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Abstract
No current therapy promotes root canal disinfection and regeneration of the pulp-dentin complex in cases of pulp necrosis. Antibiotic pastes used to eradicate canal infection negatively affect stem cell survival. Three-dimensional easy-to-fit antibiotic-eluting nanofibers, combined with injectable scaffolds, enriched or not with stem cells and/or growth factors, may increase the likelihood of achieving predictable dental pulp regeneration. Periodontitis is an aggressive disease that impairs the integrity of tooth-supporting structures and may lead to tooth loss. The latest advances in membrane biomodification to endow needed functionalities and technologies to engineer patient-specific membranes/constructs to amplify periodontal regeneration are presented.
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102
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Kim SG, Malek M, Sigurdsson A, Lin LM, Kahler B. Regenerative endodontics: a comprehensive review. Int Endod J 2018; 51:1367-1388. [PMID: 29777616 DOI: 10.1111/iej.12954] [Citation(s) in RCA: 195] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/14/2018] [Indexed: 12/13/2022]
Abstract
The European Society of Endodontology and the American Association for Endodontists have released position statements and clinical considerations for regenerative endodontics. There is increasing literature on this field since the initial reports of Iwaya et al. (Dental Traumatology, 17, 2001, 185) and Banchs & Trope (Journal of Endodontics, 30, 2004, 196). Endogenous stem cells from an induced periapical bleeding and scaffolds using blood clot, platelet rich plasma or platelet-rich fibrin have been utilized in regenerative endodontics. This approach has been described as a 'paradigm shift' and considered the first treatment option for immature teeth with pulp necrosis. There are three treatment outcomes of regenerative endodontics; (i) resolution of clinical signs and symptoms; (ii) further root maturation; and (iii) return of neurogenesis. It is known that results are variable for these objectives, and true regeneration of the pulp/dentine complex is not achieved. Repair derived primarily from the periodontal and osseous tissues has been shown histologically. It is hoped that with the concept of tissue engineering, namely stem cells, scaffolds and signalling molecules, that true pulp regeneration is an achievable goal. This review discusses current knowledge as well as future directions for regenerative endodontics. Patient-centred outcomes such as tooth discolouration and possibly more appointments with the potential for adverse effects needs to be discussed with patients and parents. Based on the classification of Cvek (Endodontics and Dental Traumatology, 8, 1992, 45), it is proposed that regenerative endodontics should be considered for teeth with incomplete root formation although teeth with near or complete root formation may be more suited for conventional endodontic therapy or MTA barrier techniques. However, much is still not known about clinical and biological aspects of regenerative endodontics.
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Affiliation(s)
- S G Kim
- Division of Endodontics, Columbia University College of Dental Medicine, New York, NY, USA
| | - M Malek
- Department of Endodontics, New York University College of Dentistry, New York, NY, USA
| | - A Sigurdsson
- Department of Endodontics, New York University College of Dentistry, New York, NY, USA
| | - L M Lin
- Department of Endodontics, New York University College of Dentistry, New York, NY, USA
| | - B Kahler
- The University of Queensland School of Dentistry, Brisbane, Australia
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103
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Miller AA, Takimoto K, Wealleans J, Diogenes A. Effect of 3 Bioceramic Materials on Stem Cells of the Apical Papilla Proliferation and Differentiation Using a Dentin Disk Model. J Endod 2018; 44:599-603. [DOI: 10.1016/j.joen.2017.12.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 11/20/2017] [Accepted: 12/19/2017] [Indexed: 12/23/2022]
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104
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Montero-Miralles P, Martín-González J, Alonso-Ezpeleta O, Jiménez-Sánchez MC, Velasco-Ortega E, Segura-Egea JJ. Effectiveness and clinical implications of the use of topical antibiotics in regenerative endodontic procedures: a review. Int Endod J 2018; 51:981-988. [PMID: 29480932 DOI: 10.1111/iej.12913] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 02/20/2018] [Indexed: 12/13/2022]
Abstract
Regenerative endodontic procedures (REPs) are biologically based procedures planned to replace damaged tissues, including dentinee and root structures, as well as cells of the pulp-dentine complex. Effective sterilization of the root canal is essential in REPs, and antibiotics have been widely used to disinfect root canals. The aim of this paper was to review the scientific literature on (i) Effectiveness of antibiotics used in REPs against bacteria implicated in endodontic disease; (ii) Scientific evidence supporting the use of topical antibiotics in REPs; (iii) Clinical implications of the use of antibiotics in REPs and the possible side effects; (iv) Effect of antibiotics on dental pulp stem cells; and (v) Ongoing research on the use of antibiotics in REPs. Antibiotics used in REPs are effective against bacteria implicated in endodontic infections. Triple antibiotic pastes with minocycline attain complete disinfection of immature teeth with necrotic pulps, without affecting SCAP. Experimental studies carried out in dogs support the use of antibiotics in REPs. Clinical studies report high success rates of RET using antibiotics as intracanal dressings. However, tooth discolouration is an important side effect of the use of TAP. An antibiotic paste containing only metronidazole and ciprofloxacin could be a good alternative to the use of TAP. The use of antibiotic-containing scaffolds or clindamycin-modified triple antibiotic (metronidazole, ciprofloxacin and clindamycin) polymer could be a biologically safe antimicrobial drug delivery system in REPs.
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Affiliation(s)
- P Montero-Miralles
- Endodontics Section, Department of Stomatology, School of Dentistry, University of Sevilla, Sevilla, Spain
| | - J Martín-González
- Endodontics Section, Department of Stomatology, School of Dentistry, University of Sevilla, Sevilla, Spain
| | - O Alonso-Ezpeleta
- Endodontics Section, Department of Stomatology, School of Dentistry, University of Zaragoza, Zaragoza, Spain
| | - M C Jiménez-Sánchez
- Endodontics Section, Department of Stomatology, School of Dentistry, University of Sevilla, Sevilla, Spain
| | - E Velasco-Ortega
- Comprehensive Dentistry, Department of Stomatology, School of Dentistry, University of Sevilla, Sevilla, Spain
| | - J J Segura-Egea
- Endodontics Section, Department of Stomatology, School of Dentistry, University of Sevilla, Sevilla, Spain
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105
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Scott MB, Zilinski GS, Kirkpatrick TC, Himel VT, Sabey KA, Lallier TE. The Effects of Irrigants on the Survival of Human Stem Cells of the Apical Papilla, Including Endocyn. J Endod 2018; 44:263-268. [DOI: 10.1016/j.joen.2017.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/01/2017] [Accepted: 09/01/2017] [Indexed: 12/24/2022]
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106
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Lin LM, Kim SG, Martin G, Kahler B. Continued root maturation despite persistent apical periodontitis of immature permanent teeth after failed regenerative endodontic therapy. AUST ENDOD J 2018; 44:292-299. [DOI: 10.1111/aej.12252] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Louis M. Lin
- Department of Endodontics; College of Dentistry; New York University; New York New York USA
| | - Sahng G. Kim
- Division of Endodontics; College of Dental Medicine; Columbia University; New York New York USA
| | - Gabriela Martin
- Department of Endodontics; School of Health Sciences; Catholic University of Cordoba; Cordoba Argentina
| | - Bill Kahler
- School of Dentistry; University of Queensland; Brisbane Australia
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107
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Jamal M, Greish Y, Chogle S, Goodis H, Karam SM. Growth and Differentiation of Dental Stem Cells of Apical Papilla on Polycaprolactone Scaffolds. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1077:31-40. [PMID: 30357682 DOI: 10.1007/978-981-13-0947-2_3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Biodegradable scaffolds are useful tools in the field of tissue engineering and regenerative medicine. The aim of this study was to test the potential of the human stem cells of apical papilla (SCAP) to attach, proliferate and differentiate on a polycaprolactone (PCL)-based scaffolds. SCAP were extracted from the root apical papillae of freshly extracted immature premolar teeth by using enzymatic digestion. Porous PCL scaffolds were fabricated using particle leaching method and NaCl or mannitol as porogens. SCAP of passage 3 were seeded on non-porous and porous PCL scaffolds for up to 14 days. For control, cells were cultured on glass coverslips. Picogreen DNA quantification was used to assay for cell proliferation. Cell differentiation and development of calcification nodules were examined using scanning electron microscopy and alizarin red staining. SCAP showed a comparable attachment, growth and proliferation patterns on PCL scaffolds and coverslips. Cell proliferation was enhanced on mannitol scaffolds at all time points. Calcification nodules were detected in all PCL scaffolds while it was not present on glass coverslips. These nodules were detected on NaCl-scaffolds by day 7 and on mannitol and non-porous scaffolds by day 14. In conclusion, SCAP were able to attach, proliferate and differentiate on PCL scaffolds without using any inductive media, indicating their potential application for dental tissue regeneration.
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Affiliation(s)
- Mohamed Jamal
- Department of Anatomy, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
- Department of Endodontics, Hamdan Bin Mohamed College of Dental Medicine, Mohamed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Yaser Greish
- Department of Chemistry, College of Science, UAE University, Al-Ain, United Arab Emirates
| | - Sami Chogle
- Department of Endodontics, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | - Harold Goodis
- Department of Preventive & Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, CA, USA
| | - Sherif M Karam
- Department of Anatomy, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.
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108
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Required Time for Migration of Bone Marrow-derived Cells to Dental Pulp after Bone Marrow Transplantation. J Endod 2017; 44:438-445. [PMID: 29275852 DOI: 10.1016/j.joen.2017.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/12/2017] [Accepted: 10/14/2017] [Indexed: 01/09/2023]
Abstract
INTRODUCTION This study aimed to evaluate the time required for bone marrow-derived cells (BMDCs) from transgenic green fluorescent protein (GFP)+ donor mice (GFP+ mice) to migrate into the dental pulp of wild-type GFP- recipient mice (GFP- mice) by using bone marrow transplantation (BMT) as an in vivo model for tracking BMDCs from GFP+ mice (GFP+ BMDCs). METHODS GFP+ BMDCs were injected into irradiated GFP- mice. Maxillary arches, tibiae, and femora from GFP- mice were isolated and processed at 24 hours, 48 hours, 4, 7, and 14 days, and 7 weeks after BMT. Confocal laser microscopy analyses were performed to assess the presence of GFP+ BMDCs in the dental pulp, and flow cytometry of BM was performed to confirm the efficiency of engraftment of GFP+ BMDCs. RESULTS Confocal laser microscopy analyses evidenced the presence of GFP+ BMDCs in the dental pulp of GFP- mice from 14 days to 7 weeks after BMT. There was no presence of GFP+ BMDCs at 24 hours, 48 hours, 4 days, and 7 days. Flow cytometry of the BM of GFP- mice demonstrated a constant increase in the presence of GFP+ BMDCs at 24 hours, 48 hours, and 4 days after BMT, which stabilized from 7 days to 7 weeks. CONCLUSIONS The study demonstrated the presence of GFP+ BMDCs in the dental pulp from 14 days to 7 weeks after BMT and the feasibility of using GFP+ animals and BMT as an in vivo model for tracking GFP+ BMDCs.
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109
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Lee JY, Kersten DD, Mines P, Beltran TA. Regenerative Endodontic Procedures among Endodontists: A Web-based Survey. J Endod 2017; 44:250-255. [PMID: 29229459 DOI: 10.1016/j.joen.2017.09.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 09/10/2017] [Accepted: 09/22/2017] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The protocols that endodontists implement for regenerative endodontic procedures (REPs) are unknown. The aim of this study was to examine current REP protocols among practicing endodontists in the United States. METHODS A Web-based survey was sent to 4060 active members of the American Association of Endodontists (AAE). A total of 850 participants completed the survey, representing a 20.9% response rate. RESULTS Responses indicated 60% reported having performed REPs; most performed 1 to 3 per year. The most commonly selected source (60.8%) for the clinical protocol was the "AAE Clinical Considerations for a Regenerative Procedure." Time constraints were the most common reason why 92.4% of respondents did not report their REP cases to the AAE.org database; additionally, 15.5% were unaware of it. Almost half (49.8%) of the participants reported they would attempt an REP on a patient of any age. The most commonly used irrigants were >3% sodium hypochlorite at the first appointment and EDTA at the scaffold formation appointment. As the intracanal medicament, 52.2% used calcium hydroxide, whereas 23.5% used triple antibiotic paste. At the scaffold formation appointment, 77.1% used a local anesthetic without a vasoconstrictor, and 94.3% used a blood clot as the scaffold. Mineral trioxide aggregate was the coronal barrier most often selected. Considering factors most likely to encourage the use of REPs in the future, 79.8% reported the availability of good candidates followed by 40.1% who desired better evidence. CONCLUSIONS Based on the results of this survey, REP protocols appear to be heterogeneous and do not strictly conform to the "AAE Clinical Considerations for a Regenerative Procedure."
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Affiliation(s)
- Jonathan Y Lee
- United States Army Endodontic Residency Program, Fort Bragg, North Carolina; Uniformed Services University of the Health Sciences, Bethesda, Maryland.
| | - Daniel D Kersten
- United States Army Endodontic Residency Program, Fort Bragg, North Carolina; Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Pete Mines
- United States Army Endodontic Residency Program, Fort Bragg, North Carolina; Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Thomas A Beltran
- Department of Clinical Investigation, Womack Army Medical Center, Fort Bragg, North Carolina
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110
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Kahler B, Chugal N, Lin LM. Alkaline Materials and Regenerative Endodontics: A Review. MATERIALS 2017; 10:ma10121389. [PMID: 29206139 PMCID: PMC5744324 DOI: 10.3390/ma10121389] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/23/2017] [Accepted: 11/29/2017] [Indexed: 12/16/2022]
Abstract
Periapical health is the primary goal of endodontic treatment in mature and immature teeth. In addition, the goals of treatment of immature teeth with arrested root development include root growth to length and maturation of the apex, as well as thickening of the canal wall. These goals are valid for immature teeth that have been subjected to trauma and dental caries or that are the result of developmental anomalies that expose the tooth to the risk of pulp necrosis and consequently result in the cessation of root maturation. Regenerative endodontic procedures (REPs) have been described as a “paradigm shift” in the treatment of immature teeth with pulp necrosis and underdeveloped roots, as there is the potential for further root maturation and return of vitality. Treatment with REPs is advocated as the treatment of choice for immature teeth with pulp necrosis. REP protocols involve the use of alkaline biomaterials, primarily sodium hypochlorite, calcium hydroxide, mineral trioxide aggregates and Biodentine, and are the essential components of a successful treatment regimen.
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Affiliation(s)
- Bill Kahler
- The School of Dentistry, The University of Queensland, Brisbane 4072, Australia.
| | - Nadia Chugal
- School of Dentistry, UCLA, CHS A3-075, Los Angeles, CA 90095-1668, USA.
| | - Louis M Lin
- College of Dentistry, New York University, 345 East 24th Street, New York, NY 10010, USA.
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111
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Large Periapical or Cystic Lesions in Association with Roots Having Open Apices Managed Nonsurgically Using 1-step Apexification Based on Platelet-rich Fibrin Matrix and Biodentine Apical Barrier: A Case Series. J Endod 2017; 44:179-185. [PMID: 29079056 DOI: 10.1016/j.joen.2017.08.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 08/20/2017] [Accepted: 08/28/2017] [Indexed: 01/06/2023]
Abstract
Teeth having open apices in the absence of a natural apical constriction pose several challenges during conventional endodontic treatment, especially when establishing an apical seal. Treatment is further challenging when these teeth are associated with large periapical or cystic lesions having resulted in expansion and/or thinning of adjacent cortical plates. Although surgical intervention is commonly adopted in the management of such cases, a conservative treatment option offering equally good prognosis is always desirable. This case series describes 3 cases: a 39-year-old woman, a 45-year-old woman, and a 15-year-old boy having teeth with concomitant open apices and large periapical/cystic lesions managed conservatively by (1) following a strict intracanal disinfection protocol, (2) intracanal aspiration with digital decompression of associated swelling, and (3) 1-step apexification for closure of the root apex by placing a preliminary barrier of platelet-rich fibrin (PRF) and a secondary barrier of Biodentine (Septodont, Saint-Maur-des-Fossés, France). In all 3 cases, the treatment outcomes, both clinical and radiographic, were highly satisfactory. PRF and Biodentine collectively rendered an apical plug that proved to be a suitable alternative to commonly used mineral trioxide aggregate in 1-step apexification. Biodentine provides good interfacial adhesion and sealing with dentin attributed to its property of hydroxyapatite crystal deposition at the material-dentin interface. Also, because of its bioactivity, it likely promotes the conversion of adjacent PRF into a calcific barrier, thus reinforcing the apical seal. Additionally, host-modulating responses of PRF contribute in expediting the healing process. Reasonable osseous healing in the periapex could be appreciated as early as 3 months in all patients. The rapidity with which healing occurred may have been an incidental finding but definitely draws attention.
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112
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An Innovative Regenerative Endodontic Procedure Using Leukocyte and Platelet-rich Fibrin Associated with Apical Surgery: A Case Report. J Endod 2017; 43:1828-1834. [PMID: 28965773 DOI: 10.1016/j.joen.2017.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/28/2017] [Accepted: 07/02/2017] [Indexed: 12/16/2022]
Abstract
Regenerative endodontic procedures (REPs) associated with apical surgery could represent an alternative treatment strategy for patients whose teeth present incomplete root formation and extensive apical lesions. Leukocyte platelet-rich fibrin (L-PRF) has potential benefits in REPs; it could promote apical root formation and optimal bone healing. The aim of this case report was to describe innovative regenerative endodontic therapy using L-PRF in the root canal and an extensive apical lesion in an immature tooth with dens invaginatus and asymptomatic apical periodontitis. A healthy 20-year-old woman was referred to the dental clinic of the Universidad de Los Andes, Santiago, Chile, for endodontic treatment in tooth # 22 with incomplete root development and an extensive apical lesion. The diagnosis was asymptomatic apical periodontitis associated with dens invaginatus type II. The patient was treated with an innovative approach using L-PRF in REPs associated with apical surgery. Follow-ups were performed at 6 months and 1 year later. They included periapical radiographs, cone-beam computed tomographic imaging, sensitivity, and vitality tests. The clinical evaluations performed at 6 months and 1 year revealed an absence of symptoms. The radiographic evaluations showed that the apical lesion was resolved. The cone-beam images indicated that the root length increased and the walls had thickened. The sensitivity tests were positive, and the laser Doppler flowmetry showed positive blood flow after 1 year. The success of the results in this case report indicate that L-PRF can be used as a complement in apical surgery and REPs and could provide an innovative alternative treatment strategy for complex clinical cases like these.
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113
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Abstract
Dental pulp mesenchymal stem cells (DPMSCs) highly express mesenchymal stem cell markers and possess the potential to differentiate into neural cells, osteoblasts, adipocytes, and chondrocytes. Thus, DPMSCs are considered suitable for tissue regeneration. The colony isolation method has commonly been used to collect relatively large amounts of heterogeneous DPMSCs. Homogenous DPMSCs can be isolated by fluorescence-activated cell sorting using antibodies against mesenchymal stem cell markers, although this method yields a limited number of cells. Both quality and quantity of DPMSCs are critical to regenerative therapy, and cell culture methods need to be improved. We thus investigated the properties of DPMSCs cultured with different methods. DPMSCs in a three-dimensional spheroid culture system, which is similar to the hanging drop culture for differentiation of embryonic stem cells, showed upregulation of odonto-/osteoblastic markers and mineralized nodule formation. This suggests that this three-dimensional spheroid culturing system for DPMSCs may be suitable for inducing hard tissues. We further examined the effect of cell culture density on the properties of DPMSCs because the properties of stem cells can be altered depending on the cell density. DPMSCs cultured under the confluent cell density condition showed slight downregulation of some mesenchymal stem cell markers compared with those under the sparse condition. The ability of DPMSCs to differentiate into hard tissue-forming cells was found to be enhanced in the confluent condition, suggesting that the confluent culture condition may not be suitable for maintaining the stemness of DPMSCs. When DPMSCs are to be used for hard tissue regeneration, dense followed by sparse cell culture conditions may be a better alternative strategy.
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114
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Gaviño Orduña JF, Caviedes-Bucheli J, Manzanares Céspedes MC, Berástegui Jimeno E, Martín Biedma B, Segura-Egea JJ, López-López J. Use of Platelet-rich Plasma in Endodontic Procedures in Adults: Regeneration or Repair? A Report of 3 Cases with 5 Years of Follow-up. J Endod 2017; 43:1294-1301. [DOI: 10.1016/j.joen.2017.04.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 03/26/2017] [Accepted: 04/11/2017] [Indexed: 12/24/2022]
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115
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Eskander MA, Takimoto K, Diogenes A. Evaluation of mesenchymal stem cell modulation of trigeminal neuronal responses to cold. Neuroscience 2017; 360:61-67. [PMID: 28757246 DOI: 10.1016/j.neuroscience.2017.07.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 01/09/2023]
Abstract
Tissue engineering protocols, such as regenerative endodontic procedures (REPs), comprise biologically based procedures designed to restore normal physiologic function. For REPs, the goal is reconstitution of the pulp-dentin complex by delivering mesenchymal stem cells (MSCs), including the stem cells of the apical papilla (SCAP) into a root canal system. Many patients regain cold sensitivity after REPs, but the mechanism is not understood. We hypothesized that SCAP modulate nociceptive function through a paracrine mechanism that activates cold-sensitive ion channels in neurons. We established a co-culture system with human SCAP and rat trigeminal (TG) sensory neurons in order to determine the effect of SCAP co-culture on neuronal responses using whole-cell patch-clamp electrophysiology. TG neurons co-cultured with SCAP demonstrated increased TRPA1-mediated (p<0.01) and TRPM8-mediated inward current densities (p<0.01) at 24h in co-culture. Cold stimulation to SCAP significantly increased ATP release (p<0.01), and supernatant collected after cold stimulation to SCAP was able to activate cultured TG neurons. Co-culture with SCAP significantly increased sustained ATP-evoked inward current density (p<0.05). These data suggest that SCAP release trophic factors that act on afferent neurons to enhance cold-sensitive ion channel activity.
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Affiliation(s)
- Michael A Eskander
- Department of Pharmacology, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Koyo Takimoto
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Anibal Diogenes
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
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116
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Turkaydin D, Demir E, Basturk FB, Sazak Övecoglu H. Efficacy of XP-Endo Finisher in the Removal of Triple Antibiotic Paste from Immature Root Canals. J Endod 2017; 43:1528-1531. [PMID: 28712635 DOI: 10.1016/j.joen.2017.04.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/29/2017] [Accepted: 04/16/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate and compare the effectiveness of the XP-Endo Finisher (FKG Dentaire, La Chaux-de-Fonds, Switzerland) with passive ultrasonic irrigation (PUI) and needle irrigation in the removal of triple antibiotic paste (TAP) from the straight immature root canals of extracted teeth. METHODS Thirty-four freshly extracted single-rooted teeth were used. All canals were prepared up to the ProTaper F5 file (Dentsply Maillefer, Ballaigues, Switzerland). Apices were drilled to simulate teeth with immature apices. The canals were filled with TAP, sealed, and incubated at 37°C and 100% humidity for 1 month. Samples were randomly assigned to 3 experimental groups according to the method used for TAP removal: XP-Endo Finisher, PUI, and needle irrigation (n = 10). Then, the roots were split into 2 halves. The amount of TAP residue in the apical portion of each segment was evaluated using a scanning electron microscopy and scored. RESULTS The amount of remaining TAP was significantly lower in the XP-Endo Finisher group compared with the needle irrigation and PUI groups (P < .05). Between the needle irrigation and PUI groups, there were no statistically significant differences (P > .05). CONCLUSIONS Within the limitations of this study, the XP-Endo Finisher removed significantly more TAP than needle irrigation and PUI.
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Affiliation(s)
- Dilek Turkaydin
- Department of Endodontics, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - Erhan Demir
- Department of Endodontics, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - Fatima Betul Basturk
- Department of Endodontics, Faculty of Dentistry, Marmara University, Istanbul, Turkey.
| | - Hesna Sazak Övecoglu
- Department of Endodontics, Faculty of Dentistry, Marmara University, Istanbul, Turkey
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117
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Kahler B, Rossi-Fedele G, Chugal N, Lin LM. An Evidence-based Review of the Efficacy of Treatment Approaches for Immature Permanent Teeth with Pulp Necrosis. J Endod 2017; 43:1052-1057. [DOI: 10.1016/j.joen.2017.03.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/25/2017] [Accepted: 03/03/2017] [Indexed: 12/15/2022]
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118
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Segura‐Egea JJ, Gould K, Hakan Şen B, Jonasson P, Cotti E, Mazzoni A, Sunay H, Tjäderhane L, Dummer PMH. European Society of Endodontology position statement: the use of antibiotics in endodontics. Int Endod J 2017; 51:20-25. [DOI: 10.1111/iej.12781] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 04/19/2017] [Indexed: 01/15/2023]
Affiliation(s)
- J. J. Segura‐Egea
- Department of Endodontics School of Dentistry University of Sevilla Sevilla Spain
| | - K. Gould
- Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne UK
| | | | - P. Jonasson
- Department of Endodontology Institute of Odontology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - E. Cotti
- Department of Conservative Dentistry and Endodontics University of Cagliari Cagliari, Sardinia Italy
| | - A. Mazzoni
- Department of Biomedical and Neuromotor Sciences DIBINEM University of Bologna Bologna Italy
| | - H. Sunay
- Department of Endodontology Dental Faculty of Istanbul Kemerburgaz University Istanbul Turkey
| | - L. Tjäderhane
- Department of Oral and Maxillofacial Diseases Helsinki University Hospital University of Helsinki Helsinki Finland
- Research Unit of Oral Health Sciences Medical Research Center Oulu (MRC Oulu) University Hospital and University of Oulu Oulu Finland
| | - P. M. H. Dummer
- School of Dentistry College of Biomedical & Life Sciences Cardiff University Cardiff UK
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Comparative Evaluation of Chemotactic Factor Effect on Migration and Differentiation of Stem Cells of the Apical Papilla. J Endod 2017; 43:1288-1293. [PMID: 28578888 DOI: 10.1016/j.joen.2017.03.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/17/2017] [Accepted: 03/06/2017] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Cell homing strategies could potentially be used in regenerative endodontic procedures (REPs) to promote the progressive coronal migration of stem cells, including stem cells of the apical papilla (SCAPs), along with formation of a new vascular network without the need for intentional apical trauma and intracanal bleeding. Although many chemotactic factors have been investigated for different mesenchymal stem cells, their effect on SCAP migration and differentiation is not fully understood. This study aimed to comparatively evaluate the effect of stromal cell-derived factor 1 (SDF-1), transforming growth factor beta 1 (TGF-β1), platelet-derived growth factor, granulocyte colony-stimulating factor (G-CSF), or fibroblast growth factor 2 (FGF-2) on the migration and differentiation of SCAPs. METHODS A characterized SCAP cell line was fluorescently labeled with Vybrant DiO dye (Life Technologies, Grand Island, NY) and used in transwell migration assays. Cells were subjected to 1, 10, or 100 ng/mL of each factor or a combination of factors followed by detection in a fluorescent plate reader. Lastly, SCAP differentiation into a mineralizing phenotype was evaluated in the presence or absence of the tested factors by quantitative alizarin red staining and alkaline phosphatase activity. Data were analyzed with 1-way analysis of variance with the Tukey post hoc test. RESULTS Maximum migration was observed with G-CSF or FGF-2, which was significantly greater than the effects observed by the other tested factors. A combination of G-CSF with TGF-β1 significantly augmented both migration and differentiation into a mineralizing phenotype. CONCLUSIONS G-CSF appears to be well suited to be further investigated as a key chemotactic factor in cell homing-based regenerative endodontic procedures.
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Palma PJ, Ramos JC, Martins JB, Diogenes A, Figueiredo MH, Ferreira P, Viegas C, Santos JM. Histologic Evaluation of Regenerative Endodontic Procedures with the Use of Chitosan Scaffolds in Immature Dog Teeth with Apical Periodontitis. J Endod 2017; 43:1279-1287. [PMID: 28577961 DOI: 10.1016/j.joen.2017.03.005] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 02/05/2017] [Accepted: 03/09/2017] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate histologically the newly formed tissues after regenerative endodontic procedures (REPs) in dogs using either a blood clot (BC) or 2 different formulations of a chitosan hydrogel as scaffolds. METHODS Apical periodontitis was induced by inoculating immature teeth with oral plaque in 4 beagle dogs. Teeth (n = 96) were divided into 2 control (n = 20) and 4 test groups (n = 76) according to the treatment: apexification and REPs with BC, sodium hyaluronate:chitosan (HA:CS) scaffolds, or pectin:chitosan (P:CS) scaffolds. All root canals were disinfected with 2.5% sodium hypochlorite and a triple antibiotic paste intracanal medicament before evoked bleeding, clot formation, or scaffold placement. Thirteen weeks after treatment, the animals were sacrificed and the jaw blocks harvested for histologic processing, histomorphometric analysis, and statistical analysis. RESULTS The lumens of the root canals were completely filled with mineral trioxide aggregate with evidence of a mineralized apical bridge between the root canal walls in 83% of the samples in the apexification group. Vital vascularized tissue was found in the REP groups; apical closure happened in 66.7% of these treatments, and root growth was detected more often as an increase in thickness (85.6%) than in length (45.6%). The greatest amount of mineralized tissue inside the canal was observed in the BC group, with statistical significance compared with the HA:CS and P:CS groups (P < .05). Further histologic evaluation revealed the presence of apical papilla. CONCLUSIONS The addition of chitosan scaffolds to blood in regenerative procedures in dogs did not improve the formation of new mineralized tissues along the root canal walls or the histologic evidence of the regeneration of a pulp-dentin complex.
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Affiliation(s)
- Paulo J Palma
- Department of Dentistry, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - João C Ramos
- Department of Dentistry, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - João B Martins
- Department of Dentistry, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Anibal Diogenes
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Maria H Figueiredo
- Department of Dentistry, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Paula Ferreira
- Chemical Process Engineering and Forest Products Research Centre (CIEPQPF), Department of Chemical Engineering, University of Coimbra, Coimbra, Portugal
| | - Carlos Viegas
- School of Agrarian and Veterinary Sciences, Department of Veterinary Sciences, Centre for the Research and Technology of Agro-Environmental and Biological Sciences, CITAB, University of Trás-os-Montes e Alto Douro - Quinta de Prados, Vila Real, Portugal
| | - João M Santos
- Department of Dentistry, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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121
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Shrestha S, Kishen A. Bioactive Molecule Delivery Systems for Dentin-pulp Tissue Engineering. J Endod 2017; 43:733-744. [PMID: 28320538 DOI: 10.1016/j.joen.2016.12.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/11/2016] [Accepted: 12/13/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Regenerative endodontic procedures use bioactive molecules (BMs), which are active signaling molecules that initiate and maintain cell responses and interactions. When applied in a bolus form, they may undergo rapid diffusion and denaturation resulting in failure to induce the desired effects on target cells. METHODS The controlled release of BMs from a biomaterial carrier is expected to enhance and accelerate functional tissue engineering during regenerative endodontic procedures. This narrative review presents a comprehensive review of different polymeric BM release strategies with relevance to dentin-pulp engineering. RESULTS Carrier systems designed to allow the preprogrammed release of BMs in a spatial- and temporal-controlled manner would aid in mimicking the natural wound healing process while overcoming some of the challenges faced in clinical translation of regenerative endodontic procedures. CONCLUSIONS Spatial- and temporal-controlled BM release systems have become an exciting option in dentin-pulp tissue engineering; nonetheless, further validation of this concept and knowledge is required for their potential clinical translation.
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Affiliation(s)
- Suja Shrestha
- Discipline of Endodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Anil Kishen
- Discipline of Endodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
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122
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Longitudinal Cohort Study of Regenerative Endodontic Treatment for Immature Necrotic Permanent Teeth. J Endod 2017; 43:395-400. [DOI: 10.1016/j.joen.2016.10.035] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/14/2016] [Accepted: 10/22/2016] [Indexed: 01/09/2023]
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123
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Second-generation Platelet Concentrate (Platelet-rich Fibrin) as a Scaffold in Regenerative Endodontics: A Case Series. J Endod 2017; 43:401-408. [DOI: 10.1016/j.joen.2016.10.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/14/2016] [Accepted: 10/11/2016] [Indexed: 12/14/2022]
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124
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Song JS, Takimoto K, Jeon M, Vadakekalam J, Ruparel NB, Diogenes A. Decellularized Human Dental Pulp as a Scaffold for Regenerative Endodontics. J Dent Res 2017; 96:640-646. [PMID: 28196330 DOI: 10.1177/0022034517693606] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Teeth undergo postnatal organogenesis relatively late in life and only complete full maturation a few years after the crown first erupts in the oral cavity. At this stage, development can be arrested if the tooth organ is damaged by either trauma or caries. Regenerative endodontic procedures (REPs) are a treatment alternative to conventional root canal treatment for immature teeth. These procedures rely on the transfer of apically positioned stem cells, including stem cells of the apical papilla (SCAP), into the root canal system. Although clinical success has been reported for these procedures, the predictability of expected outcomes and the organization of the newly formed tissues are affected by the lack of an available suitable scaffold that mimics the complexity of the dental pulp extracellular matrix (ECM). In this study, we evaluated 3 methods of decellularization of human dental pulp to be used as a potential autograft scaffold. Tooth slices of human healthy extracted third molars were decellularized by 3 different methods. One of the methods generated the maximum observed decellularization with minimal impact on the ECM composition and organization. Furthermore, recellularization of the scaffold supported the proliferation of SCAP throughout the scaffold with differentiation into odontoblast-like cells near the dentinal walls. Thus, this study reports that human dental pulp from healthy extracted teeth can be successfully decellularized, and the resulting scaffold supports the proliferation and differentiation of SCAP. The future application of this form of an autograft in REPs can fulfill a yet unmet need for a suitable scaffold, potentially improving clinical outcomes and ultimately promoting the survival and function of teeth with otherwise poor prognosis.
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Affiliation(s)
- J S Song
- 1 Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,2 Department of Pediatric Dentistry, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - K Takimoto
- 1 Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - M Jeon
- 3 Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - J Vadakekalam
- 1 Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - N B Ruparel
- 1 Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - A Diogenes
- 1 Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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125
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Chrepa V, Pitcher B, Henry MA, Diogenes A. Survival of the Apical Papilla and Its Resident Stem Cells in a Case of Advanced Pulpal Necrosis and Apical Periodontitis. J Endod 2017; 43:561-567. [PMID: 28190588 DOI: 10.1016/j.joen.2016.09.024] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 08/10/2016] [Accepted: 09/06/2016] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Apical papilla represents a source of an enriched mesenchymal stem cell (MSC) population (stem cells of the apical papilla [SCAPs]) that modulates root development and may participate in regenerative endodontic procedures in immature teeth with pulp necrosis. The characteristics and phenotype of this tissue in the presence of inflammation are largely unknown. The purpose of this study was to characterize a human apical papilla sample that was isolated from an immature tooth with pulp necrosis and apical periodontitis. METHODS Inflamed periapical tissue that included part of the apical papilla (apical papilla clinical sample [CS]) was collected from an immature mandibular premolar previously diagnosed with pulp necrosis and apical periodontitis during an apexification procedure. Harvested cells from this tissue (SCAP CS) were compared with inflamed periapical progenitor cells (IPAPCs) and normal SCAP (SCAP-RP89) in flow cytometry and quantitative osteogenesis experiments. Part of the issue was further processed for immunohistochemistry and compared with apical papilla and coronal pulp sections from normal immature teeth as well as inflamed periapical tissues from mature teeth. RESULTS Similar to SCAP-RP89, 96.6% of the SCAP CS coexpressed the MSC markers CD73, CD90, and CD105, whereas only 66.3% of IPAPCs coexpressed all markers. The SCAP CS showed a significantly greater mineralization potential than both SCAP-RP89 and IPAPCs. Finally, immunohistochemical analysis revealed moderate infiltration of cells expressing the inflammatory markers CD45/68 in the apical papilla CS and prominent CD24, CD105, and von Willebrand factor expression. CONCLUSIONS Under inflammatory conditions, human apical papilla was found moderately inflamed with retained SCAP vitality and stemness and increased osteogenic and angiogenesis potential.
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Affiliation(s)
- Vanessa Chrepa
- Department of Endodontics, University of Washington, Seattle, Washington; Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Brandon Pitcher
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Michael A Henry
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas; University of Colorado School of Dental Medicine, Aurora, Colorado
| | - Anibal Diogenes
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
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126
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Silujjai J, Linsuwanont P. Treatment Outcomes of Apexification or Revascularization in Nonvital Immature Permanent Teeth: A Retrospective Study. J Endod 2017; 43:238-245. [DOI: 10.1016/j.joen.2016.10.030] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/07/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022]
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127
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Li L, Pan Y, Mei L, Li J. Clinical and Radiographic Outcomes in Immature Permanent Necrotic Evaginated Teeth Treated with Regenerative Endodontic Procedures. J Endod 2017; 43:246-251. [DOI: 10.1016/j.joen.2016.10.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 09/24/2016] [Accepted: 10/11/2016] [Indexed: 01/29/2023]
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128
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Segura-Egea JJ, Gould K, Şen BH, Jonasson P, Cotti E, Mazzoni A, Sunay H, Tjäderhane L, Dummer PMH. Antibiotics in Endodontics: a review. Int Endod J 2017; 50:1169-1184. [DOI: 10.1111/iej.12741] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/19/2016] [Indexed: 12/20/2022]
Affiliation(s)
- J. J. Segura-Egea
- Department of Endodontics; School of Dentistry; University of Sevilla; Sevilla Spain
| | - K. Gould
- Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle upon Tyne UK
| | | | - P. Jonasson
- Department of Endodontology; Institute of Odontology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - E. Cotti
- Department of Conservative Dentistry and Endodontics; University of Cagliari; Cagliari, Sardinia Italy
| | - A. Mazzoni
- Department of Biomedical and Neuromotor Sciences; DIBINEM; University of Bologna; Bologna Italy
| | - H. Sunay
- Department of Endodontology; Dental Faculty of Istanbul Kemerburgaz University; Istanbul Turkey
| | - L. Tjäderhane
- Department of Oral and Maxillofacial Diseases; Helsinki University Hospital; University of Helsinki; Helsinki Finland
- Research Unit of Oral Health Sciences; Medical Research Center Oulu (MRC Oulu); Oulu University Hospital and University of Oulu; Oulu Finland
| | - P. M. H. Dummer
- School of Dentistry; College of Biomedical & Life Sciences; Cardiff University; Cardiff UK
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129
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Abstract
The primary goal of conventional endodontic treatment is prevention and/or elimination of apical periodontitis for both mature permanent teeth and immature teeth with an open apex. Besides these goals, the objectives of endodontic treatment of immature teeth include preservation of pulp vitality and often further root maturation. Robust criteria for outcome assessment are an essential determinant for any measure of treatment success for both mature and immature teeth.
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Affiliation(s)
- Nadia Chugal
- Section of Endodontics, UCLA School of Dentistry, CHS A3-075, 10833 Le Conte Avenue, Los Angeles, CA 90095-1668, USA.
| | - Sanjay M Mallya
- Section of Oral and Maxillofacial Radiology, UCLA School of Dentistry, CHS 53-068B, Los Angeles, CA 90095-1668, USA
| | - Bill Kahler
- School of Dentistry, The University of Queensland Oral Health Centre, 288 Herston Road, Corner Bramston Terrace & Herston Road, Herston, Queensland 4006, Australia
| | - Louis M Lin
- Department of Endodontics, New York University College of Dentistry, 345 East 24th Street, New York, NY 10010, USA
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130
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Abstract
Immature teeth are at risk for pulp necrosis, resulting in arrested root development and poor long-term prognosis. There is growing evidence that regenerative endodontic procedures promote desirable clinical outcomes. Despite significant advances in the field of regenerative endodontics and acceptable clinical outcomes, current evidence suggests that the tissues formed following currently used procedures do not completely recapitulate the former pulp-dentin complex. Further research is needed to identify prognostic factors and predictors of successful outcomes and to develop different treatment strategies to better predictably achieve all identified clinical outcomes, while favoring tissue formation that more closely resembles the pulp-dentin complex.
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Affiliation(s)
- Anibal Diogenes
- Department of Endodontics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
| | - Nikita B Ruparel
- Department of Endodontics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
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131
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Regenerative Endodontic Procedures: A Perspective from Stem Cell Niche Biology. J Endod 2017; 43:52-62. [DOI: 10.1016/j.joen.2016.09.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 08/19/2016] [Accepted: 09/09/2016] [Indexed: 12/14/2022]
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132
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Alyas SM, Fischer BI, Ehrlich Y, Spolnik K, Gregory RL, Yassen GH. Direct and indirect antibacterial effects of various concentrations of triple antibiotic pastes loaded in a methylcellulose system. J Oral Sci 2016; 58:575-582. [PMID: 28025443 DOI: 10.2334/josnusd.16-0384] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
We investigated the direct and indirect (residual) antibacterial effects of various concentrations of triple antibiotic paste (TAP) loaded into a methylcellulose system. Enterococcus faecalis (E. faecalis) was grown on sterilized dentin blocks (n = 60) and treated with clinically used TAP (1,000 mg/mL), low concentrations of methylcellulose-based TAP (100, 10, and 1 mg/mL), placebo paste, or 1.5% NaOCl (n = 10). The pastes were then removed, and biofilm disruption assays were performed. Additional dentin blocks (n = 120) were pretreated with the same experimental groups (n = 20). The pastes were rinsed off, and the samples were immersed independently in phosphate-buffered saline for 2 and 4 weeks (n = 10). E.faecalis was then grown on the dentin blocks, and biofilm disruption assays were performed. Fisher's Exact and Wilcoxon rank sum tests were used for statistical analyses. With regard to direct antibacterial effects, all treatment groups demonstrated complete eradication of biofilms in comparison to placebo paste, while 10 mg/mL of TAP or higher provided substantial residual antibacterial effects. However, dentin treated with 1 mg/mL of TAP or 1.5% NaOCl did not provide substantial residual antibacterial effects. Dentin pretreated with 10 mg/mL of TAP or higher exhibited extended residual antibacterial effects and can thus be used during endodontic regeneration.(J Oral Sci 58, 575-582, 2016).
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Affiliation(s)
- Sarmad M Alyas
- Department of Endodontics, Indiana University School of Dentistry
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133
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Žižka R, Šedý J. Paradigm Shift from Stem Cells to Cell-Free Regenerative Endodontic Procedures: A Critical Review. Stem Cells Dev 2016; 26:147-153. [PMID: 27788624 DOI: 10.1089/scd.2016.0264] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Regenerative endodontic procedures of immature teeth with necrotic pulp have become a part of therapeutic endodontic spectrum and are considered as an alternative to calcium hydroxide or mineral trioxide aggregate apexification. In last decade, numerous case reports and series with usage of cell-free approaches known as revascularization, revitalization, or maturogenesis have been published. This cell-free approach prevails in clinical regenerative endodontics because of its relative ease of performance, lower financial demands, and absence of complications such as tumorigenesis of used stem cells. In this article, the integral steps of cell-free treatment approaches such as source of stem cells, possible endogenous scaffolds, sources of growth factors, and width of apical foramen in the context of sufficient disinfection of root canal system and outcome of treatment are discussed. Despite not being a fully established treatment protocol, the achieved outcomes are promising regardless of it having a reparative character than a regenerative one.
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Affiliation(s)
- Radovan Žižka
- 1 Faculty of Medicine and Dentistry, Department of Dentistry, Institute of Dentistry and Oral Sciences, Palacky University , Olomouc, Czech Republic
| | - Jiří Šedý
- 2 Faculty of Medicine and Dentistry, Department of Anatomy, Palacky University , Olomouc, Czech Republic
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134
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Chen SJ, Chen LP. Radiographic outcome of necrotic immature teeth treated with two endodontic techniques: A retrospective analysis. Biomed J 2016; 39:366-371. [PMID: 27884384 PMCID: PMC6138798 DOI: 10.1016/j.bj.2015.12.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 12/28/2015] [Indexed: 01/09/2023] Open
Abstract
Background The endodontic treatment of teeth with immature root has always been a challenge. To achieve a better prognosis, regenerative endodontic treatment may become a treatment trend for teeth with apical periodontitis and immature roots. Methods Clinical and radiographic data were collected from 38 endodontic treated immature teeth (21 apexification and 17 regeneration). Measure the radiographic outcome by quantifying the apical lesion. Results There was no statistical difference between the two treatments regarding PAI scores at the 1-, 3-, 6-, and 12-month follow-up (p > 0.05). In addition, different operators and the different stages of root development for both techniques showed no significant statistical difference on the final treatment results. Conclusions In this study, assessment of the radiographic outcomes indicated that regenerative endodontic treatment were identical to the apexification technique.
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Affiliation(s)
- Szu-Ju Chen
- Department of Pedodontics, Chang Gung Memorial Hospital at Taipei, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Li-Ping Chen
- Department of Pedodontics, Chang Gung Memorial Hospital at Taipei, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
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135
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Cianci E, Trubiani O, Diomede F, Merciaro I, Meschini I, Bruni P, Croce F, Romano M. Immobilization and delivery of biologically active Lipoxin A 4 using electrospinning technology. Int J Pharm 2016; 515:254-261. [PMID: 27732897 DOI: 10.1016/j.ijpharm.2016.09.077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/22/2016] [Accepted: 09/28/2016] [Indexed: 01/09/2023]
Abstract
Lipoxin (LX)A4 is a lipoxygenase-formed arachidonic acid metabolite with potent anti-inflammatory, pro-resolution properties. Its therapeutic efficacy has been largely demonstrated in a variety of cellular, preclinical and clinical models. Among these, periodontal disease, where LXA4 promotes tissue repair, also by modulating functions of human periodontal ligament stem cells (hPDLSCs). As medicated biomembranes may be particularly useful in clinical settings, where local stimulation of tissue repair is needed, we used electrospinning to embed LXA4 in membranes made of poly(ethylene oxide) (PEO) and poly(d,l-lactide) (PDLLA). These membranes were fully characterized by scanning electron microscopy, differential scanning calorimetry and biocompatibility with hPDLSCs. Here, we report that LXA4 is retained in these membranes and that ∼15-20% of the total LXA4 amount added to the reaction can be eluted from the membranes using an aqueous buffered medium. The eluted LXA4 fully retained its capability to stimulate hPDLSC proliferation. A similar effect was obtained by adding directly the LXA4-containing membranes to cells. These results demonstrate for the first time that LXA4 can be incorporated into biomembranes, which may be useful to combat local inflammation and promote tissue repair in selected clinical settings.
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Affiliation(s)
- Eleonora Cianci
- Department of Medical, Oral and Biotechnological Sciences, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy; StemTeCh Group, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy; Center of Aging Sciences and Translational Medicine (CeSI-MeT), "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Oriana Trubiani
- Department of Medical, Oral and Biotechnological Sciences, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy; StemTeCh Group, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Francesca Diomede
- Department of Medical, Oral and Biotechnological Sciences, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy; StemTeCh Group, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Ilaria Merciaro
- Department of Medical, Oral and Biotechnological Sciences, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy; StemTeCh Group, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Ida Meschini
- Department of Pharmacy, "G. D'Annunzio" Universtity of Chieti-Pescara, Chieti, Italy
| | - Pantaleone Bruni
- Department of Pharmacy, "G. D'Annunzio" Universtity of Chieti-Pescara, Chieti, Italy
| | - Fausto Croce
- Department of Pharmacy, "G. D'Annunzio" Universtity of Chieti-Pescara, Chieti, Italy
| | - Mario Romano
- Department of Medical, Oral and Biotechnological Sciences, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy; StemTeCh Group, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy; Center of Aging Sciences and Translational Medicine (CeSI-MeT), "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.
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136
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Bukhari S, Kohli MR, Setzer F, Karabucak B. Outcome of Revascularization Procedure: A Retrospective Case Series. J Endod 2016; 42:1752-1759. [PMID: 27726882 DOI: 10.1016/j.joen.2016.06.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/23/2016] [Accepted: 06/23/2016] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The purpose of this retrospective case series was to investigate the outcome of the revascularization procedure in necrotic immature teeth. METHODS The residents and faculty members at the University of Pennsylvania endodontic department were invited to submit consecutive revascularization cases treated by them, irrespective of the outcome, during the time period of 2009 to 2012. Twenty-eight of 35 submitted necrotic immature teeth met the inclusion criteria. The treatment protocol included minimal instrumentation and irrigation with 3% sodium hypochlorite and 17% EDTA. Triple antibiotic paste was placed for a minimum of 21 days. After blood clot induction, either EndoSequence Bioceramic Putty (Brasseler, Savannah, GA) or mineral trioxide aggregate was placed below the cementoenamel junction, and composite was used as a final restoration. The follow-up period ranged from 7 to 72 months. The outcome was assessed as complete healing (the absence of clinical signs and symptoms, complete resolution of periradicular radiolucency, increase in the root dentin thickness/length, and apical closure), incomplete healing (the absence of clinical signs and symptoms, the periapical lesion completely healed without any signs of root maturation or thickening, the periapical lesion either reduced in size or unchanged with/without radiographic signs of increasing root dentin thickness/length, or apical closure), and failure (persistent clinical signs and symptoms and/or increased size of the periradicular lesion). RESULTS Twenty-one of 28 cases (75%) healed completely, 3 cases (10.7%) failed during the observation period and needed further treatment, and 4 cases (14%) presented with incomplete healing. CONCLUSIONS Within the limitation of this study, the outcome of revascularization, wherein healing of periapical periodontitis and maturation of roots occurs, is fairly high, making it a viable treatment option in comparison with apexification.
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Affiliation(s)
- Sarah Bukhari
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Meetu R Kohli
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Frank Setzer
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bekir Karabucak
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Saoud TMA, Mistry S, Kahler B, Sigurdsson A, Lin LM. Regenerative Endodontic Procedures for Traumatized Teeth after Horizontal Root Fracture, Avulsion, and Perforating Root Resorption. J Endod 2016; 42:1476-82. [DOI: 10.1016/j.joen.2016.04.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 03/27/2016] [Accepted: 04/07/2016] [Indexed: 12/18/2022]
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Meschi N, Castro AB, Vandamme K, Quirynen M, Lambrechts P. The impact of autologous platelet concentrates on endodontic healing: a systematic review. Platelets 2016; 27:613-633. [PMID: 27658056 DOI: 10.1080/09537104.2016.1226497] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The current literature was reviewed to determine the impact of autologous platelet concentrates (APCs) on endodontic healing. All types of clinical study designs concerning any kind of endodontic treatment involving the application of APCs were included. Two independent reviewers searched three databases (PubMed, Embase, and Cochrane Library) for studies, complemented by hand search, until 16/1/2016. From the 423 identified records, 48 articles met the inclusion criteria. Selected randomized controlled clinical trials (RCTs) underwent Cochrane Collaboration's risk-of-bias assessment and data extraction. Only two RCTs showed low risk of bias. There was considerable heterogeneity between the RCTs with regard to the type of therapy, type of APCs, assessment method, and study quality, and therefore the data could not be analyzed quantitatively. The included case reports/series and non-randomized comparative studies underwent qualitative analysis with the revised Methodological Index for Non-Randomized Studies (MINORS) and data extraction. The two comparative non-randomized studies scored qualitatively high, though the MINORS-scores of the case series and reports were dispersed. APCs were involved in five endodontic treatment modalities, namely apexification, regenerative endodontic procedures, pulpotomy, apical surgery, and treatment of endo-perio/perio-endo lesions. APCs seem to accelerate postoperative bone healing, augment the patients' postoperative quality of life, aid further root development, and support maintenance/regaining of pulp vitality. No adverse events were reported. APCs in endodontic treatments seem to contribute to the healing of soft and hard tissues, though there is a lack of long-term high quality clinical trials and standardized treatment protocols.
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Affiliation(s)
- Nastaran Meschi
- a Department of Oral Health Sciences, Endodontology , KU Leuven & Dentistry, University Hospitals Leuven , Leuven , Belgium
| | - Ana B Castro
- b Department of Oral Health Sciences , Periodontology, KU Leuven & Dentistry, University Hospitals Leuven , Leuven , Belgium
| | - Katleen Vandamme
- c Department of Oral Health Sciences , Restorative Dentistry, KU Leuven & Dentistry, University Hospitals Leuven , Leuven , Belgium
| | - Marc Quirynen
- b Department of Oral Health Sciences , Periodontology, KU Leuven & Dentistry, University Hospitals Leuven , Leuven , Belgium
| | - Paul Lambrechts
- a Department of Oral Health Sciences, Endodontology , KU Leuven & Dentistry, University Hospitals Leuven , Leuven , Belgium
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139
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Ha WN, Duckmanton P, Kahler B, Walsh LJ. A survey of various endodontic procedures related to mineral trioxide aggregate usage by members of the Australian Society of Endodontology. AUST ENDOD J 2016; 42:132-138. [DOI: 10.1111/aej.12170] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- William N. Ha
- School of Dentistry; University of Queensland; Herston Queensland Australia
| | | | - Bill Kahler
- School of Dentistry; University of Queensland; Herston Queensland Australia
| | - Laurence J. Walsh
- School of Dentistry; University of Queensland; Herston Queensland Australia
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140
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Estefan BS, El Batouty KM, Nagy MM, Diogenes A. Influence of Age and Apical Diameter on the Success of Endodontic Regeneration Procedures. J Endod 2016; 42:1620-1625. [PMID: 27623497 DOI: 10.1016/j.joen.2016.06.020] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/17/2016] [Accepted: 06/06/2016] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Treatment of immature permanent teeth with necrotic pulp and apical pathosis constitutes a challenge for endodontists. The present study was done to evaluate the effect of age and apical diameter on the regenerative potential of young permanent immature teeth with necrotic pulps. METHODS Immature necrotic permanent maxillary incisors (n = 40) of patients 9-18 years old were divided into 2 groups according to the treatment protocol: group Y (younger age group), 9-13 years and group O (older age group), 14-18 years. Each group was further subdivided into 2 subgroups according to apical diameter, subgroup (n) (narrower diameter) between 0.5 and 1 mm and subgroup (w) (wider diameter) equal to or greater than 1 mm. Revascularization procedures were performed for all patients. Follow-up was done for up to 12 months. Standardized radiographs were digitally evaluated for increase in root length and thickness and decrease in apical diameter. RESULTS After the follow-up period, most of the cases demonstrated radiographic evidence of periapical healing. Group Y showed significant progressive increase in root length and width and decrease in apical diameter. Subgroup (w) representing wider apical diameter showed significant progress as well. CONCLUSIONS It was found that revascularization procedures can be implemented in any age ranging from 9 to 18 years; however, younger age groups were better candidates for revascularization procedure than older ones. Regarding the apical diameter, regeneration procedures were successful with apical diameters as small as 0.5 mm. However, teeth with preoperative wider diameters (≥1 mm) demonstrated greater increase in root thickness, length, and apical narrowing.
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Affiliation(s)
| | | | - Mohamed Mokhtar Nagy
- Department of Endodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt.
| | - Anibal Diogenes
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Bellamy C, Shrestha S, Torneck C, Kishen A. Effects of a Bioactive Scaffold Containing a Sustained Transforming Growth Factor-β1-releasing Nanoparticle System on the Migration and Differentiation of Stem Cells from the Apical Papilla. J Endod 2016; 42:1385-92. [PMID: 27484250 DOI: 10.1016/j.joen.2016.06.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 04/29/2016] [Accepted: 06/16/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION This 2-part study hypothesized that a bioactive scaffold containing a sustained transforming growth factor (TGF)-β1-releasing nanoparticle system will promote migration and enhance differentiation of stem cells from the apical papilla (SCAP). The study aimed to develop and characterize a novel modified chitosan-based scaffold containing TGF-β1-releasing chitosan nanoparticles (TGF-β1-CSnp) to enhance migration and differentiation of SCAP. METHODS Part I concerns the synthesis and characterization of a carboxymethyl chitosan-based scaffold and TGF-β1-CSnp. Part II examines the effect of sustained TGF-β1 release from scaffold containing TGF-β1-CSnp on odontogenic differentiation of SCAP. RESULTS The scaffold demonstrated properties conducive to cellular activities. The incorporation of TGF-β1 in CSnp allowed sustained release of TGF-β1, facilitating delivery of a critical concentration of TGF-β1 at the opportune time. TGF-β1 bioactivity was maintained for up to 4 weeks. SCAP showed greater viability, migration, and biomineralization in the presence of TGF-β1-CSnp than in the presence of free TGF-β1. SCAP cultured in TGF-β1-CSnp + scaffold showed significantly higher dentin matrix protein-1 and dentin sialophosphoprotein signals compared with free TGF-β1 + scaffold or CSnp + scaffold. CONCLUSIONS These experiments highlighted the potential of a carboxymethyl chitosan-based scaffold with growth factor releasing nanoparticles to promote migration and differentiation of SCAP. The results of this study may have direct application to improve current endodontic regenerative protocols.
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Affiliation(s)
- Craig Bellamy
- Discipline of Endodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Suja Shrestha
- Discipline of Endodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Calvin Torneck
- Discipline of Endodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Anil Kishen
- Discipline of Endodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
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143
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Schmalz G, Smith AJ. Pulp development, repair, and regeneration: challenges of the transition from traditional dentistry to biologically based therapies. J Endod 2016; 40:S2-5. [PMID: 24698689 DOI: 10.1016/j.joen.2014.01.018] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The traditional concept of replacing diseased tooth/pulp tissues by inert materials (restoration) is being challenged by recent advances in pulp biology leading to regenerative strategies aiming at the generation of new vital tissue. New tissue formation in the pulp chamber can be observed after adequate infection control and the formation of a blood clot. However, differentiation of true odontoblasts is still more speculative, and the approach is largely limited to immature teeth with open apices. A more systematic approach may be provided by the adoption of the tissue engineering concepts of using matrices, suitable (stem) cells, and signaling molecules to direct tissue events. With these tools, pulplike constructs have already been generated in experimental animals. However, a number of challenges still remain for clinical translation of pulp regeneration (eg, the cell source [resident vs nonresident stem cells, the latter associated with cell-free approaches], mechanisms of odontoblast differentiation, the pulp environment, the role of infection and inflammation, dentin pretreatment to release fossilized signaling molecules from dentin, and the provision of suitable matrices). Transition as a process, defined by moving from one form of "normal" to another, is based not only on the progress of science but also on achieving change to established treatment concepts in daily practice. However, it is clear that the significant recent achievements in pulp biology are providing an exciting platform from which clinical translation of dental pulp regeneration can advance.
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Affiliation(s)
- Gottfried Schmalz
- Department of Operative Dentistry and Periodontology, University Medical Centre Regensburg, Regensburg, Germany.
| | - Anthony J Smith
- Oral Biology, School of Dentistry, University of Birmingham, St Chads Queensway, Birmingham, United Kingdom
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144
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Harlamb SC. Management of incompletely developed teeth requiring root canal treatment. Aust Dent J 2016; 61 Suppl 1:95-106. [PMID: 26923451 DOI: 10.1111/adj.12401] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Endodontic management of the permanent immature tooth continues to be a challenge for both clinicians and researchers. Clinical concerns are primarily related to achieving adequate levels of disinfection as 'aggressive' instrumentation is contraindicated and hence there exists a much greater reliance on endodontic irrigants and medicaments. The open apex has also presented obturation difficulties, notably in controlling length. Long-term apexification procedures with calcium hydroxide have proven to be successful in retaining many of these immature infected teeth but due to their thin dentinal walls and perceived problems associated with long-term placement of calcium hydroxide, they have been found to be prone to cervical fracture and subsequent tooth loss. In recent years there has developed an increasing interest in the possibility of 'regenerating' pulp tissue in an infected immature tooth. It is apparent that although the philosophy and hope of 'regeneration' is commendable, recent histologic studies appear to suggest that the calcified material deposited on the canal wall is bone/cementum rather than dentine, hence the absence of pulp tissue with or without an odontoblast layer.
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Affiliation(s)
- S C Harlamb
- Private Practice, Burwood, New South Wales, Australia
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145
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Alghilan MA, Windsor LJ, Palasuk J, Yassen GH. Attachment and proliferation of dental pulp stem cells on dentine treated with different regenerative endodontic protocols. Int Endod J 2016; 50:667-675. [DOI: 10.1111/iej.12669] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 06/06/2016] [Indexed: 12/15/2022]
Affiliation(s)
- M. A. Alghilan
- Department of Biomedical and Applied Sciences; Indiana University School of Dentistry; Indianapolis IN USA
- Department of Restorative Dental Science; King Saud bin Abdulaziz University for Health Sciences; Riyadh Saudi Arabia
| | - L. J. Windsor
- Department of Biomedical and Applied Sciences; Indiana University School of Dentistry; Indianapolis IN USA
| | - J. Palasuk
- Department of Biomedical and Applied Sciences; Indiana University School of Dentistry; Indianapolis IN USA
| | - G. H. Yassen
- Department of Biomedical and Applied Sciences; Indiana University School of Dentistry; Indianapolis IN USA
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146
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Clinical Perspective of Electrospun Nanofibers as a Drug Delivery Strategy for Regenerative Endodontics. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s40496-016-0103-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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147
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Roudsari RV, Jawad S, Taylor C, Darcey J, Qualtrough A. Modern Endodontic Principles. Part 8: The Future of Endodontics. DENTAL UPDATE 2016; 43:430-441. [PMID: 27529911 DOI: 10.12968/denu.2016.43.5.430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Although the principles of endodontics have remained unchanged for many decades, root canal treatment has been subject to major changes in the past few years. This paper outlines the cutting-edge advances including the materials and techniques used. CPD/Clinical Relevance: This article provides an overview of bioactive materials and insight into regenerative endodontics, vital pulp therapy and intentional replantation.
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Elisa G, Mario A, Maria CA, Narcisa M, Anna L, Janira R, Daminano P, Nicola S, Elio B. Confocal scanner laser evaluation of bactericidal effect of different antibiotic mixtures used for dental pulp regeneration: a preliminary study. GIORNALE ITALIANO DI ENDODONZIA 2016. [DOI: 10.1016/j.gien.2016.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Žižka R, Buchta T, Voborná I, Harvan L, Šedý J. Root Maturation in Teeth Treated by Unsuccessful Revitalization: 2 Case Reports. J Endod 2016; 42:724-9. [DOI: 10.1016/j.joen.2016.02.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/31/2016] [Accepted: 02/08/2016] [Indexed: 12/11/2022]
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