1
|
Vatankhah M, Najary S, Dianat O. Clinical, Radiographic, and Histologic Outcomes of Regenerative Endodontic Treatment in Human Immature Teeth Using Different Biological Scaffolds: A Systematic Review and Meta-analysis. Curr Stem Cell Res Ther 2024; 19:611-627. [PMID: 36056831 DOI: 10.2174/1574888x17666220903141155] [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: 02/23/2022] [Revised: 04/20/2022] [Accepted: 06/02/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Biological scaffolds such as blood clot (BC), platelet-rich plasma (PRP), platelet- rich fibrin (PRF), and platelet pellet (PP) are used in regenerative endodontic treatments (RETs). OBJECTIVE To systematically and quantitatively evaluate clinical, radiographic, and histologic outcomes of RET studies using different biological scaffolds. METHODS MEDLINE, Scopus, Cochrane library, and Embase were searched to identify studies on RET procedures with any scaffold type performed on immature non-vital human teeth, employing any type of biological scaffold. Clinical, radiographic, and histologic outcomes were extracted. Cochrane collaboration risk of bias tool and Newcastle-Ottawa scale were used for quality assessment. Random and fixed model meta-analysis was carried out with 95% confidence interval. RESULTS Thirty-two studies were included in the qualitative analysis from the primarily retrieved 1895 studies. Only one study had high risk of bias and 71.8% of the studies had high quality. None of the studies reported any histologic findings. Thirty studies were included in meta-analysis. Clinical success rate of RET using either BC, PRP, or PRF was >99%. Furthermore, 32%, 23%, and 27% of BC, PRP, and PRF cases regained vitality, respectively. Periapical healing was seen in 67%, 75%, and 100% of BC, PRP, and PRF cases, respectively. There was no statistical difference between BC, PRP, or PRF regarding clinical success or any radiographic outcomes. CONCLUSION There was no significant difference between BC, PRP, and PRF in terms of clinical and radiographic outcomes. When it is difficult or dangerous to induce bleeding in root canals, PRP and PRF may be employed instead.
Collapse
Affiliation(s)
- Mohammadreza Vatankhah
- Iranian Center for Endodontic Research, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Najary
- Students\' Research Committee, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Dianat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, Baltimore, Maryland, USA
| |
Collapse
|
2
|
Al-Qudah A, Almomani M, Hassoneh L, Awawdeh L. Outcome of Regenerative Endodontic Procedures in Non-Vital Immature Permanent Teeth Using Two Intracanal Medications: A Prospective Randomized Clinical Study. J Endod 2023:S0099-2399(23)00279-0. [PMID: 37225036 DOI: 10.1016/j.joen.2023.05.009] [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: 03/09/2023] [Revised: 05/03/2023] [Accepted: 05/11/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION This randomized clinical trial aimed to assess and compare the long-term clinical and radiographic outcomes of Regenerative Endodontic Procedures (REP) in treating non-vital immature permanent teeth using two intra-canal medicaments. METHODS Forty-five patients yielding a total of 50 anterior and posterior non-vital immature teeth were randomly divided into 2 groups. REP utilizing either non-setting calcium hydroxide (Ca(OH)2) (n=25) or modified triple antibiotic paste (TAP) (n=25), as intra-canal medicaments were performed. NeoMTA Plus (Avalon Biomed Inc™, Houston, Texas, USA) was applied for coronal sealing. Cases were followed up clinically and radiographically for 36 months. Survival rate, success rate, and clinical outcome measures were analyzed. Preoperative and recall radiographs were evaluated for dimensional changes in root length, dentin thickness, apical diameter, and periapical radiolucency. RESULTS At 36 months follow up, success and survival rates were 81.6%, and 100% respectively, in which 79.4% of cases showed complete resolution of periapical radiolucency, with no significant difference between non-setting Ca(OH)2 and modified TAP groups (P>0.050). The cumulative changes in root length, root dentin thickness and apical diameter, throughout the study period, were observed in 47.9%, 77.1%, and 89.6 %, of cases respectively, with no significant differences between both groups (P≥ 0.39). Intra-canal calcifications were detected in 60% of cases with no significant difference between both groups (P=0.77). CONCLUSIONS REP, using either non-setting Ca(OH)2 or modified TAP as intra-canal medicament, exhibited high success and survival rates, over a follow up period of 36 months, with equally favorable clinical and radiographic outcome data.
Collapse
Affiliation(s)
- Aladdin Al-Qudah
- Department of Conservative Dentistry, Jordan University of Science and Technology, Irbid, Jordan.
| | - Mohammad Almomani
- Department of Conservative Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Layla Hassoneh
- Department of Conservative Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Lama Awawdeh
- Department of Conservative Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
3
|
Tawfeek HA, El-Bardissy AAA, Abou El-Yazeed M, Youssef R, Abd Alsamad AM. Clinical and radiographic evaluation of NeoMTA versus conventional white mineral trioxide aggregate in revascularization of non-vital immature permanent anterior teeth (A randomized controlled trial). BDJ Open 2023; 9:17. [PMID: 37117192 PMCID: PMC10144882 DOI: 10.1038/s41405-023-00143-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/07/2023] [Accepted: 03/23/2023] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVE To evaluate and compare clinically and radiographically the effect of using two different coronal plug materials (NeoMTA versus Conventional White mineral trioxide aggregate) in revascularization of non-vital immature permanent anterior teeth, with special reference to the assessment and evaluation of discoloration potential over a period of one year. METHODS Revascularization procedure was performed in (30) immature permanent non-vital anterior teeth which were randomly allocated to two equal groups (n = 15). NeoMTA was used as coronal plug material in the Experimental Group (N), while conventional White mineral trioxide aggregate (WMTA) was used as a coronal plug material in the Control Group (W). All treated teeth were evaluated clinically at 1 week, 1, 3, and 12 months and radiographically at 12 months. RESULTS The overall clinical and radiographic success rate of Groups (N) and (W) at the end of the 12-month follow-up period was 100%. The discoloration was detected in a single tooth (9.1%) in Group (N) and three teeth (27.3%) in Group (W) but the difference between groups was not statistically significant. CONCLUSIONS Both NeoMTA and conventional WMTA were successful coronal plug materials in the revascularization of non-vital immature permanent teeth achieving a high level of clinical and radiographic success. NeoMTA is a promising coronal plug material that can be used for revascularization procedures in the esthetic zone as it showed less discoloration potential compared with conventional WMTA, however, there was no statistically significant difference between both materials.
Collapse
Affiliation(s)
- Hala Ahmed Tawfeek
- Pediatric Dentistry, Orthodontics and Pediatric Dentistry Department, Oral and Dental Research Institute, National Research Centre, Giza, Egypt and Phd student in Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Cairo University, Giza, Egypt.
| | | | - Mohammed Abou El-Yazeed
- Pediatric Dentistry, Orthodontics and Pediatric Dentistry Department, Oral and Dental Research Institute, National Research Centre, Giza, Egypt
| | - Randa Youssef
- Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Cairo University, Giza, Egypt
| | | |
Collapse
|
4
|
Neural Regeneration in Regenerative Endodontic Treatment: An Overview and Current Trends. Int J Mol Sci 2022; 23:ijms232415492. [PMID: 36555133 PMCID: PMC9779866 DOI: 10.3390/ijms232415492] [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: 10/28/2022] [Revised: 11/24/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Pulpal and periapical diseases are the most common dental diseases. The traditional treatment is root canal therapy, which achieves satisfactory therapeutic outcomes-especially for mature permanent teeth. Apexification, pulpotomy, and pulp revascularization are common techniques used for immature permanent teeth to accelerate the development of the root. However, there are obstacles to achieving functional pulp regeneration. Recently, two methods have been proposed based on tissue engineering: stem cell transplantation, and cell homing. One of the goals of functional pulp regeneration is to achieve innervation. Nerves play a vital role in dentin formation, nutrition, sensation, and defense in the pulp. Successful neural regeneration faces tough challenges in both animal studies and clinical trials. Investigation of the regeneration and repair of the nerves in the pulp has become a serious undertaking. In this review, we summarize the current understanding of the key stem cells, signaling molecules, and biomaterials that could promote neural regeneration as part of pulp regeneration. We also discuss the challenges in preclinical or clinical neural regeneration applications to guide deep research in the future.
Collapse
|
5
|
El-Hady AYA, Badr AES. The Efficacy of Advanced Platelet-rich Fibrin in Revascularization of Immature Necrotic Teeth. J Contemp Dent Pract 2022; 23:725-732. [DOI: 10.5005/jp-journals-10024-3367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
6
|
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.
Collapse
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:
| |
Collapse
|
7
|
Murad M, Duggal MS. INTRA-CANAL ANTIBIOTIC PASTES MAY PROMOTE THICKER DENTIN WALLS AND CALCIUM HYDROXIDE MAY PROMOTE MORE APICAL CLOSURE. J Evid Based Dent Pract 2022; 22:101728. [PMID: 35718432 DOI: 10.1016/j.jebdp.2022.101728] [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: 11/27/2022]
Abstract
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION Báez, Viviana; Corcos, Lorena; Morgillo, Florencia; Imperatrice, Lorena; Gualtieri, Ariel Félix (2022). Meta-analysis of regenerative endodontics outcomes with antibiotics pastes and calcium hydroxide. The apex of the iceberg. J Oral Biol Craniofac Res 12(1): 90-98. SOURCE OF FUNDING Non-funded study TYPE OF STUDY/DESIGN: Systematic review and meta-analysis.
Collapse
|
8
|
Treatment Outcomes of Regenerative Endodontic Procedures in Traumatized Immature Permanent Necrotic Teeth: A Retrospective Study. J Endod 2022; 48:1129-1136. [DOI: 10.1016/j.joen.2022.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 12/11/2022]
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Bucchi C, Ohlsson E, de Anta JM, Woelflick M, Galler K, Manzanares-Cespedes MC, Widbiller M. Human Amnion Epithelial Cells: A Potential Cell Source for Pulp Regeneration? Int J Mol Sci 2022; 23:ijms23052830. [PMID: 35269973 PMCID: PMC8911206 DOI: 10.3390/ijms23052830] [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: 01/29/2022] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to analyze the suitability of pluripotent stem cells derived from the amnion (hAECs) as a potential cell source for revitalization in vitro. hAECs were isolated from human placentas, and dental pulp stem cells (hDPSCs) and dentin matrix proteins (eDMPs) were obtained from human teeth. Both hAECs and hDPSCs were cultured with 10% FBS, eDMPs and an osteogenic differentiation medium (StemPro). Viability was assessed by MTT and cell adherence to dentin was evaluated by scanning electron microscopy. Furthermore, the expression of mineralization-, odontogenic differentiation- and epithelial–mesenchymal transition-associated genes was analyzed by quantitative real-time PCR, and mineralization was evaluated through Alizarin Red staining. The viability of hAECs was significantly lower compared with hDPSCs in all groups and at all time points. Both hAECs and hDPSCs adhered to dentin and were homogeneously distributed. The regulation of odontoblast differentiation- and mineralization-associated genes showed the lack of transition of hAECs into an odontoblastic phenotype; however, genes associated with epithelial–mesenchymal transition were significantly upregulated in hAECs. hAECs showed small amounts of calcium deposition after osteogenic differentiation with StemPro. Pluripotent hAECs adhere on dentin and possess the capacity to mineralize. However, they presented an unfavorable proliferation behavior and failed to undergo odontoblastic transition.
Collapse
Affiliation(s)
- Cristina Bucchi
- Research Centre for Dental Sciences (CICO), Department of Integral Adult Dentistry, Faculty of Dentistry, Universidad de La Frontera, Temuco 4811230, Chile
- Correspondence:
| | - Ella Ohlsson
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany; (E.O.); (M.W.); (M.W.)
| | - Josep Maria de Anta
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences, Campus de Bellvitge, Universitat de Barcelona, 08907 L’Hospitalet de Llobregat, Spain; (J.M.d.A.); (M.C.M.-C.)
| | - Melanie Woelflick
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany; (E.O.); (M.W.); (M.W.)
| | - Kerstin Galler
- Department of Conservative Dentistry and Periodontology, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | - María Cristina Manzanares-Cespedes
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences, Campus de Bellvitge, Universitat de Barcelona, 08907 L’Hospitalet de Llobregat, Spain; (J.M.d.A.); (M.C.M.-C.)
| | - Matthias Widbiller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany; (E.O.); (M.W.); (M.W.)
| |
Collapse
|
11
|
Báez V, Corcos L, Morgillo F, Imperatrice L, Gualtieri AF. "Meta-analysis of regenerative endodontics outcomes with antibiotics pastes and calcium hydroxide. The apex of the iceberg". J Oral Biol Craniofac Res 2022; 12:90-98. [PMID: 34815932 PMCID: PMC8593466 DOI: 10.1016/j.jobcr.2021.11.005] [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: 05/13/2021] [Revised: 08/17/2021] [Accepted: 11/04/2021] [Indexed: 12/26/2022] Open
Abstract
PORPOSE The aim of this study was to evaluate, through a meta-analysis, the predictability of Regenerative Endodontic therapies with antibiotic pastes and calcium hydroxide [Ca(OH)2], related to four variables as follows: root dentin wall thickening, apical closure, apical repair and root lengthening. METHODS Literature electronic searches were performed in Pubmed - MEDLINE, Scopus and Lilacs-BVS platforms using appropriate search terms, Mesh (Medical Subject Headings), DeCS (Health Sciences Descriptors) and Boolean operators comprising articles published between 2009 and 2020. Thirty-two original indexed papers were included making a total of 758 regenerative endodontic procedures. A descriptive meta-analysis was performed. RESULTS Dentin wall thickening was present in 66% (CI95: 58%-73%) of the cases treated with antibiotic paste, while when Ca(OH)2 was used, a percentage of 53% (CI95: 26%-78%), was obtained. When antibiotic paste was used, apical closure was found in the 66% (CI95: 58%-73%) of the regenerative endodontic procedures, while when Ca(OH)2 was used, 88% (CI95: 80%-93%) of the cases were found to reach apical closure. Root lengthening and apical repair were found satisfactory for both disinfection protocols. CONCLUSIONS There could be differences between the two treatments since a higher percentage of root dentin wall thickening was found when using antibiotic pastes, while a higher percentage of apical closure was found when calcium hydroxide was used. Development of more clinical studies would be necessary in order to confirm the observed differences. The proposed approach could provide a useful contribution for endodontists when planning regenerative endodontic procedures, so as to guide decision-making to the best elective treatment and to select the appropriate disinfection method in accordance with preoperative radiographic diagnosis of root development stage, then increasing the predictability of regenerative endodontic treatment and reducing potential risk of root fractures.
Collapse
Affiliation(s)
- Viviana Báez
- Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Endodoncia. Buenos Aires, Argentina
- Centro de Educación Médica e Investigaciones Clínicas CEMIC, Departamento de Odontología. Buenos Aires, Argentina
| | - Lorena Corcos
- Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Endodoncia. Buenos Aires, Argentina
| | - Florencia Morgillo
- Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Endodoncia. Buenos Aires, Argentina
| | - Lorena Imperatrice
- Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Endodoncia. Buenos Aires, Argentina
| | - Ariel Félix Gualtieri
- Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Biofísica y Bioestadística. Buenos Aires, Argentina
| |
Collapse
|
12
|
Jayadevan V, Gehlot PM, Manjunath V, Madhunapantula SV, Lakshmikanth JS. A comparative evaluation of Advanced Platelet-Rich Fibrin (A-PRF) and Platelet-Rich Fibrin (PRF) as a Scaffold in Regenerative Endodontic Treatment of Traumatized Immature Non-vital permanent anterior teeth: A Prospective clinical study. J Clin Exp Dent 2021; 13:e463-e472. [PMID: 33981393 PMCID: PMC8106940 DOI: 10.4317/jced.57902] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/20/2020] [Indexed: 11/17/2022] Open
Abstract
Background Regenerative endodontic treatment (RET) is a promising treatment alternative for traumatized immature non-vital teeth. Advanced platelet-rich fibrin (A-PRF) contains significantly more growth factors than Platelet-rich fibrin (PRF) and has not been evaluated as a scaffold in RET. The aim of the present study was to evaluate and compare A-PRF and PRF as scaffolds in the RET concerning periapical healing, and root development of traumatized immature non-vital teeth.
Material and Methods In the present study, RET was performed on 30 traumatized immature non-vital maxillary incisors in 28 patients aged between 8-27 years. Minimal mechanical debridement and irrigation with 1.5% sodium hypochlorite and 17% ethylenediaminetetraacetic acid was performed. Canals were disinfected using modified triple antibiotic paste consisting of ciprofloxacin, metronidazole and cefaclor. Based on the type of scaffold, teeth were randomly assigned into A-PRF (n=15) and PRF groups (n=15). Periapical healing, apical response and quantitative root dimensions (length and thickness) were analyzed radiographically after 12 months follow-up.
Results Nineteen patients with 21 teeth (A-PRF n=11, PRF n=10) completed the follow-up and 9 patients were excluded. Clinically, patients in both the groups were asymptomatic. The survival rates for A-PRF and PRF were 78.5% and 77.5%, respectively. No statistically significant differences were detected between A-PRF and PRF regarding periapical healing and type of apical response (p& 0.05). The difference in the pre-operative and follow-up root thickness and root length in both A-PRF and PRF groups were statistically significant (p< 0.05).
Conclusions Based on short-term results of 13 months, both A-PRF and PRF can be used as scaffold in regenerative endodontic treatment of traumatized immature non-vital teeth. A-PRF could be recommended in such cases since it yielded more root dentin thickness which is crucial for reinforcing immature teeth. Key words:Regenerative endodontic treatment, dental trauma, Non-vital teeth, immature teeth, platelet-rich fibrin, advanced platelet-rich fibrin.
Collapse
Affiliation(s)
- Veena Jayadevan
- BDS. Department of Conservative Dentistry and Endodontics. JSS Dental College and Hospital. JSS Academy of Higher Education and Research. Sri Shivarathreeshwara Nagar. Mysuru- 570015, Karnataka, India
| | - Paras-Mull Gehlot
- MDS. Department of Conservative Dentistry and Endodontics. JSS Dental College and Hospital. JSS Academy of Higher Education and Research. Sri Shivarathreeshwara Nagar. Mysuru- 570015, Karnataka, India
| | - Vinutha Manjunath
- MDS. Department of Conservative Dentistry and Endodontics. JSS Dental College and Hospital. JSS Academy of Higher Education and Research. Sri Shivarathreeshwara Nagar. Mysuru- 570015, Karnataka, India
| | - Subbarao V Madhunapantula
- BSc, B.Ed, M.Sc, Ph.D. Department of Biochemistry. JSS Medical College and Hospital. JSS Academy of Higher Education and Research. Sri Shivarathreeshwara Nagar. Mysuru- 570015, Karnataka, India
| | - Jyothi-Swandenahalli Lakshmikanth
- M Pharm. Department of Pharmaceutics. JSS College of Pharmacy. JSS Academy of Higher Education and Research. Sri Shivarathreeshwara Nagar. Mysuru- 570015, Karnataka, India
| |
Collapse
|
13
|
What is the best long-term treatment modality for immature permanent teeth with pulp necrosis and apical periodontitis? Eur Arch Paediatr Dent 2021; 22:311-340. [PMID: 33420674 PMCID: PMC8213569 DOI: 10.1007/s40368-020-00575-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/17/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate and assess the current knowledge about apexification and regenerative techniques as a meaningful treatment modality and to map the scientific evidence for the efficacy of both methods for the management of traumatised immature teeth with pulp necrosis and apical periodontitis. METHODS This systematic review searched five databases: PubMed, Web of Science, Cochrane Library, Ovid (Medline), and Embase. Published articles written in English were considered for inclusion. The following keywords were used: Regenerative endodontic treatment OR regenerat* OR revital* OR endodontic regeneration OR regenerative endodontics OR pulp revascularization OR revasculari* OR 'traumatized immature teeth'. Only peer-reviewed studies with a study size of at least 20 cases followed up for 24 months were included. Eligibility assessment was performed independently in a blinded manner by three reviewers and disagreements were resolved by consensus. Subgroup analyses were performed on three clinical outcomes: survival, success, and continued root development. RESULTS Seven full texts out of 1359 citations were included and conventional content analysis was performed. Most of the identified citations were case reports and case series. CONCLUSIONS In the present systematic review, the qualitative analysis revealed that both regenerative and apexification techniques had equal rates of success and survival and proved to be effective in the treatment of immature necrotic permanent teeth. Endodontic regenerative techniques appear to be superior to apexification techniques in terms of stimulation of root maturation, i.e. root wall thickening and root lengthening. Knowledge gaps were identified regarding the treatment and follow-up protocols for both techniques.
Collapse
|
14
|
Matoug-Elwerfelli M, Nazzal H, Raif EM, Wilshaw SP, Esteves F, Duggal M. Ex-vivo recellularisation and stem cell differentiation of a decellularised rat dental pulp matrix. Sci Rep 2020; 10:21553. [PMID: 33299073 PMCID: PMC7725831 DOI: 10.1038/s41598-020-78477-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/18/2020] [Indexed: 01/09/2023] Open
Abstract
Implementing the principles of tissue engineering within the clinical management of non-vital immature permanent teeth is of clinical interest. However, the ideal scaffold remains elusive. The aim of this work was to assess the feasibility of decellularising rat dental pulp tissue and evaluate the ability of such scaffold to support stem cell repopulation. Rat dental pulps were retrieved and divided into control and decellularised groups. The decellularisation protocol incorporated a low detergent concentration and hypotonic buffers. After decellularisation, the scaffolds were characterised histologically, immunohistochemistry and the residual DNA content quantified. Surface topography was also viewed under scanning electron microscopy. Biocompatibility was evaluated using cytotoxicity assays utilising L-929 cell line. Decellularised scaffolds were recellularised with human dental pulp stem cells up to 14 days in vitro. Cellular viability was assessed using LIVE/DEAD stain kit and the recellularised scaffolds were further assessed histologically and immunolabelled using makers for odontoblastic differentiation, cytoskeleton components and growth factors. Analysis of the decellularised scaffolds revealed an acellular matrix with histological preservation of structural components. Decellularised scaffolds were biocompatible and able to support stem cell survival following recellularisation. Immunolabelling of the recellularised scaffolds demonstrated positive cellular expression against the tested markers in culture. This study has demonstrated the feasibility of developing a biocompatible decellularised dental pulp scaffold, which is able to support dental pulp stem cell repopulation. Clinically, decellularised pulp tissue could possibly be a suitable scaffold for use within regenerative (reparative) endodontic techniques.
Collapse
Affiliation(s)
- Manal Matoug-Elwerfelli
- Division of Oral Biology, School of Dentistry, University of Leeds, Leeds, UK.,Department of Clinical Dental Science, Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Hani Nazzal
- Department of Paediatric Dentistry, School of Dentistry, University of Leeds, Leeds, UK.,Hamad Dental Centre, Hamad Medical Corporation, Doha, Qatar
| | - El Mostafa Raif
- Division of Oral Biology, School of Dentistry, University of Leeds, Leeds, UK
| | - Stacy-Paul Wilshaw
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK.,School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
| | - Filomena Esteves
- Leeds Institute of Cancer and Pathology, St James University Hospital, Leeds, UK
| | - Monty Duggal
- Department of Paediatric Dentistry, School of Dentistry, University of Leeds, Leeds, UK. .,Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, National University Singapore, Singapore, Singapore.
| |
Collapse
|
15
|
Ong TK, Lim GS, Singh M, Fial AV. Quantitative Assessment of Root Development after Regenerative Endodontic Therapy: A Systematic Review and Meta-Analysis. J Endod 2020; 46:1856-1866.e2. [DOI: 10.1016/j.joen.2020.08.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/07/2020] [Accepted: 08/13/2020] [Indexed: 12/15/2022]
|
16
|
Maniglia-Ferreira C, Gurgel Filho ED, Gomes FDA, Reis SA, Pappen FG. 12-Year Follow-Up of Regenerative Endodontic Treatment of Immature Permanent Upper Incisors with Acute Abscess. Braz Dent J 2020; 31:680-684. [PMID: 33237241 DOI: 10.1590/0103-6440202003663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/23/2020] [Indexed: 11/21/2022] Open
Abstract
This case report discusses the endodontic treatment of a 7-year-old girl who suffered trauma (intrusion) to the immature upper central incisors secondary to a fall from a bicycle. Thirty days after the accident the patient was brought by her mother for clinical and radiographic assessment with a chief complaint of swelling and tenderness to percussion and palpation. Acute apical abscess associated with immature teeth were diagnosed. A decision was made to perform regenerative endodontic treatment. Access cavities were made and the root canals were disinfected by irrigation with 2.5% sodium hypochlorite. Final irrigation was performed with 17% EDTA. Due to pain and presence of secretions, 2% chlorhexidine gel was applied as an intracanal medicament. Seven days later, at the second visit, the root canals were once again disinfected and the canals of the right and left permanent upper central incisors were filled with double antibiotic paste (metronidazole/ciprofloxacin) and calcium hydroxide paste, respectively. Zinc oxide was mixed in both pastes. At the third visit, after 21 more days, the pastes were removed and the periapical areas were stimulated with a #80 K-file to encourage clot formation within the pulp cavities. A mineral trioxide aggregate (MTA) paste cervical plug was placed and the teeth were restored with glass ionomer cement. Radiographs and CBCT scans demonstrated complete root formations. The patient has been followed for 12 years, with evidence of clinical success throughout.
Collapse
Affiliation(s)
- Claudio Maniglia-Ferreira
- Department of Endodontics, School of Dentistry, UNIFOR - Universidade de Fortaleza, Fortaleza, CE, Brazil
| | - Eduardo Diogo Gurgel Filho
- Department of Endodontics, School of Dentistry, UNIFOR - Universidade de Fortaleza, Fortaleza, CE, Brazil
| | - Fabio de Almeida Gomes
- Department of Endodontics, School of Dentistry, UNIFOR - Universidade de Fortaleza, Fortaleza, CE, Brazil
| | - Sthefanny Amaral Reis
- Department of Endodontics, School of Dentistry, UNIFOR - Universidade de Fortaleza, Fortaleza, CE, Brazil
| | - Fernanda Geraldo Pappen
- Department of Semiology and Clinics, Diagnostic Center for Oral Diseases, School of Dentistry, UFPEL - Universidade Federal de Pelotas, Pelotas, RS, Brazil
| |
Collapse
|
17
|
Pereira AC, Oliveira MLD, Cerqueira-Neto ACCL, Gomes BPFA, Ferraz CCR, Almeida JFAD, Marciano MA, DE-Jesus-Soares A. Treatment outcomes of pulp revascularization in traumatized immature teeth using calcium hydroxide and 2% chlorhexidine gel as intracanal medication. J Appl Oral Sci 2020; 28:e20200217. [PMID: 32997087 PMCID: PMC7518246 DOI: 10.1590/1678-7757-2020-0217] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/17/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Pulp revascularization is an effective treatment for immature necrotic teeth. Calcium hydroxide has been used in pulp revascularization as an intracanal medication due to its antimicrobial action and the non-exhibition of crown discoloration and cytotoxicity for stem cells from the apical papilla. Our study aimed to investigate the clinical success and quantitative radiographic changes of root development in immature traumatized teeth using calcium hydroxide plus 2% chlorhexidine gel as intracanal medication. METHODOLOGY In this retrospective study, 16 patients were treated with a standardized pulp revascularization protocol. Calcium hydroxide and 2% chlorhexidine gel were manipulated in a 1:1 (v/v) ratio and inserted into root canals with Lentulo spirals (Dentsply Maillefer, Baillaigues, Switzerland). Patients were followed up for a period from 9 to 36 months for the evaluation of clinical and radiological data. Radiographic measurements of root length, root width, apical diameter, and MTA placement from the apex were quantified using software ImageJ. Wilcoxon test and t-test were used, according to nonparametric or parametric data, respectively, for changes over time in root length, root width, and apical diameter. RESULTS Fifteen teeth survived during the follow-up period (93.75%) and met the criteria for clinical success. Although the changes seem to be very small in many cases, significant increases in the average root length (14.28%, p<0.0001), root width (8.12%, p=0.0196), and decrease in apical diameter (48.37%, p=0.0007) were observed. MTA placement from the apex and age at the time of treatment was not significantly associated with the quantitative radiographic outcomes. CONCLUSIONS Pulp revascularization in traumatized immature teeth treated with calcium hydroxide plus 2% chlorhexidine gel as intracanal medication had high success and survival rates, showing periodontal healing and resolution of signs and symptoms. However, concerning the continued root development, the outcomes can still be considered unpredictable.
Collapse
Affiliation(s)
- Andrea Cardoso Pereira
- Universidade Estadual Campinas - UNICAMP. Faculdade de Odontologia de Piracicaba. Departamento de Odontologia Restauradora, área de Endodontia. Piracicaba, SP, Brasil
| | - Matheus Lima de Oliveira
- Universidade Estadual Campinas - UNICAMP. Faculdade de Odontologia de Piracicaba. Departamento de Diagnóstico Oral, área de Radiologia Oral, Piracicaba, SP, Brasil
| | - Ana Carolina C L Cerqueira-Neto
- Universidade Estadual Campinas - UNICAMP. Faculdade de Odontologia de Piracicaba. Departamento de Odontologia Restauradora, área de Endodontia. Piracicaba, SP, Brasil
| | - Brenda P F A Gomes
- Universidade Estadual Campinas - UNICAMP. Faculdade de Odontologia de Piracicaba. Departamento de Odontologia Restauradora, área de Endodontia. Piracicaba, SP, Brasil
| | - Caio Cezar Randi Ferraz
- Universidade Estadual Campinas - UNICAMP. Faculdade de Odontologia de Piracicaba. Departamento de Odontologia Restauradora, área de Endodontia. Piracicaba, SP, Brasil
| | - José Flávio Affonso de Almeida
- Universidade Estadual Campinas - UNICAMP. Faculdade de Odontologia de Piracicaba. Departamento de Odontologia Restauradora, área de Endodontia. Piracicaba, SP, Brasil
| | - Marina Angélica Marciano
- Universidade Estadual Campinas - UNICAMP. Faculdade de Odontologia de Piracicaba. Departamento de Odontologia Restauradora, área de Endodontia. Piracicaba, SP, Brasil
| | - Adriana DE-Jesus-Soares
- Universidade Estadual Campinas - UNICAMP. Faculdade de Odontologia de Piracicaba. Departamento de Odontologia Restauradora, área de Endodontia. Piracicaba, SP, Brasil
| |
Collapse
|
18
|
Tong HJ, Sim YF, Berdouses E, Al-Jundi S, El Shahawy O, Nazzal H. Regenerative endodontic therapy (RET) for managing immature non-vital teeth: experiences and opinions of paediatric dental practitioners in the European and Arabian regions. Eur Arch Paediatr Dent 2020; 22:145-155. [PMID: 32535749 DOI: 10.1007/s40368-020-00542-w] [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: 10/10/2019] [Accepted: 05/29/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE MTA apical plug approach is considered the gold standard in managing immature teeth with necrotic pulp tissues but does not increase root dimensions. Regenerative Endodontic Therapy (RET) has been advocated as an alternative technique for management of these teeth. This study aimed to assess the knowledge, experience and the opinions of dentists treating paediatric patients in the European and Arabian regions on RET. METHODS A cross-sectional, pre-piloted 23-item self-administered questionnaire survey was distributed electronically using the Bristol Online Survey tool through the mailing list of the European Academy of Paediatric Dentistry, the Arabian Academy of Paediatric Dentistry's and the Egyptian Society of Paediatric Dentistry. RESULTS 308 respondents completed the survey. Approximately half practised RET (N = 158; 51.3%), which was most frequently used to manage non-vital traumatized teeth. Majority of RET practitioners worked in university or dental institute practices. Protocol differences with deviation from the current published RET guidelines were observed. Half of the respondents reported discolouration as an undesirable outcome. Lack of training, materials, evidence and suitable cases were reasons for not using RET. CONCLUSIONS Although RET is being practised by European and Arabian paediatric dentists, different protocols are being used with clear deviations from the current evidence-based guidelines.
Collapse
Affiliation(s)
- H J Tong
- Faculty of Dentistry, National University of Singapore, National University Centre for Oral Health, 9 Lower Kent Ridge Road, #10-01, Singapore, 119085, Singapore.
| | - Y F Sim
- Faculty of Dentistry, National University of Singapore, National University Centre for Oral Health, 9 Lower Kent Ridge Road, #10-01, Singapore, 119085, Singapore
| | - E Berdouses
- , 22 Kodrou str, Halandri, 151 27, Athens, Greece
| | - S Al-Jundi
- Faculty of Dentistry, Jordan University of Science and Technology, Ar Ramtha 3030،, Ramtha, Jordan
| | - O El Shahawy
- Department of Pediatric Dentistry, Future University Egypt, 90th St, First New Cairo, Cairo Governorate, 11835, Egypt
| | - H Nazzal
- Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
19
|
ElSheshtawy AS, Nazzal H, El Shahawy OI, El Baz AA, Ismail SM, Kang J, Ezzat KM. The effect of platelet-rich plasma as a scaffold in regeneration/revitalization endodontics of immature permanent teeth assessed using 2-dimensional radiographs and cone beam computed tomography: a randomized controlled trial. Int Endod J 2020; 53:905-921. [PMID: 32249441 DOI: 10.1111/iej.13303] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/26/2020] [Indexed: 12/20/2022]
Abstract
AIM To assess the outcomes of platelet-rich plasma as a scaffold in regenerative/revitalization endodontics (RET) using cone beam computed tomography (CBCT) and 2-dimensional radiographs. METHODOLOGY Twenty-six healthy patients with mean age of 12.66 ± 4.47, and immature permanent anterior teeth with necrotic pulps, were randomly allocated to two groups, whereby RET was performed using platelet-rich plasma (PRP, test group) and blood clot (BLC, control group). Changes in root length (RL), root dentinal thickness (RDT), apical foramen width (AFW) and radiographic root area (RRA), were assessed using both radiographic methods, whilst changes in periapical area diameter (PAD) were assessed using CBCT, over a period of 12 months. T-test and chi-square/Fisher's exact tests were used to compare continuous and categorical data between BLC and PRP groups, respectively. Changes in RL, RDT, AFW, RRA and PAD were examined by comparing the two groups (PRP versus BLC) using multilevel modelling, considering the clustering effect of repeated measures of several teeth originating from the same participant. RESULTS Changes in RL, RDT, AFW, RRA and PAD, over time, were found to be significant for both groups. There was, however, no difference between the RET techniques (PRP versus BLC), using both radiographic and CBCT methods. The results of both assessment techniques (CBCT and 2-dimensional radiographic methods) were highly consistent (overall ICC ranged between 0.80 and 0.94). In addition, a significant effect of baseline PAD was found on RL, RRA and AD at 12 months (RL effect = -0.68, P < 0.001; RRA effect = -1.91, P = 0.025; AD effect = 0.08, P = 0.024). CONCLUSION The current study highlights successful and comparable clinical and radiographic outcomes of RET techniques using PRP and BLC. Standardized and calibrated 2-dimensional radiographic assessment was as effective as CBCT in assessing RET outcomes; therefore, the routine use of CBCT in RET is not recommended. Although an effect of baseline periapical lesion diameter on root development outcomes, at 12 months, were observed, more studies are recommended in order to assess such an effect.
Collapse
Affiliation(s)
- A S ElSheshtawy
- Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - H Nazzal
- Paediatric Dentistry Section, Hamad Dental Center, Hamad Medical Corporation, Doha, Qatar
| | - O I El Shahawy
- Department of Pediatric Dentistry, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - A A El Baz
- Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - S M Ismail
- Department of Endodontics, The National Research Center, Cairo, Egypt
| | - J Kang
- Department of Oral Biology, School of Dentistry, University of Leeds, Leeds, UK
| | - K M Ezzat
- Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| |
Collapse
|
20
|
Koç S, Del Fabbro M. Does the Etiology of Pulp Necrosis Affect Regenerative Endodontic Treatment Outcomes? A Systematic Review and Meta-analyses. J Evid Based Dent Pract 2020; 20:101400. [PMID: 32381409 DOI: 10.1016/j.jebdp.2020.101400] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 12/01/2019] [Accepted: 01/17/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate if there is a connection between the causes of pulp necrosis (eg, caries, trauma, dental anomaly) and the success of regenerative endodontic treatment. METHODS Electronic databases (PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Embase) were searched for studies on regenerative endodontic treatment, which used both clinical and radiographic evaluation of root maturation after at least 6 months of follow-up. The search terms "necrotic pulp", "regenerative endodontic treatment", "revascularization", and "revitalization" were combined using Boolean operators. The main journals on endodontics and dental traumatology were additionally hand-searched. Studies were included if they specified the causes of pulp necrosis. The primary question under review was, "Does the cause of pulp necrosis affect the outcome of regenerative endodontic treatment?" Other factors such as tooth type, intracanal medicament, irrigation protocol, use of a collagen matrix, and the type of scaffold were evaluated for possible relation with the outcome. The risk-of-bias assessment for randomized and nonrandomized studies was performed separately, using a modified Cochrane Collaboration's tool and risk of bias in non-randomized studies of interventions-I tool, respectively. Meta-analysis was performed, when possible, between studies comparing treatment outcomes of teeth whose pulp necrosis had different etiology. The search strategy yielded 1197 items. After screening, 18 studies reporting 445 regenerative endodontic treatment cases were included. RESULTS The overall success rate for 274 teeth with trauma etiology was 94.8%, for 95 teeth with dens evaginatus etiology was 93.1%, and for 24 teeth with caries etiology was 96%. No significant difference was found between the results of regenerative endodontic treatment among teeth with trauma, dens evaginatus, and caries etiology (P = .055). Meta-analysis of studies comparing teeth with caries vs dens evaginatus and those with trauma vs caries confirmed that there was no evidence for difference in outcomes. CONCLUSION Further randomized studies specifically testing such hypothesis are needed to confirm the preliminary results of this review.
Collapse
Affiliation(s)
- Simay Koç
- Department of Endodontics, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy; IRCCS Orthopedic Institute Galeazzi, Milan, Italy.
| |
Collapse
|
21
|
Revitalisation endodontic treatment of traumatised immature teeth: a prospective long-term clinical study. Eur Arch Paediatr Dent 2019; 21:587-596. [PMID: 31808111 PMCID: PMC7518998 DOI: 10.1007/s40368-019-00501-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/28/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Continuation of root development following revitalisation endodontics (RET) has been shown to be unpredictable with lower success rates in traumatised teeth. This study reports the outcomes for RET in traumatised teeth over a review period of 4 years. METHODS A prospective uncontrolled study, where RET was performed on traumatised upper immature anterior teeth with necrotic pulps in 15 children (mean age = 8.3 years), was conducted. Patients were reviewed at 3, 9, 12, 24, and 48 months, where clinical and radiographic assessments were performed. At the last review appointment, patients and parents answered questions assessing their perception and acceptance of tooth colour change over time. McNemar's Exact test and linear mixed model assessment were used to assess changes in pulpal electrical response and radiographic evidence of continuation of root development over time, respectively. RESULTS There was 83.3% healing with no significant changes in EPT responses, and no significant changes in root lengths, while significant changes in root widths (p < 0.05) and root apex widths (p < 0.001) were found over time. Twenty-five percent of patients and 33% of parents felt that there were changes in tooth colour following RET over time. CONCLUSION Within the limitations of this study, traumatised teeth treated using RET showed no significant root lengthening, however, acceptable periapical healing, slow thickening of root dentinal walls, and rapid development of apical closure were evident over a period of 43 months. Using Portland cement and omitting minocycline, did not eliminate crown colour change following RET.
Collapse
|
22
|
Antov H, Duggal MS, Nazzal H. Management of discolouration following revitalization endodontic procedures: A case series. Int Endod J 2019; 52:1660-1670. [PMID: 31127956 DOI: 10.1111/iej.13160] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 05/22/2019] [Indexed: 01/09/2023]
Abstract
AIM To discuss the causes and management of tooth crown discolouration following regenerative/revitalization endodontic therapy (RET) and to present the decision-making process affecting three RET-related cases of crown discolouration. SUMMARY This case series outlines several approaches used in the management of post-RET discolouration. The cases highlight the influence of the material used in creating a coronal seal on the choice and success of the management techniques provided. The first two cases highlight successful management of post-RET discolouration through the use of internal-external bleaching. The use of internal bleaching in the third case was not recommended; therefore, external bleaching followed by a direct composite veneer was carried out.
Collapse
Affiliation(s)
- H Antov
- Oral & Maxillofacial Surgery, Pinderfields Hospital, Wakefield, UK
| | - M S Duggal
- Department of Paediatric Dentistry, National University of Singapore, Singapore.,Department of Paediatric Dentistry, Leeds Dental Institute, University of Leeds, Leeds, UK
| | - H Nazzal
- Department of Paediatric Dentistry, Leeds Dental Institute, University of Leeds, Leeds, UK.,Department of Paediatric Dentistry, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
23
|
Bucchi C, Marcé‐Nogué J, Galler KM, Widbiller M. Biomechanical performance of an immature maxillary central incisor after revitalization: a finite element analysis. Int Endod J 2019; 52:1508-1518. [DOI: 10.1111/iej.13159] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/17/2019] [Indexed: 12/17/2022]
Affiliation(s)
- C. Bucchi
- Department of Pathology and Experimental Therapy Universitat de Barcelona Barcelona Spain
- Department of Integral Adult Dentistry, Research Centre for Dental Sciences Universidad de La Frontera Temuco Chile
| | - J. Marcé‐Nogué
- Center of Natural History University of Hamburg Hamburg Germany
- Institut Català de Paleontologia Miquel Crusafont Universitat Autònoma de Barcelona Barcelona Spain
| | - K. M. Galler
- Department of Conservative Dentistry and Periodontology University Hospital Regensburg Regensburg Germany
| | - M. Widbiller
- Department of Conservative Dentistry and Periodontology University Hospital Regensburg Regensburg Germany
| |
Collapse
|
24
|
Jawad Z, Bates C, Duggal M, Nazzal H. Orthodontic management of a non-vital immature tooth treated with regenerative endodontics: a case report. J Orthod 2018; 45:289-295. [PMID: 30022713 DOI: 10.1080/14653125.2018.1501935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Management of non-vital immature permanent teeth in children remains a challenge in paediatric dentistry. The resulting short roots, thin root dentinal walls, and compromised crown root ratios, not only affect the long-term survival of these teeth but also complicate any intended orthodontic treatment. This case report shows a successful orthodontic movement of a traumatised non-vital immature tooth treated using regenerative endodontics.
Collapse
Affiliation(s)
- Zynab Jawad
- a Orthodontic Department , Leeds Dental Institute , Leeds , UK
| | - Claire Bates
- a Orthodontic Department , Leeds Dental Institute , Leeds , UK
| | - Mandeep Duggal
- b Paediatric Department , Leeds Dental Institute , Leeds , UK
| | - Hani Nazzal
- b Paediatric Department , Leeds Dental Institute , Leeds , UK
| |
Collapse
|
25
|
Nazzal H, Tong H, Nixon P, Duggal M. Regenerative endodontic therapy for managing immature non-vital teeth: a national survey of UK paediatric dental specialists and trainees. Br Dent J 2018; 224:247-254. [DOI: 10.1038/sj.bdj.2018.122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2017] [Indexed: 12/18/2022]
|