construct is a promising biocompatible disinfection strategy for immature permanent teeth with necrotic pulps. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1576-1586, 2019.
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Affiliation(s)
- Marco C. Bottino
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan School of Dentistry, Ann Arbor, MI - 48109, USA
| | - Maria T. P. Albuquerque
- Department of Clinical Dentistry (Endodontics), Federal University of Bahia, Salvador, BA - 40110, Brazil
| | - Asma Azabi
- Department of Biomedical & Applied Sciences, Indiana University School of Dentistry (IUSD), Indianapolis, IN - 46202, USA
| | - Eliseu A. Münchow
- Department of Dentistry, Health Science Institute, Federal University of Juiz de Fora, Governador Valadares, MG - 35010, Brazil
| | | | - Jacques E. Nör
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan School of Dentistry, Ann Arbor, MI - 48109, USA
| | - Paul C. Edwards
- Department of Oral Pathology, Medicine, and Radiology, IUSD, Indianapolis, IN - 46202, USA
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Sasanakul P, Ampornaramveth RS, Chivatxaranukul P. Influence of Adjuncts to Irrigation in the Disinfection of Large Root Canals. J Endod 2019; 45:332-337. [PMID: 30803542 DOI: 10.1016/j.joen.2018.11.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The aims of this study were to evaluate the effectiveness of disinfection methods and determine the most promising irrigation protocol for regenerative endodontics in teeth with large root canals. METHODS Sterilized root samples with 0.8-mm wide apical foramen (n = 94) were prepared from human mandibular premolars. Ninety-two samples were infected with Enterococcus faecalis for 21 days and biofilm formation was verified using scanning electron microscopy (n = 2). The 90 infected samples were randomly assigned into 9 groups: no intervention (initial), 1.5% NaOCl irrigation (1.5 N), 2.5% NaOCl irrigation (2.5 N), 1.5 N + intermittent passive ultrasonic irrigation (PUI), 1.5 N + intermittent canal brushing with Navitip FX (NFX), 1.5 N + intermittent XP-endo Finisher (XPF), 1.5 N + circumferential filing (CF), 1.5 N + 1-min Self-adjusting File (SAF), and 1.5 N + mechanical instrumentation using #90‒110 files (MI). Subsequently, the root canal walls were shaved for microbial analysis. The mean colony-forming units (CFUs) were determined and analyzed using 1-way analysis of variance. RESULTS The mean CFU count was lowest in the MI group (63.5 CFU/mL), followed by the NFX, XPF, SAF, 2.5 N, CF, PUI, 1.5 N, and initial groups. The remaining bacteria in the 1.5 N group was 3.6-fold higher than that of the PUI group; 4- to 5-fold higher than that of the 2.5 N, CF, and SAF groups; and 22-fold and 36-fold higher than that of the XPF and NFX groups, respectively. The 2.5 N and 1.5 N groups with adjunctive treatments, excluding the PUI group, had significantly fewer remaining bacteria compared with the 1.5 N group (P < .05). CONCLUSIONS Performing various procedures supplemental to 1.5 N improved large root canal disinfection. Adjunctive NFX most effectively reduced the number of bacteria without dentin removal.
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Affiliation(s)
- Parnwad Sasanakul
- Department of Operative Dentistry, Chulalongkorn University, Bangkok, Thailand
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