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Pekpinarli B, Kaval ME, Cogulu D, Ilhan B, Sorsa T, Tervahartiala T, Oncag O. The effect of calcium hydroxide and double antibiotic paste on radiographic outcomes and periapical MMP-8 levels in regenerative endodontic procedures: a randomized clinical trial. J Appl Oral Sci 2024; 32:e20240122. [PMID: 39319904 PMCID: PMC11464082 DOI: 10.1590/1678-7757-2024-0122] [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: 03/28/2024] [Revised: 06/12/2024] [Accepted: 07/30/2024] [Indexed: 09/26/2024] Open
Abstract
OBJECTIVE The primary goal is to evaluate the effects of two different intracanal medicaments, calcium hydroxide [Ca(OH)2] and double antibiotic paste (DAP), on radiographic outcomes during regenerative endodontic procedures (REP) of immature permanent mandibular first molars with symptomatic irreversible pulpitis and symptomatic apical periodontitis (SIP/SAP). Additionally, the secondary goal was to evaluate MMP-8 levels during REP using two different intracanal medicaments. METHODOLOGY The study included 20 patients with immature mandibular first molars exhibiting SIP/SAP. Participants were randomly assigned into two groups based on the applied intracanal medicament. Ca(OH)2 (n=10) was prepared by mixing it with sterile distilled water, while the same amount of powdered metronidazole and ciprofloxacin were mixed and combined with sterile distilled water for DAP (n=10). MMP-8 in periapical samples were measured at baseline and on the 14th day using immunofluorometric assay. Image-J software with TurboReg plug-in was utilized to determine changes in root length, root width, radiographic root area (RRA) during the 12-month follow-up period. Data were analyzed by SPSS 25.0 (p<.05). RESULTS Significant increase in MMP-8 on the 14th day compared to baseline in both groups (p<0.001). There was no significant difference between the two groups in terms of the increase in MMP-8 (p>0.05). Root length significantly increased in both groups (p=0.001), with Ca(OH)2 showing a greater increase (p=0.046). Root width and RRA increased similarly in both groups at 12th month. CONCLUSION Both Ca(OH)2 and DAP applications resulted in a significant increase in periapical MMP-8 levels. Increase in radiographic root width and root area was similar between two groups, but Ca(OH)2 led to a significantly greater increase in root length. Further studies with larger sample sizes are necessary to validate our findings during REP of vital immature permanent mandibular molars. Clinical Trials database: NCT05581706.
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Affiliation(s)
- Burc Pekpinarli
- Ege University, Faculty of Dentistry, Department of Pediatric Dentistry, Izmir, Turkey
| | - Mehmet Emin Kaval
- Ege University, Faculty of Dentistry, Department of Endodontology, Izmir, Turkey
| | - Dilsah Cogulu
- Ege University, Faculty of Dentistry, Department of Pediatric Dentistry, Izmir, Turkey
| | - Betul Ilhan
- Ege University, Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Izmir, Turkey
| | - Timo Sorsa
- University of Helsinki, Institute of Dentistry, Helsinki University Central Hospital (HUCH), Department of Oral and Maxillofacial Diseases, Helsinki, Finland
- Karolinska Institutet, Department of Dental Medicine, Huddinge, Sweden
| | - Taina Tervahartiala
- University of Helsinki, Institute of Dentistry, Helsinki University Central Hospital (HUCH), Department of Oral and Maxillofacial Diseases, Helsinki, Finland
| | - Ozant Oncag
- Ege University, Faculty of Dentistry, Department of Pediatric Dentistry, Izmir, Turkey
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Sabeti MA, Saqib Ihsan M, Adami D, Hassani SN, Moushekhian S, Shafieian R, Salari Sedigh H, Ghoddusi J. Cell-Based Regenerative Endodontics for the Treatment of Irreversible Pulpitis: AnIn VivoInvestigation. J Endod 2024; 50:344-350. [PMID: 38142887 DOI: 10.1016/j.joen.2023.11.014] [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: 09/15/2023] [Revised: 11/21/2023] [Accepted: 11/24/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION This study aims to investigate the ability of umbilical cord mesenchymal stem cells (UC-MSC) to enhance the regeneration of pulp-dentin complex in immature permanent teeth with irreversible pulpitis. METHODS A total of 32 mandibular premolar teeth with immature apices in 5 dogs were used in this in-vivo randomized controlled trial (RCT). Eight healthy teeth without pre-existing pathosis served as the positive control samples and received no treatment, while in another 8 teeth, the pulp was completely extirpated (negative control). Class V cavities were prepared to induce inflammation in the remaining 16 teeth (groups 3 and 4) and the pulp was extirpated 2-4 mm short of the radiographic apex. Of the 16, the 8 teeth in group 4 received 1 mL of cord blood stem cells with a hydrogel scaffold. Blood clots were covered with mineral trioxide aggregates at the cementoenamel junction in the experimental groups, and teeth were filled with RMGI and composite. Three months later, block sections were removed for histologic evaluations for the evaluation of postoperative apical closure, degree of inflammation, and presence of normal pulp tissue. The data were statistically analyzed with the chi-square test (P < .05). RESULTS All teeth with complete pulp extirpation demonstrated pulpal necrosis with no postoperative closure of their apices, while apical closure was seen in all the teeth in the remaining groups. There was a statistically significant (P < .001) difference in the presence of inflammation and normal pulp tissue between the experimental groups. The teeth in group 3 showed normal pulp tissue extending to the level of MTA, but there was inflammation within the canal space. In contrast, the teeth in the UC-MSC group demonstrated organized, normal pulp tissue with no inflammation. CONCLUSION Based on these results, the regeneration of the pulp-dentin complex is possible with no inflammation when UC-MSCs are used and 2-4 mm of the apical pulp remains intact in immature teeth with irreversible pulpitis.
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Affiliation(s)
- Mohammad A Sabeti
- Advanced Specialty Program in Endodontics, Department of Preventive and Restorative Dental Sciences, University of California, San Francisco School of Dentistry, San Francisco, California.
| | - Mohammad Saqib Ihsan
- Advanced Specialty Program in Endodontics, Department of Preventive and Restorative Dental Sciences, University of California, San Francisco School of Dentistry, San Francisco, California
| | - Dina Adami
- Advanced Specialty Program in Endodontics, Department of Preventive and Restorative Dental Sciences, University of California, San Francisco School of Dentistry, San Francisco, California
| | - Seyedeh-Nafiseh Hassani
- Head of Stem Cells and Developmental Biology Department and Advanced Therapy Medicinal Product Technology Development Center (ATMP-TDC), Royan Institute for Stem Cell Biology & Technology ACECR, Tehran, Iran
| | - Siavash Moushekhian
- Dental Research Center, Department of Endodontics, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reihaneh Shafieian
- Department of Anatomy and Cell Biology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamideh Salari Sedigh
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Jamileh Ghoddusi
- Dental Research Center, Department of Endodontics, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
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Brizuela C, Meza G, Toro P, Phillips D, Cabrera C, Dezerega A, Concha G. Regenerative endodontic procedure combined with non-surgical root canal treatment in an immature permanent maxillary molar: A 7-year follow-up case report. AUST ENDOD J 2023; 49 Suppl 1:462-469. [PMID: 36533889 DOI: 10.1111/aej.12719] [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: 07/18/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022]
Abstract
The aim of this report is to present the results of a personalised endodontic treatment for an immature molar, using regenerative endodontic procedure (REP) combined with non-surgical root canal treatment (NSRCT), with 7 years of follow-up. The tooth#3 presented combined endodontic pathologies in each root, with different pulpal and periapical status. A REP in the palatal (P) canal and a NSCRT in the mesio-buccal (MB) and disto-buccal (DB) canals were performed. Absence of clinical signs/symptoms and continuous palatal root development with apical closure were observed over 4-years. After 5-years an apical lesion in the MB root was observed. Both MB canals were selectively retreated by completely filling them with TotalFill BC RRM Fast Set putty. After 7-years, the tooth remained functional and the apical lesion was resolving. The palatal root was completely mature. This case report reveals the potential for use of combined treatment approaches for immature multirooted teeth.
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Affiliation(s)
- Claudia Brizuela
- Biology and Oral Regeneration Research Center (CIBRO), Faculty of Dentistry, Universidad de los Andes, Santiago, Chile
- Department of Endodontics, Faculty of Dentistry, Universidad de Los Andes, Santiago, Chile
| | - Gastón Meza
- Biology and Oral Regeneration Research Center (CIBRO), Faculty of Dentistry, Universidad de los Andes, Santiago, Chile
- Department of Endodontics, Faculty of Dentistry, Universidad de Los Andes, Santiago, Chile
| | - Paulina Toro
- Department of Endodontics, Faculty of Dentistry, Universidad de Los Andes, Santiago, Chile
| | - Domingo Phillips
- Department of Endodontics, Faculty of Dentistry, Universidad de Los Andes, Santiago, Chile
| | - Carolina Cabrera
- Department of Endodontics, Faculty of Dentistry, Universidad de Los Andes, Santiago, Chile
| | - Andrea Dezerega
- Department of Endodontics, Faculty of Dentistry, Universidad de Los Andes, Santiago, Chile
| | - Guillermo Concha
- Department of Endodontics, Faculty of Dentistry, Universidad de Los Andes, Santiago, Chile
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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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de Carvalho KKT, Petean IBF, Silva-Sousa AC, de Camargo R, Mazzi-Chaves JF, Silva-Sousa YTC, Sousa-Neto MD. Evaluation of rotary instruments with whipping motion in the biomechanical preparation of large root canals of young permanent teeth. AUST ENDOD J 2022; 49:130-139. [PMID: 35649116 DOI: 10.1111/aej.12633] [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: 10/26/2021] [Revised: 04/05/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022]
Abstract
Shaping ability evaluation of taper ./01 instruments in large root canals, by microcomputed tomography (micro-CT) and scanning electron microscopy (SEM). Maxillary central incisors with large diameter root canals were divided into two groups (n = 10): XP-Endo Shaper (FKG-Dentaire, Switzerland) and manual instrumentation (FKG-Dentaire). Two- and three-dimensional parameters from cervical to apical root thirds were evaluated by micro-CT. Apical stop was evaluated by SEM images. Data were analysed by ANOVA and Tukey tests (α = 5%). XP-Endo Shaper allowed a regular biomechanical preparation with less dentinal wear compared with manual instrumentation, which showed excessive wear of the thin root canal walls (p < 0.05). Roundness and SMI showed similarity between both protocols (p > 0.05). XP-Endo Shaper SEM showed a regular and well-defined shape of the apical foramen suggesting the formation of the apical stop. Reduced diameter and taper instruments promoted a conservative wear and a well-defined apical stop formation in large root canals.
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Affiliation(s)
| | - Igor Bassi Ferreira Petean
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Alice Corrêa Silva-Sousa
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Rafael de Camargo
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Jardel Francisco Mazzi-Chaves
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | | | - Manoel Damião Sousa-Neto
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
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