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Auerbach D, Alaugaily I, Davis S, Azim AA. A promising approach utilising photothermal energy to disinfect the root canal system: An in vitro investigation. AUST ENDOD J 2024. [PMID: 38995151 DOI: 10.1111/aej.12872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/30/2024] [Accepted: 06/20/2024] [Indexed: 07/13/2024]
Abstract
This study aimed to assess root canal disinfection through various irrigation protocols, including a novel photothermal system called 'LEAP'. Mandibular premolars were infected with Enterococcus faecalis and divided into five groups for different treatments: Group 1: standard needle irrigation; Group 2: passive ultrasonic irrigation; Group 3: GentleWave; Group 4: LEAP; and Group 5: Group 1 + Group 4. Microbial counts were measured before (S1) and after disinfection (S2) using colony-forming units (CFU) and confocal laser scanning microscopy (CLSM). Results revealed a significant reduction in bacterial counts for all groups (p < 0.05). While the percentage of dead bacteria near the canal wall (0-50 μm) did not differ significantly, at 50-150 μm, LEAP and SNI + LEAP exhibited significantly higher bacterial reduction than other groups (p < 0.05). The findings indicate that LEAP is comparable to existing irrigation devices in the main root canal and notably superior in tubular disinfection.
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Affiliation(s)
- Daniela Auerbach
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, USA
| | - Ibrahim Alaugaily
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, USA
- Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Scott Davis
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, USA
| | - Adham A Azim
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, USA
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2
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Kahler B, Lu J, Taha NA. Regenerative endodontic treatment and traumatic dental injuries. Dent Traumatol 2024. [PMID: 38989999 DOI: 10.1111/edt.12979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/07/2024] [Accepted: 06/11/2024] [Indexed: 07/12/2024]
Abstract
Pulp necrosis is the most common complication following dental trauma and is often associated with apical periodontitis. The management of these teeth is challenging in terms of large root canals, open apices, thin dentinal walls, and short roots. Over decades the conventional treatment for these teeth was calcium hydroxide apexification, a time-consuming procedure despite high success rates. Subsequently after the introduction of mineral trioxide aggregate and hydraulic calcium silicate materials single visit apical plug procedures became increasingly practiced with comparable success rates to the conventional apexification. The search continued afterward for a clinical procedure that may stimulate further root development and apical closure to avoid the long-term complication of root fracture after apexification. Regenerative procedures using stem cells derived from the apical papilla and blood clots as scaffolds were then introduced for the management of immature teeth, with variable protocols and success rates. This review will cover the evidence available and current position of regenerative endodontic procedures in traumatized immature teeth with apical periodontitis, in terms of clinical protocols, outcome, and potential prognostic factors.
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Affiliation(s)
- Bill Kahler
- Department of Restorative and Reconstructive Dentistry, School of Dentistry, University of Sydney, Camperdown, New South Wales, Australia
| | - Jing Lu
- Fujian Key Laboratory of Oral Diseases, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Nessrin A Taha
- Conservative Dentistry Department, Jordan University of Science and Technology, Irbid, Jordan
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Shi X, Hu X, Jiang N, Mao J. Regenerative endodontic therapy: From laboratory bench to clinical practice. J Adv Res 2024:S2090-1232(24)00267-4. [PMID: 38969092 DOI: 10.1016/j.jare.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/16/2024] [Accepted: 07/01/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Maintaining the vitality and functionality of dental pulp is paramount for tooth integrity, longevity, and homeostasis. Aiming to treat irreversible pulpitis and necrosis, there has been a paradigm shift from conventional root canal treatment towards regenerative endodontic therapy. AIM OF REVIEW This extensive and multipart review presents crucial laboratory and practical issues related to pulp-dentin complex regeneration aimed towards advancing clinical translation of regenerative endodontic therapy and enhancing human life quality. KEY SCIENTIFIC CONCEPTS OF REVIEW In this multipart review paper, we first present a panorama of emerging potential tissue engineering strategies for pulp-dentin complex regeneration from cell transplantation and cell homing perspectives, emphasizing the critical regenerative components of stem cells, biomaterials, and conducive microenvironments. Then, this review provides details about current clinically practiced pulp regenerative/reparative approaches, including direct pulp capping and root revascularization, with a specific focus on the remaining hurdles and bright prospects in developing such therapies. Next, special attention was devoted to discussing the innovative biomimetic perspectives opened in establishing functional tissues by employing exosomes and cell aggregates, which will benefit the clinical translation of dental pulp engineering protocols. Finally, we summarize careful consideration that should be given to basic research and clinical applications of regenerative endodontics. In particular, this review article highlights significant challenges associated with residual infection and inflammation and identifies future insightful directions in creating antibacterial and immunomodulatory microenvironments so that clinicians and researchers can comprehensively understand crucial clinical aspects of regenerative endodontic procedures.
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Affiliation(s)
- Xin Shi
- Center of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan 430022, China
| | - Xiaohan Hu
- Outpatient Department Office, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Nan Jiang
- Central Laboratory, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing 100081, China.
| | - Jing Mao
- Center of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan 430022, China.
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Nogueira APA, Grazziotin-Soares R, Leal AMM, Freitas Júnior SAG, Gonçalves BLL, Bauer J, Ferreira MC, Carvalho CN. Root Canal Dentin Microhardness after Contact with Antibiotic Medications: An In Vitro Study. Dent J (Basel) 2024; 12:201. [PMID: 39056988 PMCID: PMC11276266 DOI: 10.3390/dj12070201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/19/2024] [Accepted: 05/21/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Antibiotic pastes used as intracanal medication in cases of revascularization therapy might cause negative effects on tooth properties, such as a reduction in dentin microhardness. This in vitro study investigated dentin microhardness in three different locations distancing from the canal lumen after 20 days of treatment with a tri-antibiotic paste (ciprofloxacin, metronidazole, and minocycline), and with a double-antibiotic paste (ciprofloxacin and metronidazole), with calcium hydroxide [Ca(OH)2] UltracalTM XS-treated dentin as comparison. Material and Methods: Human mandibular premolars (n = 48) had the root canals cleaned and shaped and were used to produce dentin slices. Dentin slices remained immersed in the medications for 20 days. The Knoop microhardness (KHN) test was performed before (baseline/Day-0) and after treatment (Day-20) with the medications. Indentations were made at 25 µm, 50 µm, and 100 µm distances from the root canal lumen. The KHN was compared intra-group using Wilcoxon's test. Independent groups were compared using Mann-Whitney's and Kruskal-Wallis' tests, at α = 5%. Results: The microhardness in all the tested groups was reduced at Day-20 in comparison with Day-0 (p < 0.001) (intra-group comparison/same distances). The Day-0 values were similar, and the Day-20 values were higher for the Ca(OH)2 group (p < 0.05) (comparison between groups/same distances). Conclusions: Calcium hydroxide for 20 days would be preferred rather than antibiotic pastes to minimize the expected reduction in dentin microhardness during regenerative procedures.
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Affiliation(s)
- Amanda Palmeira Arruda Nogueira
- School of Dentistry, CEUMA University, São Luís 65075-120, MA, Brazil; (A.P.A.N.); (A.M.M.L.); (S.A.G.F.J.); (B.L.L.G.); (M.C.F.)
| | - Renata Grazziotin-Soares
- Department of Oral Biological Medical Sciences, Faculty of Dentistry, University of British Columbia UBC, Vancouver, BC V6T 1Z4, Canada;
| | - Adriana Marques Mesquita Leal
- School of Dentistry, CEUMA University, São Luís 65075-120, MA, Brazil; (A.P.A.N.); (A.M.M.L.); (S.A.G.F.J.); (B.L.L.G.); (M.C.F.)
| | | | - Bruna Laís Lins Gonçalves
- School of Dentistry, CEUMA University, São Luís 65075-120, MA, Brazil; (A.P.A.N.); (A.M.M.L.); (S.A.G.F.J.); (B.L.L.G.); (M.C.F.)
| | - José Bauer
- Dental Materials Laboratory, School of Dentistry, University Federal of Maranhão (UFMA), São Luís 5085-582, MA, Brazil;
| | - Meire Coelho Ferreira
- School of Dentistry, CEUMA University, São Luís 65075-120, MA, Brazil; (A.P.A.N.); (A.M.M.L.); (S.A.G.F.J.); (B.L.L.G.); (M.C.F.)
| | - Ceci Nunes Carvalho
- School of Dentistry, CEUMA University, São Luís 65075-120, MA, Brazil; (A.P.A.N.); (A.M.M.L.); (S.A.G.F.J.); (B.L.L.G.); (M.C.F.)
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Abat VH, Bayrak GD, Gündoğar M. Assessment of apical extrusion in regenerative endodontics: a comparative study of different irrigation methods using three-dimensional immature tooth models. Odontology 2024:10.1007/s10266-024-00961-x. [PMID: 38913232 DOI: 10.1007/s10266-024-00961-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 06/04/2024] [Indexed: 06/25/2024]
Abstract
To investigate the apical extrusion of sodium hypochlorite in immature permanent teeth caused by conventional syringe irrigation (CSI), EDDY, XP-endo Finisher file (XP-F), and a new laser irrigation activation system [shock-wave-enhanced-emission-photo-acoustic-streaming (SWEEPS)]. Three-dimensionally printed forty-nine teeth with immature central incisor morphology were randomly assigned to seven experimental groups, based on the irrigation activation methods and insertion depths (1 mm and 2 mm short of the working length) as follows: CSI-1, CSI-2, EDDY-1, EDDY-2, XP-1, XP-2, and SWEEPS. Prior to the irrigation activation process, samples were placed in metacresol mixed agar gel in Eppendorf tubes. To evaluate NaOCI extrusion into the gel, each sample was digitally photographed, and the area of apical extrusion was analyzed using ImageJ software. To examine potential significant differences between the continuous variables, the Mann-Whitney U test and Kruskal-Wallis H test, were applied (P = .05). The SWEEPS resulted in a greater amount of apical extrusion compared to the CSI method, regardless of the insertion depth (P < 0.001). The SWEEPS resulted in greater apical extrusion scores compared to EDDY-2 (P < 0.001). The EDDY-1 resulted in greater amount of apical extrusion scores compared to EDDY-2 (P < 0.001). This study, the first to show the effect of the novel SWEEPS technology on NaOCI extrusion, found that irrigation activation can cause different levels of apical extrusion depending on the method and distance from the working length. It is crucial to consider the potential occurrence of apical extrusion when applying activation methods to immature teeth.
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Affiliation(s)
- Vahide Hazal Abat
- Department of Endodontics, Faculty of Dentistry, Uskudar University, Istanbul, Turkey.
| | - Gökçen Deniz Bayrak
- Department of Pediatric Dentistry, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
| | - Mustafa Gündoğar
- Department of Endodontics, Faculty of Dentistry, Medipol University, Istanbul, Turkey
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Liu K, Li W, Yu S, Li G, Ye L, Gao B. An innovative cell-based transplantation therapy for an immature permanent tooth in an adult: a case report. BMC Oral Health 2024; 24:646. [PMID: 38824565 PMCID: PMC11143573 DOI: 10.1186/s12903-024-04410-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 05/24/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Immature teeth with necrotic pulps present multiple challenges to clinicians. In such cases, regenerative endodontic procedures (REPs) may be a favorable strategy. Cells, biomaterial scaffolds, and signaling molecules are three key elements of REPs. Autologous human dental pulp cells (hDPCs) play an important role in pulp regeneration. In addition, autologous platelet concentrates (APCs) have recently been demonstrated as effective biomaterial scaffolds in regenerative dentistry, whereas the latest generation of APCs-concentrated growth factor (CGF), especially liquid phase CGF (LPCGF)-has rarely been reported in REPs. CASE PRESENTATION A 31-year-old woman presented to our clinic with the chief complaint of occlusion discomfort in the left mandibular posterior region for the past 5 years. Tooth #35 showed no pulp vitality and had a periodontal lesion, and radiographic examination revealed that the tooth exhibited extensive periapical radiolucency with an immature apex and thin dentin walls. REP was implemented via transplantation of autologous hDPCs with the aid of LPCGF. The periodontal lesion was managed with simultaneous periodontal surgery. After the treatment, the tooth was free of any clinical symptoms and showed positive results in thermal and electric pulp tests at 6- and 12-month follow-ups. At 12-month follow-up, radiographic evidence and three-dimensional models, which were reconstructed using Mimics software based on cone-beam computed tomography, synergistically confirmed bone augmentation and continued root development, indicating complete disappearance of the periapical radiolucency, slight lengthening of the root, evident thickening of the canal walls, and closure of the apex. CONCLUSION hDPCs combined with LPCGF represents an innovative and effective strategy for cell-based regenerative endodontics.
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Affiliation(s)
- Keyue Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Dentistry and Endodontics Department, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Wenxu Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Dentistry and Endodontics Department, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Sijing Yu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Dentistry and Endodontics Department, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Guimin Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Dentistry and Endodontics Department, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Ling Ye
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Dentistry and Endodontics Department, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Bo Gao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Dentistry and Endodontics Department, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Abdellatif D, Iandolo A, De Benedetto G, Giordano F, Mancino D, Euvrard E, Pisano M. Pulp regeneration treatment using different bioactive materials in permanent teeth of pediatric subjects. JOURNAL OF CONSERVATIVE DENTISTRY AND ENDODONTICS 2024; 27:458-484. [PMID: 38939542 PMCID: PMC11205167 DOI: 10.4103/jcde.jcde_140_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/08/2024] [Accepted: 04/08/2024] [Indexed: 06/29/2024]
Abstract
Background and Objectives The present systematic review aims to assess the success rate of the pulp regeneration treatment, according to the American Association of Endodontists (AAE) criteria, using different bioactive materials in permanent teeth of pediatric subjects (6-17 years of age). Materials and Methods The study protocol was registered on PROSPERO and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The question formulation was accomplished using the PICO model, and an electronic search was carried out on Scopus, MEDLINE/PubMed, Web of Science, and Cochrane databases till April 1, 2023. A total of 30 studies were established to fulfill the inclusion criteria of this systematic review. Results A total of 273 teeth have been treated with pulp regeneration treatment. By comparing different biomaterials and the success criteria defined by the AAE, the material associated with a higher success rate was found to be the white mineral trioxide aggregate. However, the overall success rate of pulp regeneration treatment was reported for 248 out of 273 teeth (91.20%). Conclusions Data obtained support the potential that regenerative endodontics aids in continuing root development in permanent immature teeth. Further studies are needed for a more extensive evaluation of the use of different biomaterials and the success rate in regenerative endodontics.
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Affiliation(s)
- Dina Abdellatif
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Alfredo Iandolo
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | | | - Francesco Giordano
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Davide Mancino
- Faculty of Dental Surgery, Federation of Medicine Translational of Strasbourg and Federation of Materials and Nanoscience of Alsace, University of Strasbourg, Strasbourg, CHU Besançon, France
| | - Edouard Euvrard
- Service of Maxillofacial Surgery, Stomatology and Hospital Odontology, CHU Besançon, France
- Laboratoire Sinergies EA 4662, University of Franche-Comté, Besançon, France
| | - Massimo Pisano
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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Alsofi L, Almarzouki S. Failed Regenerative Endodontic Case Treated by Modified Aspiration-irrigation Technique and Apexification. J Contemp Dent Pract 2024; 25:92-97. [PMID: 38514438 DOI: 10.5005/jp-journals-10024-3601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
AIM This report addresses the management of a large persistent discharging lesion in an 11-year-old boy. The report describes the use of aspiration-irrigation technique for the management of immature necrotic tooth with persistent discharge after a failed regenerative procedure. BACKGROUND Regenerative endodontics aim to provide an increase in root canal width, length, and in apical closure. Alternative procedures, such as apexification, should be attempted when regeneration fails. If the canal cannot be dried to persistent discharge, the aspiration-irrigation technique can be used. The technique relies on using aspiration along with irrigation to remove pus from the periapical area. CASE DESCRIPTION This is a case for an 11-year-old patient who had trauma to tooth #11, which resulted in the complicated crown fracture. He had an emergency management that included pulpectomy and intracanal medication at another clinic. Two years later, the patient was presented to our clinic. Upon examination, the diagnosis was previously initiated therapy with asymptomatic apical periodontitis in immature tooth #11. Regeneration was attempted first but failed. The mineral trioxide aggregate (MTA) plug was removed, and the canal had persistent pus discharge. The canal was filled with intracanal medication, and then 2 weeks later, the canal was filled with triple antibiotic paste (TAP). Next visit, and due to continuous discharge, tooth #11 was treated conservatively with an intracanal aspiration-irrigation technique. An IrriFlex needle attached to a high-volume suction was used to aspirate the cystic fluid. Mineral trioxide aggregate plug apexification was performed in a later visit and the tooth was restored. CONCLUSION During the 3-month and 16-month follow-up, there was resolution of the symptoms, a decrease in the periapical lesion size, and soft tissues appeared within normal limits. CLINICAL SIGNIFICANCE Regenerative procedures are a good option for immature necrotic teeth. These procedures may fail due to persistent pus discharge from the root canals. The aspiration-irrigation technique is a good treatment option in cases of consciously discharging canals. How to cite this article: Alsofi L, Almarzouki S. Failed Regenerative Endodontic Case Treated by Modified Aspiration-irrigation Technique and Apexification. J Contemp Dent Pract 2024;25(1):92-97.
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Affiliation(s)
- Loai Alsofi
- Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia, Phone: +966 555318481, e-mail:
| | - Sara Almarzouki
- Department of Endodontics, University Dental Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
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Alharbi TM, Thabet AM, Alabbadi SH, Alhazmi MY, Khan HF, AlRasheed MA, Al-Twalbeh NA, Alsuhaim AS, Alqahtani NS. Unlocking the Potential of Cellular Guidance in Endodontics: Advancing the Process of Pulp Regeneration and Beyond. Cureus 2024; 16:e51651. [PMID: 38318576 PMCID: PMC10839349 DOI: 10.7759/cureus.51651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 02/07/2024] Open
Abstract
Regenerative endodontics represents a paradigm shift in dental therapy, with the potential to not only restore damaged dental tissues but also to preserve the vitality of teeth. At the heart of this innovative approach is cell homing, a technique that harnesses the body's own healing mechanisms by recruiting endogenous stem cells to the site of dental injury for effective tissue regeneration. This review delves into the intricate processes of cell homing in the context of regenerative endodontics, particularly focusing on its application in immature teeth with open apices. It examines the role of bioactive molecules, scaffolds, and growth factors in orchestrating cell migration and differentiation within the root canal space. In addition, the review addresses the current limitations in clinical practice, such as the challenges in completely regenerating the pulp-dentin complex and the unpredictability in long-term outcomes. It also explores future possibilities, including the potential for more refined and effective regenerative strategies. By providing a comprehensive overview of the current state of cell homing in regenerative endodontics, this article aims to contribute to the ongoing development of advanced therapeutic techniques that could revolutionize endodontic treatment and improve patient care.
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Affiliation(s)
- Tariq M Alharbi
- Endodontics, King Fahad General Hospital, Medina, SAU
- Endodontics, Speciality Dental Center, Medina, SAU
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Teawcharoensopa C, Srisuwan T. The potential use of ascorbic acid to recover the cellular senescence of lipopolysaccharide-induced human apical papilla cells: an in vitro study. Clin Oral Investig 2023; 28:49. [PMID: 38153550 DOI: 10.1007/s00784-023-05455-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/18/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVES To examine the effect of lipopolysaccharide (LPS) on cellular senescence induction of human apical papilla cells (hAPCs) and evaluate the potential use of 50 μg/ml ascorbic acid to recover cellular senescence and regenerative functions. MATERIALS AND METHODS hAPCs were treated with LPS at 1 and 10 μg/ml either with or without 50 μg/ml ascorbic acid for 48 h. The cellular senescence biomarkers were analyzed by senescence-associated β-galactosidase (SA-β-gal) staining and senescence-related gene expression, p16 and p21. Cell migration, at 12 h and 24 h, was evaluated using a scratch wound assay. Mineralization potential was assessed at 21 days using Alizarin red S staining and dentine sialophosphoprotein (DSPP) and bone sialoprotein (BSP) gene expression. RESULTS 1 μg/ml and 10 μg/ml LPS stimulation for 48 h induced cellular senescence, as shown by remarkable SA-β-gal staining and p16 and p21 gene expression. The percentage of wound closure and mineralized formation was reduced. The co-incubation with ascorbic acid significantly down-regulated the level of SA-β-gal staining. The reduction of senescence-associated gene expressions was observed. Ascorbic acid improved cell migration, mineralized nodule formation, and the expression of DSPP and BSP genes in LPS-treated hAPCs. CONCLUSIONS LPS significantly promoted cellular senescence on hAPCs and diminished the cell function capacity. Co-presence of ascorbic acid could impede cellular senescence and possibly improve the regenerative capacity of LPS-induced senescent hAPCs in vitro. CLINICAL RELEVANCE The data support the in vitro potential benefit of ascorbic acid on cellular senescence recovery of apical papilla cells.
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Affiliation(s)
- Chananporn Teawcharoensopa
- Department of Restorative Dentistry and Periodontology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, TH, Thailand
- Sikhoraphum Hospital Dental Department, Surin, TH, Thailand
| | - Tanida Srisuwan
- Department of Restorative Dentistry and Periodontology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, TH, Thailand.
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da Silva Magalhães K, Kuerten Gil AC, Goulart TS, Schuldt DPV, Coelho BS, Figueiredo DDR, Garcia LDFR, de Almeida J. Efficacy of disinfection procedures performed prior to regenerative endodontic therapy: An integrative review. AUST ENDOD J 2023; 49:418-427. [PMID: 35932453 DOI: 10.1111/aej.12670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 07/17/2022] [Indexed: 11/30/2022]
Abstract
The aim of this integrative review was to identify whether the disinfection procedures performed prior to regenerative endodontic treatment were effective on biofilm removal from the root canals. The research was based on PubMed, Latin American and Caribbean Health Sciences Literature (Lilacs) and Scientific Electronic Library Online (SciELO) databases. Four articles were selected; one of the studies was in vivo and the others ex vivo. Different disinfection procedures were studied, characterised mainly by the use of intracanal medication, highlighting the double antibiotic paste, triple antibiotic paste and calcium hydroxide paste. Disinfection ability was evaluated against Enterococcus faecalis and multispecies biofilms by using the fluorescence technique and colony forming unit counting, for 7 to 21 days. Double antibiotic paste and triple antibiotic paste demonstrated excellent antibiofilm activity, unlike CH paste that showed limited disinfection, even when associated with different antimicrobial agents. Triple antibiotic paste was the most effective medication against biofilm.
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Affiliation(s)
| | - Ana Clara Kuerten Gil
- Department of Endodontics, University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Taynara Santos Goulart
- Department of Endodontics, University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil
| | | | - Beatriz Serrato Coelho
- Department of Endodontics, University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil
| | | | | | - Josiane de Almeida
- Department of Endodontics, University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil
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12
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Santos LM, Cardoso PES, Diniz EA, Rahhal JG, Sipert CR. Different concentrations of fetal bovine serum affect cytokine modulation in Lipopolysaccharide-activated apical papilla cells in vitro. J Appl Oral Sci 2023; 31:e20230020. [PMID: 37493700 PMCID: PMC10382075 DOI: 10.1590/1678-7757-2023-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/13/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Fetal bovine serum (FBS) is the most used supplement in culture media; however, it may interfere with in vitro assays via effects on cell proliferation and cytokine production. The ideal FBS concentration for assays using apical papilla cells (APCs) remains unknown. Therefore, this study aimed to evaluate the effects of FBS on APC activation, cell viability/proliferation, and cytokine production. METHODOLOGY Human APCs were cultured, plated, and maintained in media containing increasing concentrations of FBS for 24 h, 48 h, 72 h, 7 days, and 14 days in the presence of Lipopolysaccharide (LPS - 1 µg/mL). At each time point, the cells were subjected to the MTT assay. The cytokines transforming growth factor (TGF)-β1, osteoprotegerin (OPG), and interleukin (IL)-6, along with the chemokine CCL2, were quantified using the enzyme-linked immunosorbent assay at the 24-h time-point. Statistical analysis was performed using two-way analysis of variance (ANOVA) followed by Tukey's post-hoc test (p<0.05). RESULTS In general, APCs exhibited increasing metabolic activity in an FBS concentration-dependent fashion, regardless of the presence of LPS. In contrast, FBS interfered with the production of all the cytokines evaluated in this study, affecting the response induced by the presence of LPS. CONCLUSION FBS increased APC metabolism in a concentration-dependent manner and differentially affected the production of TGF-β1, OPG, IL-6, and CCL2 by APCs in vitro.
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Affiliation(s)
- Letícia Martins Santos
- Universidade de São Paulo, Departamento de Dentística, Faculdade de Odontologia, São Paulo, SP, Brasil
| | - Patricia E Silva Cardoso
- Universidade de São Paulo, Departamento de Dentística, Faculdade de Odontologia, São Paulo, SP, Brasil
| | - Elisa Abreu Diniz
- Universidade de São Paulo, Departamento de Dentística, Faculdade de Odontologia, São Paulo, SP, Brasil
| | - Juliana Garuba Rahhal
- Universidade de São Paulo, Departamento de Dentística, Faculdade de Odontologia, São Paulo, SP, Brasil
| | - Carla Renata Sipert
- Universidade de São Paulo, Departamento de Dentística, Faculdade de Odontologia, São Paulo, SP, Brasil
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Naik SV, Prakash AJ, Prabhakar Attiguppe R. A survey on awareness and knowledge among dentist practicing regenerative endodontics towards current regenerative endodontic protocols and the scaffolds used in regenerative dentistry. Saudi Dent J 2023; 35:559-566. [PMID: 37520602 PMCID: PMC10373079 DOI: 10.1016/j.sdentj.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/02/2023] [Accepted: 05/14/2023] [Indexed: 08/01/2023] Open
Abstract
There are many inconsistencies in the protocols followed for Regenerative Endodontic Procedures (REP's).This study was formulated with an aim to conduct a survey among Pediatric Dentists, Endodontists and General Practioners treating Necrotic young permanent teeth to examine their awareness and Knowledge on Current Regenerative Endodontic Protocols and Scaffolds used in regenerative dentistry. Methods A Cross-Sectional Survey was carried out amongst 100 Pediatric dentists,100 Endodontists and 100 General Practioners. It was web-based survey and the questionnaire was formulated and all the items in the questionnaire were tested for reliability and validity before circulation of the questionnaire for the purpose of the study. Results The results of the study indicated that all the three groups were unaware that failure of cases should be reported to AEE (American Academy of Endodontics) REP Database and only 20.2, 20.1 and 0.3 % of Pediatric dentists,Endodontists and General Dentists preferred Regenerative Dentistry as a clinical protocol for REP. With respect to knowledge regarding irrigation and disinfection procedures all three groups were lacking in the knowledge regarding intracanal medicament for disinfection and the irrigation solutions. Conclusion There is a lack of homogeneity in protocols followed for REP among those practicing Regenerative Endodontics as a protocol. Since it's an evolving science there is a need to bring about a uniformity in practices to increase the evidences to support the causal effect relation of regenerative endodontics.
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Affiliation(s)
- Saraswathi V. Naik
- Department of Pedodontics and Preventive Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka, India
| | - Aarathi J. Prakash
- Department of Pediatrics and Preventive Dentistry, Malabar Dental College and Research Center, India
| | - R. Prabhakar Attiguppe
- Department of Pediatrics and Preventive Dentistry, Malabar Dental College and Research Center, India
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14
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Hristov K, Doitchinova L, Gateva N. Regenerative endodontic treatment of immature permanent teeth after mechanical instrumentation with XP-Endo Finisher. Folia Med (Plovdiv) 2023; 65:460-467. [PMID: 38351823 DOI: 10.3897/folmed.65.e80063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/18/2022] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION The traditional treatment of immature permanent teeth with necrotic pulp involves creating an apical barrier by using calcium hydroxide or an MTA plug for an extended period of time. A novel therapeutic approach called regenerative endodontic procedures (REP) is used to allow root development to continue.
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15
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Hu X, Wang Q, Ma C, Li Q, Zhao C, Xiang K. Is Etiology a Key Factor for Regenerative Endodontic Treatment Outcomes? J Endod 2023:S0099-2399(23)00293-5. [PMID: 37285935 DOI: 10.1016/j.joen.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/29/2023] [Accepted: 05/29/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION This study aimed to evaluate treatment outcomes of regenerative endodontic treatment (RET) in nonvital immature permanent teeth due to developmental malformation and trauma, and to analyze the influence of etiology on the prognosis. METHODS Fifty-five cases were included and divided into a malformation group (n=33) and a trauma group (n=22). Treatment outcomes were classified as healed, healing and failure. Root development was evaluated in terms of root morphology and the percentage changes in root length, root width and apical diameter during a follow-up period of 12 to 85 months (mean 30.8 months). RESULTS The mean age and the mean degree of root development in the trauma group were significantly younger than that in the malformation group. The success rate of RET was 93.9% (81.8% healed, 12.1% healing) in the malformation group and 90.9% (68.2% healed, 22.7% healing) in the trauma group, showing no statistically significant difference. The proportion of type I-III root morphology in the malformation group (97%, 32/33) was significantly higher than that in the trauma group (77.3%, 17/22) (P<0.05), whereas there was no significant difference in the percentage changes of root length, root width and apical diameter between the two groups. Six cases (6/55, 10.9%) showed no significant root development (type IV-V) (1 in the malformation group and 5 in the trauma group). Six cases (6/55, 10.9%) revealed intracanal calcification. CONCLUSIONS RET achieved reliable outcomes regarding the healing of apical periodontitis and continued root development. The etiology seems to influence the outcome of RET. Malformation cases presented with a better prognosis than trauma cases after RET.
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Affiliation(s)
- Xiaoyan Hu
- Stomatologic Hospital & College, Anhui Medical University, Key Lab. of Oral Diseases Research of Anhui Province, Hefei, 230032, China.
| | - Qingtong Wang
- Institute of Clinical Pharmacology, Anhui Medical University, Key Laboratory of Anti-inflammatory and Immune Medicine, Ministry of Education, Collaborative Innovation Center of Anti-inflammatory and Immune Medicine, Hefei, 230032, China
| | - Chenxue Ma
- Stomatologic Hospital & College, Anhui Medical University, Key Lab. of Oral Diseases Research of Anhui Province, Hefei, 230032, China
| | - Quanli Li
- Stomatologic Hospital & College, Anhui Medical University, Key Lab. of Oral Diseases Research of Anhui Province, Hefei, 230032, China
| | - Chunhui Zhao
- Stomatologic Hospital & College, Anhui Medical University, Key Lab. of Oral Diseases Research of Anhui Province, Hefei, 230032, China
| | - Kun Xiang
- Stomatologic Hospital & College, Anhui Medical University, Key Lab. of Oral Diseases Research of Anhui Province, Hefei, 230032, China
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Dubey N, Ribeiro JS, Zhang Z, Xu J, Ferreira JA, Qu L, Mei L, Fenno JC, Schwendeman A, Schwendeman SP, Nör JE, Bottino MC. Gelatin methacryloyl hydrogel as an injectable scaffold with multi-therapeutic effects to promote antimicrobial disinfection and angiogenesis for regenerative endodontics. J Mater Chem B 2023; 11:3823-3835. [PMID: 36946228 PMCID: PMC10160005 DOI: 10.1039/d2tb02788g] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Regenerative endodontics represents a paradigm shift in dental pulp therapy for necrotic young permanent teeth. However, there are still challenges associated with attaining maximum root canal disinfection while supporting angiogenesis and preserving resident stem cells viability and differentiation capacity. Here, we developed a hydrogel system by incorporating antibiotic-eluting fiber-based microparticles in gelatin methacryloyl (GelMA) hydrogel to gather antimicrobial and angiogenic properties while prompting minimum cell toxicity. Minocycline (MINO) or clindamycin (CLIN) was introduced into a polymer solution and electrospun into fibers, which were further cryomilled to attain MINO- or CLIN-eluting fibrous microparticles. To obtain hydrogels with multi-therapeutic effects, MINO- or CLIN-eluting microparticles were suspended in GelMA at distinct concentrations. The engineered hydrogels demonstrated antibiotic-dependent swelling and degradability while inhibiting bacterial growth with minimum toxicity in dental-derived stem cells. Notably, compared to MINO, CLIN hydrogels enhanced the formation of capillary-like networks of endothelial cells in vitro and the presence of widespread vascularization with functioning blood vessels in vivo. Our data shed new light onto the clinical potential of antibiotic-eluting gelatin methacryloyl hydrogel as an injectable scaffold with multi-therapeutic effects to promote antimicrobial disinfection and angiogenesis for regenerative endodontics.
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Affiliation(s)
- Nileshkumar Dubey
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA.
- Faculty of Dentistry, National University of Singapore, Singapore
| | - Juliana S Ribeiro
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA.
- Department of Dentistry, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Zhaocheng Zhang
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA.
| | - Jinping Xu
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA.
| | - Jessica A Ferreira
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA.
| | - Liu Qu
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA.
- Department of Endodontics, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Ling Mei
- Department of Pharmaceutical Sciences and the Biointerfaces Institute, University of Michigan, Ann Arbor, Michigan, USA
| | - J Christopher Fenno
- Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Anna Schwendeman
- Department of Pharmaceutical Sciences and the Biointerfaces Institute, University of Michigan, Ann Arbor, Michigan, USA
| | - Steven P Schwendeman
- Department of Pharmaceutical Sciences and the Biointerfaces Institute, University of Michigan, Ann Arbor, Michigan, USA
| | - Jacques E Nör
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA.
- Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Marco C Bottino
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA.
- Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, Michigan, USA
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Rathinam E, Rajasekharan S, Declercq H, Vanhove C, De Coster P, Martens L. Effect of Intracoronal Sealing Biomaterials on the Histological Outcome of Endodontic Revitalisation in Immature Sheep Teeth-A Pilot Study. J Funct Biomater 2023; 14:jfb14040214. [PMID: 37103304 PMCID: PMC10144940 DOI: 10.3390/jfb14040214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/17/2023] [Accepted: 04/08/2023] [Indexed: 04/28/2023] Open
Abstract
The influence of intracoronal sealing biomaterials on the newly formed regenerative tissue after endodontic revitalisation therapy remains unexplored. The objective of this study was to compare the gene expression profiles of two different tricalcium silicate-based biomaterials alongside the histological outcomes of endodontic revitalisation therapy in immature sheep teeth. The messenger RNA expression of TGF-β, BMP2, BGLAP, VEGFA, WNT5A, MMP1, TNF-α and SMAD6 was evaluated after 1 day with qRT-PCR. For evaluation of histological outcomes, revitalisation therapy was performed using Biodentine (n = 4) or ProRoot white mineral trioxide aggregate (WMTA) (n = 4) in immature sheep according to the European Society of Endodontology position statement. After 6 months' follow-up, one tooth in the Biodentine group was lost to avulsion. Histologically, extent of inflammation, presence or absence of tissue with cellularity and vascularity inside the pulp space, area of tissue with cellularity and vascularity, length of odontoblast lining attached to the dentinal wall, number and area of blood vessels and area of empty root canal space were measured by two independent investigators. All continuous data were subjected to statistical analysis using Wilcoxon matched-pairs signed rank test at a significance level of p < 0.05. Biodentine and ProRoot WMTA upregulated the genes responsible for odontoblast differentiation, mineralisation and angiogenesis. Biodentine induced the formation of a significantly larger area of neoformed tissue with cellularity, vascularity and increased length of odontoblast lining attached to the dentinal walls compared to ProRoot WMTA (p < 0.05), but future studies with larger sample size and adequate power as estimated by the results of this pilot study would confirm the effect of intracoronal sealing biomaterials on the histological outcome of endodontic revitalisation.
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Affiliation(s)
- Elanagai Rathinam
- ELOHA (Equal Lifelong Oral Health for All) Research Group, Paediatric Dentistry, Oral Health Sciences, Ghent University Hospital, 9000 Ghent, Belgium
| | - Sivaprakash Rajasekharan
- ELOHA (Equal Lifelong Oral Health for All) Research Group, Paediatric Dentistry, Oral Health Sciences, Ghent University Hospital, 9000 Ghent, Belgium
| | - Heidi Declercq
- Tissue Engineering and Biomaterials Group, Department of Human Structure and Repair, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium
- Tissue Engineering Laboratory, Department of Development and Regeneration, KU Leuven, 8500 Kortrijk, Belgium
| | - Christian Vanhove
- Medical Imaging & Signal Processing, Infinity Laboratory, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium
| | - Peter De Coster
- Department of Reconstructive Dentistry and Oral Biology, Dental School, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium
| | - Luc Martens
- ELOHA (Equal Lifelong Oral Health for All) Research Group, Paediatric Dentistry, Oral Health Sciences, Ghent University Hospital, 9000 Ghent, Belgium
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Das S, Srivastava R, Thosar NR, Khubchandani M, Ragit R, Malviya N. Regenerative Endodontics-Reviving the Pulp the Natural Way: A Case Report. Cureus 2023; 15:e36587. [PMID: 37095799 PMCID: PMC10122445 DOI: 10.7759/cureus.36587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/22/2023] [Indexed: 04/26/2023] Open
Abstract
Regenerative endodontic therapy (RET) offers a novel treatment option for developing teeth with pulp necrosis. In the current instance, RET was used to treat an immature mandibular permanent first molar that had been identified with irreversible pulpitis. The root canals were treated with triple antibiotic paste (TAP) and 1.5% sodium hypochlorite (NaOCl) irrigation. TAP was removed, and 17% ethylenediaminetetraacetic acid (EDTA) was used to treat the root canals during the second visit. As a scaffold, Platelet-rich fibrin (PRF) was applied. Mineral trioxide aggregate (MTA) was applied over PRF, and composite resin was used to repair the teeth. Radiographs taken from the posterior were utilized to assess the healing. The teeth displayed no signs of pain and healing after the six-month follow-up periods, and pulp sensibility tests using a cold and electric pulp tester produced no results. Conservative treatment options should be considered to save immature permanent teeth and assist in the regeneration of the root apex.
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Affiliation(s)
- Simran Das
- Pediatric Dentistry, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rashi Srivastava
- Pediatric Dentistry, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nilima R Thosar
- Pediatric Dentistry, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Monika Khubchandani
- Pediatric Dentistry, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rutuja Ragit
- Pediatric Dentistry, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nishi Malviya
- Pediatric Dentistry, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Huang F, Cheng L, Li J, Ren B. Nanofibrous scaffolds for regenerative endodontics treatment. Front Bioeng Biotechnol 2022; 10:1078453. [PMID: 36578510 PMCID: PMC9790898 DOI: 10.3389/fbioe.2022.1078453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
Untreated dental caries, tooth trauma and dental anatomical variations such as dens invaginatus can result in pulpitis. However, standard root canal therapy cannot treat immature permanent teeth due to an open apical foramen and thin dentinal walls. Thus, regenerative endodontics treatment (RET) following a disinfection step with pulp regeneration has been developed. Pulp connective-tissue, dentin formation, revascularization and reinnervation can occur in this procedure which should be supplemented with intelligent biomaterials to improve repeatability and support well-coordinated regeneration. Furthermore, nanofibrous scaffolds, as one of the most commonly used materials, show promise. The purpose of this article is to highlight the advantages of nanofibrous scaffolds and discuss the future modification and application of them.
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Affiliation(s)
- Fangting Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, Sichuan, China,Department of Preventive Dentistry, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lei Cheng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, Sichuan, China,Department of Operative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Jiyao Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, Sichuan, China,Department of Operative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China,*Correspondence: Jiyao Li, ; Biao Ren,
| | - Biao Ren
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, Sichuan, China,*Correspondence: Jiyao Li, ; Biao Ren,
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20
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Expert consensus on regenerative endodontic procedures. Int J Oral Sci 2022; 14:55. [PMID: 36450715 PMCID: PMC9712432 DOI: 10.1038/s41368-022-00206-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/02/2022] [Accepted: 10/09/2022] [Indexed: 12/05/2022] Open
Abstract
Regenerative endodontic procedures (REPs) is a biologic-based treatment modality for immature permanent teeth diagnosed with pulp necrosis. The ultimate objective of REPs is to regenerate the pulp-dentin complex, extend the tooth longevity and restore the normal function. Scientific evidence has demonstrated the efficacy of REPs in promotion of root development through case reports, case series, cohort studies, and randomized controlled studies. However, variations in clinical protocols for REPs exist due to the empirical nature of the original protocols and rapid advancements in the research field of regenerative endodontics. The heterogeneity in protocols may cause confusion among dental practitioners, thus guidelines and considerations of REPs should be explicated. This expert consensus mainly discusses the biological foundation, the available clinical protocols and current status of REPs in treating immature teeth with pulp necrosis, as well as the main complications of this treatment, aiming at refining the clinical management of REPs in accordance with the progress of basic researches and clinical studies, suggesting REPs may become a more consistently evidence-based option in dental treatment.
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Pereira ACC, Aguiar APS, Araujo LMP, Dantas LO, Mayer MPA, Karygianni L, Thurnheer T, Pinheiro ET. Antibiofilm Activity of LL-37 Peptide and D-Amino Acids Associated with Antibiotics Used in Regenerative Endodontics on an Ex Vivo Multispecies Biofilm Model. Life (Basel) 2022; 12:life12111686. [PMID: 36362840 PMCID: PMC9695550 DOI: 10.3390/life12111686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022] Open
Abstract
The antimicrobial peptide LL-37 and D-amino acids (D-AAs) have been proposed as antibiofilm agents. Therefore, this study aimed to test the antimicrobial effect of antibiofilm agents associated with antibiotics used in regenerative endodontic procedures (the triple antibiotic paste—TAP: ciprofloxacin + metronidazole + minocycline). An endodontic-like biofilm model grown on bovine dentin discs was used in this study. After 21-day growth, the biofilms were treated with 1 mg/mL TAP, 10 μM LL-37, an association of LL-37 + TAP, 40 mM D-AAs solution, an association of D-AAs + TAP, and phosphate-buffered saline (negative control). Colony forming unit (CFU) data were analyzed by two-way ANOVA and Tukey’s multiple comparison test (p < 0.05). LL-37 + TAP showed the best antibacterial activity (7-log10 CFU/mL ± 0.5), reaching a 1 log reduction of cells in relation to the negative control (8-log10 CFU/mL ± 0.7) (p < 0.05). In turn, no significant reduction in bacterial cells was observed with TAP, LL-37, D-AAs, and D-AAs + TAP compared to the negative control. In conclusion, the combination of antibiotics and LL-37 peptide showed mild antibacterial activity, while the combination of antibiotics and D-AAs showed no activity against complex biofilms.
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Affiliation(s)
- Ana C. C. Pereira
- Department of Dentistry, School of Dentistry, University of São Paulo, São Paulo 05508-000, Brazil
| | - Alana P. S. Aguiar
- Department of Dentistry, School of Dentistry, University of São Paulo, São Paulo 05508-000, Brazil
| | - Leticia M. P. Araujo
- Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo, São Paulo 05508-000, Brazil
| | - Larissa O. Dantas
- Department of Dentistry, School of Dentistry, University of São Paulo, São Paulo 05508-000, Brazil
| | - Marcia P. A. Mayer
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
| | - Lamprini Karygianni
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, 8032 Zürich, Switzerland
| | - Thomas Thurnheer
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, 8032 Zürich, Switzerland
| | - Ericka T. Pinheiro
- Department of Dentistry, School of Dentistry, University of São Paulo, São Paulo 05508-000, Brazil
- Correspondence:
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Minic S, Vital S, Chaussain C, Boukpessi T, Mangione F. Tissue Characteristics in Endodontic Regeneration: A Systematic Review. Int J Mol Sci 2022; 23:ijms231810534. [PMID: 36142446 PMCID: PMC9504778 DOI: 10.3390/ijms231810534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 12/01/2022] Open
Abstract
The regenerative endodontic procedure (REP) represents a treatment option for immature necrotic teeth with a periapical lesion. Currently, this therapy has a wide field of pre-clinical and clinical applications, but no standardization exists regarding successful criteria. Thus, by analysis of animal and human studies, the aim of this systematic review was to highlight the main characteristics of the tissue generated by REP. A customized search of PubMed, EMBASE, Scopus, and Web of Science databases from January 2000 to January 2022 was conducted. Seventy-five human and forty-nine animal studies were selected. In humans, the evaluation criteria were clinical 2D and 3D radiographic examinations. Most of the studies identified a successful REP with an asymptomatic tooth, apical lesion healing, and increased root thickness and length. In animals, histological and radiological criteria were considered. Newly formed tissues in the canals were fibrous, cementum, or bone-like tissues along the dentine walls depending on the area of the root. REP assured tooth development and viability. However, further studies are needed to identify procedures to successfully reproduce the physiological structure and function of the dentin–pulp complex.
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Affiliation(s)
- Sandra Minic
- URP 2496 Laboratory of Orofacial Pathologies, Imaging and Biotherapies, Life Imaging Platform (PIV), Laboratoire d’excellence INFLAMEX, UFR Odontology, Université Paris Cité, 92120 Montrouge, France
| | - Sibylle Vital
- URP 2496 Laboratory of Orofacial Pathologies, Imaging and Biotherapies, Life Imaging Platform (PIV), Laboratoire d’excellence INFLAMEX, UFR Odontology, Université Paris Cité, 92120 Montrouge, France
- Louis Mourier Hospital, AP-HP, DMU ESPRIT, 92700 Colombes, France
| | - Catherine Chaussain
- URP 2496 Laboratory of Orofacial Pathologies, Imaging and Biotherapies, Life Imaging Platform (PIV), Laboratoire d’excellence INFLAMEX, UFR Odontology, Université Paris Cité, 92120 Montrouge, France
- Bretonneau Hospital Dental Department and Reference Center for Rare Diseases of Calcium and Phosphorus Metabolism, AP-HP, 75018 Paris, France
| | - Tchilalo Boukpessi
- URP 2496 Laboratory of Orofacial Pathologies, Imaging and Biotherapies, Life Imaging Platform (PIV), Laboratoire d’excellence INFLAMEX, UFR Odontology, Université Paris Cité, 92120 Montrouge, France
- Pitié Salpétrière Hospital, DMU CHIR, AP-HP, 75013 Paris, France
| | - Francesca Mangione
- URP 2496 Laboratory of Orofacial Pathologies, Imaging and Biotherapies, Life Imaging Platform (PIV), Laboratoire d’excellence INFLAMEX, UFR Odontology, Université Paris Cité, 92120 Montrouge, France
- Henri Mondor Hospital, AP-HP, 94000 Créteil, France
- Correspondence:
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Iranmanesh P, Torabinejad M, Saatchi M, Toghraie D, Razavi SM, Khademi A. Effect of Duration of Root Canal Infection on the Ability of Dentin-Pulp Complex Regeneration of Immature Permanent Teeth: An Animal Study. J Endod 2022; 48:1301-1307.e2. [PMID: 35933045 DOI: 10.1016/j.joen.2022.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Persistent infection is always considered the most important reason for the failure of dentin-pulp complex regeneration. The present study aims to evaluate the effect of the duration of root canal infection (from one to twelve weeks) on the ability of dentin-pulp complex regeneration. METHODS In this animal study, 64 roots of immature premolar teeth of four dogs were randomly divided into four groups. Positive control group; eight root canals treated with regenerative endodontic procedure (REP), negative control group; 12 infected root canals, intervention groups; 36 root canals infected with supragingival plaque (one, three, six, and 12 weeks) and treated with REP, an additional positive control group; eight normal roots. After three months, the teeth were investigated by radiographic images and immunohistochemical staining (CD31, CD34, S100 markers). In addition, DSPP gene expression was assessed using a real-time PCR technique. The results were analyzed at a significance level of 0.05. RESULTS Based on radiological evaluation among the intervention groups, the highest root canal development (length and width) occurred in the intervention group of one week, and the lowest radiological results were in the intervention groups of six and 12 weeks (One-way ANOVA, P <0.05). There was a significant difference between the groups in terms of CD31, CD34, S100 and, DSPP expression percentage (One-way ANOVA, P <0.05), in which the highest and lowest expression percentages belonged to the one- and 12 weeks groups, respectively, among the intervention groups. CONCLUSION This study demonstrated that long root canal infection decreased the ability of the body to regenerate dentin-pulp complex.
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Affiliation(s)
- Pedram Iranmanesh
- Department of Endodontics, Dental Research Center, School of Dentistry, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Masoud Saatchi
- Department of Endodontics, Dental Research Center, School of Dentistry, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Davood Toghraie
- Department of Mechanical Engineering, Khomeinishahr Branch, Islamic Azad University, Khomeinishahr, Iran.
| | - Sayed Mohammad Razavi
- Department of Oral and Maxillofacial Pathology and Dental Implants Research Center, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abbasali Khademi
- Department of Endodontics, Dental Research Center, School of Dentistry, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
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Treatment of Necrotic Anterior and Posterior Teeth with Regenerative Endodontic Procedures Using PRF as a Scaffold: A Retrospective Study. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12136774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We assessed the impact of regenerative endodontic procedures (REP) using a platelet-rich fibrin (PRF) scaffold on necrotic immature permanent anterior and posterior teeth based on the following parameters: periapical healing, changes in root development, and associations between increases in the radiographic root area (RRA), and degree of root to apical closure. The study included 50 teeth consisting of 57 roots (36 anterior and 21 posterior) treated between 2017 and 2019, with an average follow-up of two years. Complete periapical healing was achieved in 91.2% teeth, and uncertain healing was achieved in 8.8%. RRA increased in 95% of teeth and root lengthening was achieved in 86% teeth (without any mutual effect). Apical closure was significantly associated with tooth location (89% and 30% of the posterior and anterior roots, respectively). Trauma was the most common aetiology of necrotic anterior teeth, whereas caries was the only aetiology of necrotic posterior teeth. REP using PRF scaffold achieved a high success rate for periapical healing and root maturation in both anterior and posterior necrotic immature teeth. The favourable results obtained in posterior teeth may encourage the use of REP for treating necrotic immature permanent posterior teeth.
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Lee C, Song M. Failure of regenerative endodontic procedures: case analysis and subsequent treatment options. J Endod 2022; 48:1137-1145. [PMID: 35714726 DOI: 10.1016/j.joen.2022.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/15/2022] [Accepted: 06/05/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Regenerative endodontic procedures (REPs) are considered effective treatments for immature necrotic permanent teeth, with favorable outcomes. However, failed cases require subsequent treatment. This study aimed to review and analyze failed cases after REPs and suggest a treatment algorithm to aid clinical decision making. METHODS A total of 111 REP cases were selected that conducted between 2015-2020. Clinical outcomes were assessed based on clinical and radiographic evaluations. The criteria for failure included persistence of clinical signs or symptoms and/or periapical radiolucency showing persistent apical periodontitis. Cases requiring any treatment intervention, including extraction, were also considered failures. RESULTS Sixteen cases were included as failures. The etiology of pulpal disease was stratified into dental trauma (56%), dens evaginatus (25%), and dental caries (12.5%), with the remaining one case having an undocumented cause. The primary reasons for treatment failure were persistent infection (81.3%) and root resorption (18.7%). The identification time of failure varied, with six cases (37.5%) detected in less than six months and ten cases (62.5%) later than six months after REPs. Sixteen failed cases received five different interventions: second REPs, apexification, conventional root canal treatment, surgical approach, and extraction. CONCLUSION Interventions for failed REPs are challenging. Consideration of the treatability of the tooth, accessibility to the canal, and the presence of an apical seat might be key factors in clinical decision making to obtain a successful outcome.
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Affiliation(s)
- Chaehwan Lee
- Department of Conservative Dentistry, College of Dentistry, Yonsei University, Seoul, Korea.
| | - Minju Song
- Department of Conservative Dentistry, College of Dentistry, Dankook University, Cheonan, Korea.
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Galler KM, Akamp T, Knüttel H, Widbiller M. A critical analysis of clinical research methods to study regenerative endodontics. Int Endod J 2022; 55 Suppl 2:456-470. [PMID: 35338660 DOI: 10.1111/iej.13734] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
Regenerative endodontic treatment such as revitalization provides a treatment option for immature teeth with pulp necrosis. The main difference to the alternative procedure, the apical plug, is the induction of a blood clot inside the canal as a scaffold for healing and new tissue formation. Due to the biology-based and minimally-invasive nature of the treatment, revitalization has raised considerable interest in recent years. Whereas the procedure is fairly new and recommendations from endodontic societies have been in place only for a few years, the treatment protocol has evolved over the past two decades. Evidence has been created, not only from laboratory and animal work, but also from clinical studies including case reports, cohort studies and eventually prospective randomized controlled clinical trials, systematic reviews and meta-analyses. However, the research methods and clinical studies with subsequent reports oftentimes present with methodical limitations, which makes it difficult to objectively assess the value of this treatment modality. Several open questions remain, including the need for a more differentiated indication of revitalization after different traumatic injuries, the long-term prognosis of treated teeth and the true benefits for the patient. Therefore, this review aims to identify and reflect on such limitations, scrutinizing study design, diagnostic tools, procedural details and outcome parameters. A core outcome set is also proposed in this context, which can be considered in future clinical investigations. These considerations may lead to a more detailed and stringent planning and execution of future studies in order to create high-quality evidence for the treatment modality of revitalization and thus provide more robust data, create a larger body of knowledge for clinicians and further specify current recommendations.
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Affiliation(s)
- K M Galler
- Department of Operative Dentistry and Periodontology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen
| | - T Akamp
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
| | - H Knüttel
- University Library, University of Regensburg, Germany
| | - M Widbiller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
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Cehreli ZC, Erbas Unverdi G, Eymirli P, Mergen I, Arslan E, Esenturk G. Combined conventional and regenerative treatment in molars with coexistent closed and open apices: A case series. AUST ENDOD J 2022; 48:197-201. [PMID: 35262234 DOI: 10.1111/aej.12616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/28/2022] [Indexed: 11/29/2022]
Abstract
Regenerative endodontic treatment (RET) may not be suitable in some necrotic young permanent molars due to coexistent roots with closed and open apices, and/or inadequate apical bleeding in one or more roots. Here, we present a combined treatment approach utilising conventional root canal treatment in the closed-apex roots and RET on the open-apex roots of necrotic young molars. The closed-apex roots of 8 molars received root fillings, and their open-apex roots were treated with a regenerative endodontic procedure. In another molar, the failed RET on one root was retreated by conventional root canal filling, preserving other revitalised roots. After 4-6 years, all teeth showed periapical healing in the absence of clinical symptoms. The combined conventional and regenerative treatment approach can yield favourable healing outcomes in necrotic, young molar roots with different levels of apical closure. Likewise, failed revitalised roots can be retreated separately with conventional root filling.
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Affiliation(s)
- Zafer C Cehreli
- Department of Pediatric Dentistry, Hacettepe University Faculty of Dentistry, Ankara, Turkey
| | - Gizem Erbas Unverdi
- Department of Pediatric Dentistry, Hacettepe University Faculty of Dentistry, Ankara, Turkey
| | - Pinar Eymirli
- Department of Pediatric Dentistry, Hacettepe University Faculty of Dentistry, Ankara, Turkey
| | - Irem Mergen
- Department of Pediatric Dentistry, Hacettepe University Faculty of Dentistry, Ankara, Turkey
| | - Ezgihan Arslan
- Department of Pediatric Dentistry, Hacettepe University Faculty of Dentistry, Ankara, Turkey
| | - Gulce Esenturk
- Department of Pediatric Dentistry, Hacettepe University Faculty of Dentistry, Ankara, Turkey
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Almutairi W, Al-Dahman Y, Alnassar F, Albalawi O. Intracanal calcification following regenerative endodontic treatment: a systematic review and meta-analysis. Clin Oral Investig 2022; 26:3333-3342. [PMID: 35243550 DOI: 10.1007/s00784-021-04333-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/01/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Calcification is a common finding in endodontic cases after regenerative endodontic therapy (RET). We aimed to identify the prevalence of intracanal calcification after RET and to compare intracanal calcification outcomes in RET using either calcium hydroxide [Ca(OH)2] or antibiotics. MATERIALS AND METHODS We searched PubMed, Web of Science, ProQuest Dissertations & Theses, and Scopus databases for clinical, cross-sectional, case-control, and cohort RET studies published until May 2020 in the English language and reporting a calcified case after RET. The Cochrane risk-of-bias tool for randomized trials and Risk of Bias In Non-randomized Studies of Interventions were used for bias assessment. Meta-analyses were performed, overall and separately, for intracanal medicaments using a random-effects model with weighted inverse variance methods. Subgroup analysis was performed according to the calcification type. RESULTS Eight studies were included. The overall prevalence of intracanal calcification after RET was 30.7% (95% confidence interval [CI]: 0.15-0.45,[Formula: see text]=92.6%), 46.5% with Ca(OH)2 vs. 25.8% with antibiotic-based intracanal medicaments. Subgroup analyses for complete calcification outcome showed a higher prevalence of complete calcification in the Ca(OH)2 group (46.5%, 95% CI: 0.17-0.68,[Formula: see text]%) than in the antibiotic group (10%, 95% CI: - 0.04-0.43,[Formula: see text]%). CONCLUSIONS Based on the studies included, available evidence shows a statistically significant association between complete calcification and Ca(OH)2 paste as an intracanal medicament. Other contributing factors, such as blood clot formation and follow-up time, might also play an essential role in forming intracanal calcification. CLINICAL RELEVANCE This study highlights the significant association between complete calcification and Ca(OH)2 paste.
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Affiliation(s)
- Waleed Almutairi
- Department of Endodontics, College of Dentistry, Qassim University, Qassim, P. O. Box: 1162, Saudi Arabia.
| | - Yousef Al-Dahman
- Department of Endodontics, Eastern Riyadh Dental Center, Second Health Cluster in Riyadh, Ministry of Health, Riyadh, Saudi Arabia
| | - Faisal Alnassar
- Department of Restorative Dental Sciences, College of Dentistry, Majmaah University, Al Majmaah, Saudi Arabia
| | - Olayan Albalawi
- Department of Statistic, Faculty of Science, Tabuk University, Tabuk, Saudi Arabia
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Zhou C, Yuan Z, Xu H, Wu L, Xie C, Liu J. Regenerative Endodontic Procedures in Immature Permanent Teeth With Dental Trauma: Current Approaches and Challenges. FRONTIERS IN DENTAL MEDICINE 2022. [DOI: 10.3389/fdmed.2021.767226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
After dental trauma to immature permanent teeth (IPT), there can be pulpitis, necrotic, and periapical periodontitis, which will halt further root development. Traditional endodontic root canal treatments and apexification cannot revitalize the necrotic pulp to revitalize the tooth to promote further root development. As a consequence, IPT with thin dentinal walls can be prone to fracture and if a fracture occurs, the patient will likely suffer the loss of the tooth. In an attempt to save IPT, there has been a growing interest among dentists to use regenerative endodontic procedures (REPs) to revitalize a replace dental pulp to continue root development and strengthen the dentinal walls to help prevent a subsequent loss of the tooth. However, the effectiveness of REPs and the precise methods to successfully accomplish REPs are controversial. Therefore, the objective of this review is to compare the different approaches to REPs in case reports by highlighting their advantages and limitations.
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Antibiofilm and immunomodulatory resorbable nanofibrous filing for dental pulp regenerative procedures. Bioact Mater 2022; 16:173-186. [PMID: 35386316 PMCID: PMC8965695 DOI: 10.1016/j.bioactmat.2022.01.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/05/2022] [Accepted: 01/17/2022] [Indexed: 12/22/2022] Open
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Iandolo A, Amato A, Pantaleo G, Dagna A, Ivaldi L, di Spirito F, Abdellatif D. An innovative technique to safely perform active cleaning in teeth with open apices: CAB technique. J Conserv Dent 2021; 24:153-157. [PMID: 34759581 PMCID: PMC8562844 DOI: 10.4103/jcd.jcd_42_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/10/2021] [Accepted: 02/22/2021] [Indexed: 12/30/2022] Open
Abstract
The current study aims to evaluate in vitro the extrusion of NaOCl, using an artificial root canal with an open apex, using different canal irrigation protocols. For this study, a transparent artificial root canal was used. The apex was shaped to be oversized and irregular in form. After root canal mechanical shaping, the artificial cylindrical chamber, which was made below the large apical foramen, was filled with fuchsine-stained bovine pulp tissue. Afterward, irrigation protocols were carried out and compared regarding their safety with regards to irrigant extrusion. Subsequently, the examiner created two groups, Group A: internal heating associated with ultrasonic activation and Group B: internal heating associated with ultrasonic activation, using the CAB technique. In both the groups, 5.25% sodium hypochlorite solution was used as the irrigant. Regarding assessing the presence or absence of the extrusion, photographs at ×20 were taken and analyzed. For the statistical analysis, a t-test for paired samples was used. Extrusion of irrigant beyond the apex was present only in Group A. The main objective of endodontic treatment is the removal of damaged tissues and bacteria. For this reason, active cleaning is crucial in all endodontic treatment cases. Internal heating followed with ultrasonic activation while using the CAB technique was an effective and safe technique to ensure no irrigant extrusion beyond the open apex.
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Affiliation(s)
- Alfredo Iandolo
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Alessandra Amato
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Giuseppe Pantaleo
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Alberto Dagna
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Section of Dentistry, Endodontic Unit, University of Pavia, Pavia, Italy
| | | | | | - Dina Abdellatif
- Department of Endodontics, Faculty of Dentistry, University of Alexandria, Alexandria, Egypt
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Amonkar AD, Dhaded NS, Doddwad PK, Patil AC, Hugar SM, Bhandi S, Raj AT, Patil S, Zanza A, Testarelli L. Evaluation of the Effect of Long-term Use of Three Intracanal Medicaments on the Radicular Dentin Microhardness and Fracture Resistance: An in vitro study. Acta Stomatol Croat 2021; 55:291-301. [PMID: 34658375 PMCID: PMC8514225 DOI: 10.15644/asc55/3/6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/01/2021] [Indexed: 11/01/2022] Open
Abstract
Objectives The aim of this research was to evaluate the effect of long-term use of three intracanal medicaments on the radicular dentin microhardness and fracture resistance. Material and methods A chemomechanical preparation was done using the Protaper rotary instruments up to F3. The teeth were stored in an incubator at 37°C at 100% humidity and were categorized in three groups by random allocation, namely: Triple Antibiotic Paste (TAP), Calcium hydroxide paste (Apexcal) and Ledermix. Following medicament application, the access openings of all teeth were sealed with 4 mm thickness of cavit. The samples were stored for periods of 1 week, 1 month and 3months. Two dentin cylinders measuring 5mm and 3mm were obtained from each sample. The cervical third was used for fracture resistance and the middle third was used for micro hardness evaluation. The microhardness testing was done using a Knoop microhardness tester, and the fracture resistance testing was done using the universal testing machine. Results Calcium hydroxide showed maximally negative effect on the physical properties of radicular dentin compared to TAP (p= 0.0100 at one month and Ledermix (p=0.0001 at one month). With an increase in the application time, there was an increased deterioration in the physical properties of radicular dentin. Conclusion Long-term placement of calcium hydroxide, Triple Antibiotic Paste, and Ledermix (p= 0.0001at 3 months) significantly affects the microhardness and fracture resistance of radicular dentin.
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Affiliation(s)
| | - Neha Sunil Dhaded
- Department of Conservative Dentistry and Endodontics, KAHER's V.K. Institute of Dental Sciences, Belagavi, India
| | - Preeti Kore Doddwad
- Department of Conservative Dentistry and Endodontics, KAHER's V.K. Institute of Dental Sciences, Belagavi, India
| | - Anand C Patil
- Department of Conservative Dentistry and Endodontics, KAHER's V.K. Institute of Dental Sciences, Belagavi, India
| | - Shivayogi M Hugar
- Department of Pedodontics and Preventive Dentistry,KLE Vishwanath Katti Institute of Dental Sciences, KLE Academy of Higher Education and Research, Belagavi, India
| | - Shilpa Bhandi
- Department of Restorative Dental Sciences, College of Dentistry; Jazan University, Jazan, Saudi Arabia
| | - A Thirumal Raj
- Department of Oral Pathology and Microbiology, Sri Venkateswara Dental College and Hospital, Chennai, India
| | - Shankargouda Patil
- Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
| | - Alessio Zanza
- Department of Oral and Maxillofacial Sciences, Sapienza University, University of Rome, Italy
| | - Luca Testarelli
- Department of Oral and Maxillofacial Sciences, Sapienza University, University of Rome, Italy
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Srisuwan T, Wattanapakkavong K. Direct effect of transforming growth factor-beta 1 (TGF-β1) on human apical papilla cell proliferation and mineralisation. AUST ENDOD J 2021; 48:322-330. [PMID: 34596309 DOI: 10.1111/aej.12572] [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: 05/25/2021] [Revised: 08/27/2021] [Accepted: 09/19/2021] [Indexed: 01/30/2023]
Abstract
Firstly, this study investigated the direct effect of Transforming Growth Factor-beta 1 at 10, 5, 2.5 and 1.25 ng mL-1 on human apical papilla cell proliferation and mineralisation. Cell proliferation was examined at 0, 2, 4, 6, 24, 48, 72, 96 and 120 h using Alamar BlueTM assay. Cell mineralisation was examined at day 21 with a quantitative Alizarin Red S staining. Secondly, the study aimed to estimate the amount of Transforming Growth Factor-beta 1 (TGF-β1) released from the dentin after root canal irrigation. The solution collected from a root canal after rinsing with various protocols (normal saline solution, ethylenediaminetetraacetic acid or chlorhexidine) was analysed with an enzyme-linked immunosorbent assay. Data were statistically analysed using a one-way analysis of variance. The results, from the first part, revealed cell proliferation reduction in all experimental groups presented with TGF-β1. The higher concentration generated more deteriorating effects. Cell mineralisation was highest in a group with TGF-β1 at 1.25 ng mL-1 (P < 0.05). For the growth factor released from dentin, the highest amount was detected only when ethylenediaminetetraacetic acid was associated with the irrigation (P < 0.05). In summary, the direct effects of TGF-β1 on cell proliferation and differentiation were diverse, depending on concentration. The release of TGF-β1 from root dentin can be achieved after rinsing with ethylenediaminetetraacetic acid.
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Affiliation(s)
- Tanida Srisuwan
- Department of Restorative Dentistry and Periodontology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
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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: 27] [Impact Index Per Article: 9.0] [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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Krastl G, Weiger R, Filippi A, Van Waes H, Ebeleseder K, Ree M, Connert T, Widbiller M, Tjäderhane L, Dummer PMH, Galler K. Endodontic management of traumatized permanent teeth: a comprehensive review. Int Endod J 2021; 54:1221-1245. [PMID: 33683731 DOI: 10.1111/iej.13508] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 03/05/2021] [Indexed: 12/15/2022]
Abstract
The pulp plays a key role in the treatment of traumatic dental injuries (TDIs) and is strongly associated with the outcome, particularly in severe cases. A correct pulp diagnosis is essential as it forms the basis for developing the appropriate management strategy. However, many TDIs are complex, and their treatment requires a profound knowledge of the physiological and pathological responses of the affected tissues. This comprehensive review will look at the dentine-pulp complex and its interaction with the surrounding tissues following TDIs. The literature up to 2020 was reviewed based on several searches on PubMed and the Cochrane Library using relevant terms. In addition to the recently revised guidelines of the International Association of Dental Traumatology, this article aims to provide background information with a focus on endodontic aspects and to gather evidence on which a clinician can make decisions on the choice of the appropriate endodontic approach for traumatized permanent teeth.
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Affiliation(s)
- G Krastl
- Department of Conservative Dentistry and Periodontology, Center of Dental Traumatology, University Hospital of Würzburg, Würzburg, Germany
| | - R Weiger
- Department of Periodontology, Endodontology and Cardiology, University School of Dental Medicine, Basel, Switzerland.,Center of Dental Traumatology, University School of Dental Medicine, Basel, Switzerland
| | - A Filippi
- Center of Dental Traumatology, University School of Dental Medicine, Basel, Switzerland.,Department of Oral Surgery, University School of Dental Medicine, Basel, Switzerland
| | - H Van Waes
- Department of Paediatric Dentistry, Clinic for Orthodontics and Paediatric Dentistry, University of Zürich, Zürich, Switzerland
| | - K Ebeleseder
- University Clinic of Dental Medicine and Oral Health, Medical University Graz, Graz, Austria
| | - M Ree
- Private Practice, Purmerend, Netherlands
| | - T Connert
- Department of Periodontology, Endodontology and Cardiology, University School of Dental Medicine, Basel, Switzerland.,Center of Dental Traumatology, University School of Dental Medicine, Basel, Switzerland
| | - M Widbiller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
| | - 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, University of Oulu, Oulu, Finland
| | - P M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - K Galler
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
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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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Matichescu A, Ardelean LC, Rusu LC, Craciun D, Bratu EA, Babucea M, Leretter M. Advanced Biomaterials and Techniques for Oral Tissue Engineering and Regeneration-A Review. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E5303. [PMID: 33238625 PMCID: PMC7700200 DOI: 10.3390/ma13225303] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/15/2020] [Accepted: 11/19/2020] [Indexed: 12/11/2022]
Abstract
The reconstruction or repair of oral and maxillofacial functionalities and aesthetics is a priority for patients affected by tooth loss, congenital defects, trauma deformities, or various dental diseases. Therefore, in dental medicine, tissue reconstruction represents a major interest in oral and maxillofacial surgery, periodontics, orthodontics, endodontics, and even daily clinical practice. The current clinical approaches involve a vast array of techniques ranging from the traditional use of tissue grafts to the most innovative regenerative procedures, such as tissue engineering. In recent decades, a wide range of both artificial and natural biomaterials and scaffolds, genes, stem cells isolated from the mouth area (dental follicle, deciduous teeth, periodontal ligament, dental pulp, salivary glands, and adipose tissue), and various growth factors have been tested in tissue engineering approaches in dentistry, with many being proven successful. However, to fully eliminate the problems of traditional bone and tissue reconstruction in dentistry, continuous research is needed. Based on a recent literature review, this paper creates a picture of current innovative strategies applying dental stem cells for tissue regeneration in different dental fields and maxillofacial surgery, and offers detailed information regarding the available scientific data and practical applications.
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Affiliation(s)
- Anamaria Matichescu
- Department of Preventive Dentistry, Community and Oral Health, “Victor Babeș” University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania;
| | - Lavinia Cosmina Ardelean
- Department of Technology of Materials and Devices in Dental Medicine, “Victor Babeș” University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
| | - Laura-Cristina Rusu
- Department of Oral Pathology, “Victor Babeș” University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (L.-C.R.); (D.C.); (M.B.)
| | - Dragos Craciun
- Department of Oral Pathology, “Victor Babeș” University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (L.-C.R.); (D.C.); (M.B.)
| | - Emanuel Adrian Bratu
- Department of Implant Supported Restorations, “Victor Babeș” University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
| | - Marius Babucea
- Department of Oral Pathology, “Victor Babeș” University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (L.-C.R.); (D.C.); (M.B.)
| | - Marius Leretter
- Department of Prosthodontics, “Victor Babeș” University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania;
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38
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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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39
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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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40
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Huang GTJ, Liu J, Zhu X, Yu Z, Li D, Chen CA, Azim AA. Pulp/Dentin Regeneration: It Should Be Complicated. J Endod 2020; 46:S128-S134. [PMID: 32950184 DOI: 10.1016/j.joen.2020.06.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Stem cell-mediated regenerative endodontics has reached the human clinical trial phase; however, many issues still exist that prevent such technology to be a widely used clinical practice. These issues are not straightforward and are complicated. They should be because pulp regeneration is dealing with a small dead-end space. In addition, when regeneration is needed, the space is often heavily infected. The true standard of pulp regeneration should be everything except generation of some fibrous connective tissue and amorphous mineral deposit. As of now, we are still far short of reaching the standard of complete vascularized and innervated pulp regeneration with newly formed tubular dentin in all types of teeth. Thus, we need to go back to the bench and use established animal models or create new animal models to tackle those issues. This article will address several key issues including the possibility of pulp regeneration in small canals of molar teeth by enhancing the neovascularization, and whether the organized tubular dentin can be generated on the canal walls. Data from our semi-orthotopic tooth fragment mouse model have shown that complete pulp regeneration using dental pulp stem cells (DPSCs) in small canal has been inconsistent because of limited blood supply. This inconsistency is similar in our orthotopic miniature swine model, although in some cases vascularized pulp-like tissue can be formed throughout the canal space after DPSC transplantation. Furthermore, no tubular dentin was observed in the orthotopic pulp regeneration, despite the fact that DPSCs have the capacity to generate some tubular dentin-like structure in the hydroxyapatite/tricalcium phosphate-mediated ectopic pulp/dentin formation model in mice. Potential strategies to be tested to address these regeneration issues are discussed herein.
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Affiliation(s)
- George T-J Huang
- University of Tennessee Health Science Center, College of Dentistry, Department of Bioscience Research, Memphis, Tennessee.
| | - Jie Liu
- University of Tennessee Health Science Center, College of Dentistry, Department of Bioscience Research, Memphis, Tennessee
| | - Xiaofei Zhu
- University of Tennessee Health Science Center, College of Dentistry, Department of Bioscience Research, Memphis, Tennessee; VIP Dental Service and Geriatric Dentistry, School and Hospital of Stomatology, Peking University, Beijing, China
| | - Zongdong Yu
- University of Tennessee Health Science Center, College of Dentistry, Department of Bioscience Research, Memphis, Tennessee
| | - Dong Li
- University of Tennessee Health Science Center, College of Dentistry, Department of Bioscience Research, Memphis, Tennessee
| | - Chao-An Chen
- University of Tennessee Health Science Center, College of Dentistry, Department of Bioscience Research, Memphis, Tennessee; Chi Mei Medical Center, Department of Endodontics, Liouying, Tainan, Taiwan
| | - Adham A Azim
- University of Tennessee Health Science Center, College of Dentistry, Department of Bioscience Research, Memphis, Tennessee; University at Buffalo, School of Dental Medicine, Division of Endodontics, Buffalo, New York
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Abstract
Two increasingly common endodontic procedures, vital pulp therapy (VPT) and regenerative endodontic procedures, rely on dental tissue regeneration/repair mechanisms with the aid of biomaterials. These materials are applied in close contact to the pulpal tissue and are required to be biocompatible, form an antimicrobial seal, not induce staining, and be easy to manipulate. Historically, calcium hydroxide played an important role in VPT. However, over the last 3 decades, significant efforts in research and industry have been made to develop various biomaterials, including hydraulic tricalcium silicate cements. The present review summarized various hydraulic tricalcium silicate cements and their biological properties in clinical procedures, namely VPT and regenerative endodontic procedures.
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42
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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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43
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Pulyodan MK, Paramel Mohan S, Valsan D, Divakar N, Moyin S, Thayyil S. Regenerative Endodontics: A Paradigm Shift in Clinical Endodontics. J Pharm Bioallied Sci 2020; 12:S20-S26. [PMID: 33149426 PMCID: PMC7595546 DOI: 10.4103/jpbs.jpbs_112_20] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/06/2020] [Accepted: 03/09/2020] [Indexed: 02/06/2023] Open
Abstract
Preserving the natural dentition in its normal form and function is one of the major goals of endodontic treatment. Re-establishing the lost vitality and development of root maturation in immature permanent teeth with pulp necrosis/apical periodontitis is quiet challenging clinically. The very basis of regenerative endodontics relies on the concept of tissue engineering using stem cells, biomimetic scaffold, and bioactive growth factors to regenerate the pulp tissue damaged by microbial infection, injury, or developmental defects. In clinical endodontics, this approach is referred to as a “paradigm shift.” Even though repair instead of true regeneration is achieved with current protocols, it is hoped that further research in the area of stem-cell-based tissue engineering will allow for true regeneration and improved treatment outcomes. The aim of this review is to discuss about the various aspects of regenerative endodontics, current clinical protocols, and the future of pulp regeneration techniques.
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Affiliation(s)
- Manoj Kumar Pulyodan
- Department of Conservative Dentistry and Endodontics, Sree Anjaneya Institute of Dental Sciences, Calicut, Kerala, India
| | - Sunil Paramel Mohan
- Department of Oral Pathology and Microbiology, Sree Anjaneya Institute of Dental Sciences, Calicut, Kerala, India
| | - Dhanya Valsan
- Department of Conservative Dentistry and Endodontics, Sree Anjaneya Institute of Dental Sciences, Calicut, Kerala, India
| | - Namitha Divakar
- Department of Conservative Dentistry and Endodontics, Sree Anjaneya Institute of Dental Sciences, Calicut, Kerala, India
| | - Shabna Moyin
- Department of Conservative Dentistry and Endodontics, Sree Anjaneya Institute of Dental Sciences, Calicut, Kerala, India
| | - Shamsheer Thayyil
- Department of Conservative Dentistry and Endodontics, Sree Anjaneya Institute of Dental Sciences, Calicut, Kerala, India
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44
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An Immunofluorescence Study to Analyze Wound Healing Outcomes of Regenerative Endodontics in an Immature Premolar with Chronic Apical Abscess. J Endod 2020; 46:627-640. [DOI: 10.1016/j.joen.2020.01.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/06/2020] [Accepted: 01/21/2020] [Indexed: 02/07/2023]
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45
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Pizzatto LN, Meneses CCB, Diniz EA, Dionísio TJ, Santos CF, Sipert CR. Angiotensin II Regulates Proliferation and Function of Stem Cells of Apical Papilla. J Endod 2020; 46:810-817. [PMID: 32331838 DOI: 10.1016/j.joen.2020.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/20/2020] [Accepted: 03/10/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Stem cells of apical papilla (SCAP) may be affected by inflammatory mediators released by activation with lipopolysaccharide (LPS) from infected pulpal cavities of necrotic immature teeth. Therefore, this study aimed to investigate the presence of a local renin-angiotensin system (RAS) and the role of angiotensin II (Ang II) on the modulation of SCAP in vitro. METHODS Primary cultures of SCAP were incubated with LPS (0.1-10 μg/mL) for cell viability and quantification of the chemokine CCL2. Components of RAS were searched by gene expression of angiotensinogen (AGTN), angiotensin converting enzyme (ACE), renin, angiotensin receptor 1 (AT1) and 2 (AT2), and Mas receptor. Ang II was investigated in SCAP supernatants. Immunofluorescence was used to detect AGTN and AT1. Next, cells were treated with Ang II for viability/proliferation assessment, quantification of CCL2 and interleukin 6, and mineralization assay. Data were evaluated by analysis of variance using Tukey post hoc comparisons or the Student t test. P values <.05 were considered to be significant. RESULTS LPS increased CCL2 production at 1 and 10 μg/mL. The gene expression of AGTN, renin, ACE, and AT1 was detected, but only ACE was increased by LPS. Ang II peptide was found in SCAP supernatants but unaltered by LPS. Both AGTN and AT1 proteins were detected by immunostaining. Ang II significantly induced SCAP proliferation, increased CCL2 production, down-regulated IL-6 release, and reduced the SCAP mineralization rate. CONCLUSIONS A local RAS was found at the apical papilla, and Ang II was able to modulate SCAP function in vitro.
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Affiliation(s)
- Lais Nicolay Pizzatto
- Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Claudia C B Meneses
- Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Elisa A Diniz
- Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Thiago J Dionísio
- Department of Biological Sciences, Dental School of Bauru, University of São Paulo, Bauru, Brazil
| | - Carlos Ferreira Santos
- Department of Biological Sciences, Dental School of Bauru, University of São Paulo, Bauru, Brazil
| | - Carla R Sipert
- Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil.
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46
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Regenerative Endodontic Management of an Immature Molar Using Calcium Hydroxide and Triple Antibiotic Paste: a Two-Year Follow-Up. Case Rep Dent 2020; 2020:9025847. [PMID: 32095292 PMCID: PMC7035542 DOI: 10.1155/2020/9025847] [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: 12/12/2019] [Accepted: 01/22/2020] [Indexed: 01/01/2023] Open
Abstract
The regenerative endodontic procedure (REP) is considered a viable treatment option for immature teeth with necrotic pulp and periapical radiolucency which can facilitate continued root formation. In this report, an immature necrotic mandibular molar received REP in three appointments wherein chemomechanical debridement was performed with a sequential application of nonsetting calcium hydroxide (in the whole canal) and triple antibiotics paste (in the root's middle third) dressings in the first and second appointments, respectively. In the third appointment, blood clots were created in the root canals. MTA was placed over the blood clots and the tooth was restored with a composite filling and stainless-steel crown. Recall appointments were performed for two years where the tooth was deemed asymptomatic clinically and a complete root formation with significant periapical healing was evident radiographically. More cases are required to warrant the feasibility of this disinfection protocol.
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47
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Khoshkhounejad M, Sobhi Afshar M, Jabalameli F, Emaneini M, Sharifian M. Cytotoxicity Evaluation of Minimum Antibacterial Values of Different Medicaments Used in Endodontic Regenerative Procedures. Eur J Dent 2019; 13:514-520. [PMID: 31891968 PMCID: PMC6938419 DOI: 10.1055/s-0039-3401369] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the cytotoxicity of minimum antibacterial values of medicaments used in endodontic regeneration on stem cells. MATERIALS AND METHODS "Minimum inhibitory concentration," "minimum bactericidal concentration," and "minimum biofilm inhibitory concentration" of triple and double antibiotic paste, a modified triple antibiotic paste (minocycline replaced by clindamycin), Augmentin, and calcium hydroxide were determined using Enterococcus faecalis (ATCC 29212) by microtiter plate method. Direct cytotoxic effects of drugs were evaluated by lactate dehydrogenase and water-soluble tetrazolium salt-1 assays using stem cells of apical papilla obtained from immature third molars via enzymatic digestion. STATISTICAL ANALYSIS Data were analyzed using IBM SPSS Statistics 24, one-way analysis of variance and post hoc comparisons. The statistical power was set at p < 0.05. RESULTS All medicaments caused similar cytotoxicity and cell proliferation at "minimum inhibitory concentration" (p > 0.05) except Augmentin which was significantly more toxic than others (p < 0.05). At "minimum bactericidal concentration," calcium hydroxide was more toxic than other drugs (p < 0.001), but its adverse effect on cell proliferation was the same as Augmentin (p > 0.05). Triple and double antibiotic paste revealed similar favorable effects in terms of toxicity and proliferation rate at most of the tested concentrations (p > 0.05). At "minimum biofilm inhibitory concentration" both the modified paste and Augmentin caused less proliferation rate than triple and double antibiotic paste (p < 0.001and p < 0.05, respectively) and Augmentin induced more cytotoxicity (p < 0.05). CONCLUSIONS Considering the antimicrobial potency, triple antibiotic paste seems to be the safest drug for the stem cells of apical papilla, while Augmentin may have some adverse effects.
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Affiliation(s)
- Mehrfam Khoshkhounejad
- Department of Endodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.,Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Sobhi Afshar
- Department of Endodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Jabalameli
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Emaneini
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Sharifian
- Department of Endodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
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48
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Effect of a Residual Biofilm on Release of Transforming Growth Factor β1 from Dentin. J Endod 2019; 45:1119-1125. [DOI: 10.1016/j.joen.2019.05.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/01/2019] [Accepted: 05/03/2019] [Indexed: 11/22/2022]
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49
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Digka A, Sakka D, Lyroudia K. Histological assessment of human regenerative endodontic procedures (
REP
) of immature permanent teeth with necrotic pulp/apical periodontitis: A systematic review. AUST ENDOD J 2019; 46:140-153. [DOI: 10.1111/aej.12371] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Anna Digka
- Department of Endodontology School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece
| | - Dimitra Sakka
- Department of Endodontology School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece
| | - Kleoniki Lyroudia
- Department of Endodontology School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece
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50
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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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