Regenerative Endodontic Management of an Immature Molar Using Calcium Hydroxide and Triple Antibiotic Paste: a Two-Year Follow-Up

The Management of Hyperplastic Pulpitis in Immature Permanent Molar Using Vital Pulp Therapy: A Case Report with 12 Months Follow-Up

Hyperplastic pulpitis is an irreversible type of pulpitis that primarily affects young patients. It occurs when an inflamed pulp becomes exposed due to factors such as dental caries, dental trauma, or other causes. Root canal treatment is commonly employed to manage hyperplastic pulpitis. However, vital pulp therapy can be considered as a less invasive option. The main objective of this treatment is to preserve the vitality and functionality of the remaining pulp tissue. This case report discusses the potential management of hyperplastic pulpitis in an immature molar using vital pulp therapy instead of a full root canal treatment. The report includes clinical and radiographic follow-up at six and twelve months.

Regenerative Endodontic Management of an Immature Necrotic Premolar Using Advanced Platelet-Rich Fibrin

Regenerative endodontic management is a feasible treatment for immature teeth with periapical radiolucency and necrotic pulp that simplifies continued root creation. Among the most prevalent health problems in an immature root is dental pulp necrosis, which is caused by caries, improper endodontic treatments, and trauma. Necrosis of the dental pulp can affect long-term tooth survival and preservation and serve as a source of bacteria infecting the periapical tissue and the maxillofacial space. Here, we report on the application of advanced platelet-rich fibrin plus (A-PRF+) therapy, as a regenerative endodontic treatment (RET), in a 12-year-old with necrotic pulp and asymptomatic apical periodontitis. Over a 24-month follow-up post-treatment, we observed resolving of symptoms and a complete root formation with considerable periapical healing.

Antimicrobial effects of different concentrations of simvastatin versus triple antibiotic paste on Enterococcus faecalis biofilms at different stages of development

Background. This study assessed the antimicrobial effects of different concentrations of simvastatin versus triple antibiotic paste (TAP) on Enterococcus faecalis biofilms at different stages of development. Methods. In this in vitro study, 70 human single-rooted mature premolars were decoronated, instrumented, and autoclave-sterilized. Next, an E. faecalis suspension was prepared and inoculated into the canals to obtain 4- and 6-week biofilms. After ensuring biofilm formation, the samples in each group were randomly assigned to 5 subgroups (n=12): 1 mg/mL TAP, 10 mg/ mL TAP, 1 mg/mL simvastatin, 10 mg/mL simvastatin, and positive control (phosphate-buffered saline solution). The medicaments were applied in the canals, and the teeth were incubated for one week. Dentin samples were collected by a rotary file, cultured, and the number of E. faecalis colonies was counted. The Kruskal-Wallis, Mann-Whitney U, and Wilcoxon tests were used for data analysis (α=0.05). Results. There were significant differences in colony counts between the two concentrations of TAP and the control group against both 4- and 6-week biofilms (P<0.05). The antibacterial effect of 10 mg/mL TAP and simvastatin was stronger than that of 1 mg/mL concentration against the 4- and 6-week E. faecalis biofilms (P<0.05). Furthermore, 10 mg/mL TAP and simvastatin were more effective against the 4-week biofilms than the 6-week biofilms (P<0.05). Conclusion. According to the present results and since biofilms may remain viable in the root canal system for weeks to months, applying 10 mg/mL TAP and simvastatin might be more effective.

Unpredictable Outcomes of a Regenerative Endodontic Treatment

Regenerative endodontic treatment (RET) is a valuable treatment for necrotic immature teeth with many advantages such as increasing root length and thickness of root wall. The success of RETs is based on healthy stem cells, suitable scaffolds, and growth factors and takes place when bacterial contamination is well controlled. The aim of this article is to address controversy in a case with multiple success criteria. This paper reports a 9-year-old boy with a complicated crown fracture of the maxillary left central incisor about three years prior to referral with a diagnosis of intrusive luxation with spontaneous reeruption. The tooth had an underdeveloped root and a well-defined periapical radiolucent lesion around the root apex. RET was considered according to the stage of root development. Upon the three-week recall session, the clinical examination indicated that the patient was asymptomatic in the affected site. However, the patient returned two weeks later with a sinus tract pertaining to the apex of tooth #9. Therefore, debridement of the root canal space was repeated and the RET redone. On the second trial, the patient was symptom-free, but no more evidence of root maturation was observed on 18-month follow-up. The tooth was asymptomatic (without swelling, drainage, and pain) during this time, and esthetics was provided for the patient.

Roles of Dental Mesenchymal Stem Cells in the Management of Immature Necrotic Permanent Teeth

Dental caries and trauma always lead to pulp necrosis and subsequent root development arrest of young permanent teeth. The traditional treatment, apexification, with the absence of further root formation, results in abnormal root morphology and compromises long-term prognosis. Regeneration endodontics procedures (REPs) have been developed and considered as an alternative strategy for management of immature permanent teeth with pulpal necrosis, including cell-free and cell-based REPs. Cell-free REPs, including revascularization and cell homing with molecules recruiting endogenous mesenchymal stem cells (MSCs), have been widely applied in clinical treatment, showing optimistic periapical lesion healing and continued root development. However, the regenerated pulp-dentin complex is still absent in these cases. Dental MSCs, as one of the essentials of tissue engineering, are vital seed cells in regenerative medicine. Dental MSC-based REPs have presented promising potential with pulp-dentin regeneration in large animal studies and clinical trials via cell transplantation. In the present review, we summarize current understanding of the biological basis of clinical treatments for immature necrotic permanent teeth and the roles of dental MSCs during this process and update the progress of MSC-based REPs in the administration of immature necrotic permanent teeth.

An Innovative Drug Delivery System Loaded with a Modified Combination of Triple Antibiotics for Use in Endodontic Applications

The objective of the current study was to introduce "Polylactic co-Glycolic Acid- (PLGA-) Coated Ceramic Microparticles" as an innovative drug delivery system, loaded with a new combination of triple antibiotics (penicillin G, metronidazole, and ciprofloxacin (PMC)) for use in endodontic treatments. Ceramic microparticles were made from β-tricalcium phosphate and hydroxyapatite and examined by "Scanning Electronic Microscope (SEM)." Then, fixed amounts of the selected antibiotics were added to a prepared PLGA solution and stirred thoroughly. Next, the prepared ceramic microparticles were dispersed completely in the drugs solution. The deposited "PMC-loaded PLGA-coated ceramic microspheres (PPCMs)" were dried and incubated in phosphate buffer saline (PBS) for 21 days. The drug release from PPCMs was quantified by a UV spectrophotometer. The antimicrobial activity of PPCMs was investigated using the "Agar Plate Diffusion Test (ADT)," "Minimum Inhibitory Concentration (MIC)," and "Minimum Bactericidal Concentration (MBC)" against Enterococcus faecalis (E. faecalis) and Aggregatibacter actinomycetemcomitans (A.a). The cell viability test (MTT) was conducted for cytotoxicity against human gingival fibroblasts. SEM micrographs of PPCMs showed spherical-like ceramic microparticles with smooth surfaces. Crystal-like antibiotic particles (chunks) were also found on PPCMs. Initial burst of antibiotics (31 µg/mL, 160 µg/mL, and 18 µg/mL for ciprofloxacin, metronidazole, and penicillin G, respectively, in the first 4 days) followed by gradual and sustained release was observed within a period of 21 days. PPCMs demonstrated pH close to normal physiological environment and antibacterial activity against E. faecalis and A.a in the first 2 days. MTT showed cell viability of more than 70% for PPCMs after 24 h and 72 h of exposure. In conclusion, PPCMs demonstrated satisfactory release of antibiotics, antibacterial activity against the selected microorganisms, and biocompatibility. Thus, PPCMs may be used to deliver modified triple antibiotics to the root canal system for use in endodontic applications.

Regenerative Endodontic Therapy in the Management of Immature Necrotic Permanent Dentition: A Systematic Review

Materials and Methods

The electronic databases PubMed and Google Scholar were used to search the literature for relevant studies after applying specific inclusion and exclusion criteria. Studies that fulfilled both the inclusion and exclusion criteria were included in this systematic review. The search was conducted by two independent reviewers following the PRISMA guidelines.

Results

Only 46 studies that fulfilled both the inclusion and exclusion criteria, which were conducted within the last 10 years, were included in this systematic review. These studies investigated different aspects of regenerative endodontic therapy including different types of scaffolds, intracanal medications, pulpal space/barriers, root maturation stage, follow-up duration, and updated studies on their use in the management of immature necrotic permanent teeth.

Conclusions

This review concluded the compiled data observed that endodontic regenerative therapy was more efficient in treating immature necrotic permanent teeth and offered a greater advantage that should lead to wider acceptance among endodontists for effective results compared to different treatment options. However, more clinical trials with a standardized protocol and defined clinical, radiographic, and histopathological outcomes with longer follow-up periods are warranted.

The Effects of Intracanal Irrigants and Medicaments on Dental-Derived Stem Cells Fate in Regenerative Endodontics: An update

Regenerative endodontics is a biologically based treatment designed for immature permanent teeth with necrotic pulp to replace dentin and root structures, as well as dental pulp cells. This procedure has become a part of novel modality in endodontics therapeutic manner, and it is considered as an alternative to apexification. In the last decade, numerous case reports, which describe this procedure, have been published. This therapeutic approach succeeded due to its lower financial cost and ease of performance. Although the clinical protocol of this procedure is not standardized and the effects of irrigants and medicaments on dental stem cells fate remain somewhat ambiguous, however when successful, it is an improvement of endodontics treatment protocols which leads to continued root development, increased dentinal wall thickness, and apical closure of immature teeth. To ensure a successful regenerative procedure, it is essential to investigate the appropriate disinfection protocols and the use of biocompatible molecules in order to control the release of growth factors and the differentiation of stem cells. This is the first review in the literature to summarize the present knowledge regarding the effect of intracanal irrigants and medicaments on the dental derived stem cells fate in regenerative endodontic procedures.