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Li XL, Fan W, Fan B. Dental pulp regeneration strategies: A review of status quo and recent advances. Bioact Mater 2024; 38:258-275. [PMID: 38745589 PMCID: PMC11090883 DOI: 10.1016/j.bioactmat.2024.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/18/2024] [Accepted: 04/28/2024] [Indexed: 05/16/2024] Open
Abstract
Microorganisms, physical factors such as temperature or mechanical injury, and chemical factors such as free monomers from composite resin are the main causes of dental pulp diseases. Current clinical treatment methods for pulp diseases include the root canal therapy, vital pulp therapy and regenerative endodontic therapy. Regenerative endodontic therapy serves the purpose of inducing the regeneration of new functional pulp tissues through autologous revascularization or pulp tissue engineering. This article first discusses the current clinical methods and reviews strategies as well as the research outcomes regarding the pulp regeneration. Then the in vivo models, the prospects and challenges for regenerative endodontic therapy were further discussed.
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Affiliation(s)
- Xin-Lu Li
- The State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, 237 Luoyu Road, 430079, Wuhan, China
| | - Wei Fan
- The State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, 237 Luoyu Road, 430079, Wuhan, China
| | - Bing Fan
- The State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, 237 Luoyu Road, 430079, Wuhan, China
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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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Pham VK, Pham TLK, Pham AT, Le HLA, Tran TBV, Huynh KK, Tran NMH, Tran TL, Tran MH, Tran TAT, Nguyen TTD, Nguyen NP. Platelet-rich fibrin as an apical barrier for MTA placement in the treatment of teeth with open apices: a pilot study. J Transl Med 2024; 22:498. [PMID: 38796431 PMCID: PMC11128118 DOI: 10.1186/s12967-024-05318-0] [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: 02/10/2024] [Accepted: 05/20/2024] [Indexed: 05/28/2024] Open
Abstract
OBJECTIVE The aim of the present pilot study was to assess the effectiveness of the platelet-rich fibrin (PRF) apical barrier for the placement of MTA for the treatment of teeth with periapical lesions and open apices. METHODS A total of thirty teeth on twenty-eight patients with open apices and periapical periodontitis were enrolled and divided into two groups in the present pilot study. In the PRF group (fourteen teeth in thirteen patients), nonsurgical endodontic treatment was performed using PRF as an apical matrix, after which the apical plug of the MTA was created. For the non-PRF group (fourteen teeth in fourteen patients), nonsurgical endodontic therapy was performed using only the MTA for an apical plug with no further periapical intervention. Clinical findings and periapical digital radiographs were used for evaluating the healing progress after periodic follow-ups of 1, 3, 6, and 9 months. The horizontal dimension of the periapical lesion was gauged, and the changes in the dimensions were recorded each time. The Friedman test, Dunn-Bonferroni post hoc correction, and Mann-Whitney U test were used for statistical analysis, with P < 0.05 serving as the threshold for determining statistical significance. RESULTS All patients in both groups in the present pilot study had no clinical symptoms after 1 month, with a significant reduction in the periapical lesion after periodic appointments. The lesion width of the PRF group was significantly smaller than that of the non-PRF group in the sixth and ninth month after treatment. CONCLUSIONS PRF is a promising apical barrier matrix when combined with MTA for the treatment of teeth with open apices and periapical periodontitis. Small number of study subjects and the short time of follow-up period limit the generalizability of these results. TRIAL REGISTRATION TCTR, TCTR20221109006. Registered 09 November 2022 - Retrospectively registered, https://www.thaiclinicaltrials.org/show/TCTR20221109006 .
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Affiliation(s)
- Van-Khoa Pham
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
| | - Tran-Lan-Khue Pham
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - An-Tran Pham
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Hoang-Lan-Anh Le
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Thi-Bich-Van Tran
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Kim-Khang Huynh
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | | | - Thuan-Loc Tran
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Minh-Hong Tran
- National Hospital of Odonto-Stomatology, Ho Chi Minh City, Vietnam
| | - Thi-Anh-Thu Tran
- National Hospital of Odonto-Stomatology, Ho Chi Minh City, Vietnam
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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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Elnawam H, Abdallah A, Nouh S, Khalil NM, Elbackly R. Influence of extracellular matrix scaffolds on histological outcomes of regenerative endodontics in experimental animal models: a systematic review. BMC Oral Health 2024; 24:511. [PMID: 38689279 PMCID: PMC11061952 DOI: 10.1186/s12903-024-04266-x] [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: 01/05/2024] [Accepted: 04/16/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Decellularized extracellular matrix (dECM) from several tissue sources has been proposed as a promising alternative to conventional scaffolds used in regenerative endodontic procedures (REPs). This systematic review aimed to evaluate the histological outcomes of studies utilizing dECM-derived scaffolds for REPs and to analyse the contributing factors that might influence the nature of regenerated tissues. METHODS The PRISMA 2020 guidelines were used. A search of articles published until April 2024 was conducted in Google Scholar, Scopus, PubMed and Web of Science databases. Additional records were manually searched in major endodontic journals. Original articles including histological results of dECM in REPs and in-vivo studies were included while reviews, in-vitro studies and clinical trials were excluded. The quality assessment of the included studies was analysed using the ARRIVE guidelines. Risk of Bias assessment was done using the (SYRCLE) risk of bias tool. RESULTS Out of the 387 studies obtained, 17 studies were included for analysis. In most studies, when used as scaffolds with or without exogenous cells, dECM showed the potential to enhance angiogenesis, dentinogenesis and to regenerate pulp-like and dentin-like tissues. However, the included studies showed heterogeneity of decellularization methods, animal models, scaffold source, form and delivery, as well as high risk of bias and average quality of evidence. DISCUSSION Decellularized ECM-derived scaffolds could offer a potential off-the-shelf scaffold for dentin-pulp regeneration in REPs. However, due to the methodological heterogeneity and the average quality of the studies included in this review, the overall effectiveness of decellularized ECM-derived scaffolds is still unclear. More standardized preclinical research is needed as well as well-constructed clinical trials to prove the efficacy of these scaffolds for clinical translation. OTHER The protocol was registered in PROSPERO database #CRD42023433026. This review was funded by the Science, Technology and Innovation Funding Authority (STDF) under grant number (44426).
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Affiliation(s)
- Hisham Elnawam
- Endodontics, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Champollion Street, Azarita, Alexandria, Egypt.
- Tissue Engineering Laboratories, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
| | - Amr Abdallah
- Endodontics, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Champollion Street, Azarita, Alexandria, Egypt
| | - Samir Nouh
- Tissue Engineering Laboratories, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
- Surgery Department, Faculty of Veterinary Medicine, Alexandria University, Alexandria, Egypt
| | - Nesma Mohamed Khalil
- Oral Biology Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Rania Elbackly
- Endodontics, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Champollion Street, Azarita, Alexandria, Egypt
- Tissue Engineering Laboratories, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Gomez-Sosa JF, Cardier JE, Wittig O, Díaz-Solano D, Lara E, Duque K, Ramos-González G. Allogeneic Bone Marrow Mesenchymal Stromal Cell Transplantation Induces Dentin Pulp Complex-like Formation in Immature Teeth with Pulp Necrosis and Apical Periodontitis. J Endod 2024; 50:483-492. [PMID: 38237659 DOI: 10.1016/j.joen.2024.01.002] [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: 07/19/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Dental pulp regeneration is challenging in endodontics. Cellular therapy is an alternative approach to induce dental pulp regeneration. Mesenchymal stromal cells (MSCs) have the capacity to induce dental pulp-like tissue formation. In this study, we evaluated the capacity of allogeneic bone marrow MSCs (BM-MSCs) to regenerate pulp following necrosis and apical periodontitis in children's permanent immature apex teeth. METHODS Patients aged 8 to 12 years with pulp necrosis and apical periodontitis were evaluated. The study included 15 teeth (13 incisors and 2 molars) from 14 patients (8 boys and 6 girls). Radiographic evaluation showed periapical radiolucency and immature apex teeth. There was no response to cold or electric pulp testing. The root canal of each tooth was cleaned, shaped, and Ca(OH)2 used as an interappointment medication. Cryopreserved allogeneic BM-MSCs were thawed, expanded, incorporated into preclotted platelet-rich plasma, and implanted into the tooth's pulp cavity. They were sealed with bioceramic cement and composite. Sensibility, apical foramen, calcium deposits within the root canal, and resolution of periapical lesions were evaluated in each tooth over the following 12 months. RESULTS Based on 9 variables established for dental pulp-like tissue regeneration, all MSC-treated teeth showed evidence of successful regeneration. Clinical and radiographic evaluation of the treated teeth showed periapical lesion healing, sensitivity to cold and electricity, decreased width of the apical foramen, and mineralization within the canal space. CONCLUSIONS Transplantation of allogeneic MSCs induces the formation of dental pulp-like tissue in permanent immature apex teeth with pulp necrosis and apical periodontitis. Implant of MSCs constitutes a potential therapy in regenerative endodontics in pediatric dentistry. Future studies incorporating a larger sample size may confirm these results.
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Affiliation(s)
- Jose Francisco Gomez-Sosa
- Unidad de Terapia Celular-Laboratorio de Patología Celular y Molecular, Centro de Medicina Regenerativa, Instituto Venezolano de Investigaciones Científicas (IVIC), Caracas, Venezuela.
| | - José E Cardier
- Unidad de Terapia Celular-Laboratorio de Patología Celular y Molecular, Centro de Medicina Regenerativa, Instituto Venezolano de Investigaciones Científicas (IVIC), Caracas, Venezuela
| | - Olga Wittig
- Unidad de Terapia Celular-Laboratorio de Patología Celular y Molecular, Centro de Medicina Regenerativa, Instituto Venezolano de Investigaciones Científicas (IVIC), Caracas, Venezuela
| | - Dylana Díaz-Solano
- Unidad de Terapia Celular-Laboratorio de Patología Celular y Molecular, Centro de Medicina Regenerativa, Instituto Venezolano de Investigaciones Científicas (IVIC), Caracas, Venezuela
| | - Eloisa Lara
- Unidad de Terapia Celular-Laboratorio de Patología Celular y Molecular, Centro de Medicina Regenerativa, Instituto Venezolano de Investigaciones Científicas (IVIC), Caracas, Venezuela
| | - Kharelys Duque
- Unidad de Terapia Celular-Laboratorio de Patología Celular y Molecular, Centro de Medicina Regenerativa, Instituto Venezolano de Investigaciones Científicas (IVIC), Caracas, Venezuela
| | - Giselle Ramos-González
- Unidad de Terapia Celular-Laboratorio de Patología Celular y Molecular, Centro de Medicina Regenerativa, Instituto Venezolano de Investigaciones Científicas (IVIC), Caracas, Venezuela
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Sabeti M, Ghobrial D, Zanjir M, da Costa BR, Young Y, Azarpazhooh A. Treatment outcomes of regenerative endodontic therapy in immature permanent teeth with pulpal necrosis: A systematic review and network meta-analysis. Int Endod J 2024; 57:238-255. [PMID: 37966465 DOI: 10.1111/iej.13999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 10/21/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Abstract
AIM The aim of this study was to assess which treatment modality regarding scaffold selection for immature permanent teeth with pulpal necrosis will be the most successful for regenerative endodontic treatment (RET). METHODOLOGY PubMed, Cochrane, Web of Science and Embase, and additional records until August 2022 were searched providing a total of 3021 articles, and nine of these articles were included for quantitative synthesis. The reviewers selected eligible randomized controlled trials and extracted pertinent data. Network meta-analysis was conducted to estimate treatment effects for primary outcomes (clinical and radiographic healing) and secondary outcomes (apical closure, root length and root wall thickness increase) following RET [mean difference (MD); 95% credible interval (CrI) and surface under the cumulative ranking curve (SUCRA)]. The quality of the included studies was appraised by the revised Cochrane risk of bias tool, and the quality of evidence was assessed using the GRADE approach. RESULTS Six interventions from nine included studies were identified: blood clot scaffold (BC), blood clot scaffold with basic fibroblast growth factor, blood clot scaffold with collagen, platelet pellet, platelet-rich plasma (PRP) and platelet-rich fibrin (PRF). The PRP scaffold showed the greatest increase in root lengthening at 6-12 months (MD = 4.2; 95% CrI, 1.2 to 6.8; SUCRA = 89.0%, very low confidence). PRP or PRF achieved the highest level of success for primary and secondary outcomes at 1-6 and 6-12 months. Blood clot scaffold (with collagen or combined with basic fibroblast growth factor (bFGF)) achieved the highest level of success for secondary outcomes beyond 12 months follow-up. A very low to low quality of evidence suggests that both PRP and PRF exhibit the greatest success evaluating primary and secondary outcomes within 12 months postoperatively compared to the traditional blood clot scaffold protocol. CONCLUSION Limited evidence suggests both PRP and PRF exhibit success in the short-term, not long-term. The value of this information stems in its recommendation for future randomized trials prioritizing both of these materials in their protocol.
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Affiliation(s)
- Mohammad Sabeti
- Department of Preventive and Restorative Dental Science, UCSF School of Dentistry, San Francisco, California, USA
| | - Daniel Ghobrial
- PG Endodontic Resident, UCSF School of Dentistry, San Francisco, California, USA
| | - Maryam Zanjir
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Bruno R da Costa
- Clinical Epidemiology & Health Care Research, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Yating Young
- UCSF School of Dentistry, San Francisco, California, USA
| | - Amir Azarpazhooh
- Head Division of Endodontics and Research, Director, Department of Dentistry, Faculty of Advanced Training Program in Orofacial, Faculty of Dentistry, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
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Asgary S, Shamszadeh S, Nosrat A, Aminoshariae A, Sabeti M. Management Strategies for Immature Teeth with Pulp Necrosis: An Umbrella Review of Systematic Reviews. IRANIAN ENDODONTIC JOURNAL 2024; 19:242-253. [PMID: 39469509 PMCID: PMC11512712 DOI: 10.22037/iej.v19i4.46292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 09/14/2024] [Indexed: 10/30/2024]
Abstract
Introduction This review evaluates the effectiveness of treatment modalities for immature teeth with pulp necrosis, focusing on calcium hydroxide (CH) and mineral trioxide aggregate (MTA) apexification, as well as regenerative endodontic treatments (RETs). Recent advancements and clinical outcomes are highlighted. Materials and Methods A comprehensive search of MEDLINE (PubMed), Embase, Cochrane Library, Scopus, and grey literature was conducted from inception to July 2024. Systematic reviews and meta-analyses (SR/MAs) assessing apexification and RET outcomes in immature teeth with pulp necrosis were included. Studies were selected based on predefined criteria, and data on study design, interventions, and outcomes were extracted. Methodological quality was evaluated using the AMSTAR-2 tool. Results 31 SR/MAs were included. The quality ranged from critically low to low, except one rated as high. MTA apexification was more effective than CH for faster apical barrier formation, though overall success rates were similar. MTA is preferred for its efficiency, but standardized protocols are needed, and tooth discoloration was noted as a potential complication. RET generally outperforms apexification in root maturation, with platelet concentrates like platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) showing promising results; PRP was associated with greater root length, while PRF showed superior apical healing. Variability in RET outcomes was noted due to the lack of standardized protocols. Comparative studies of RET versus apexification showed no significant differences in survival or overall success rates. RET often provides better apical closure and root development, though results vary. Both approaches are viable, but more research with standardized protocols and larger samples is needed to establish definitive clinical advantages. Conclusions MTA apexification and RET are viable alternatives to CH apexification, with RET showing greater potential for root development and apical healing. Future research should focus on developing standardized protocols and uniform RET guidelines, and evaluating long-term outcomes to establish efficacy and safety.
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Affiliation(s)
- Saeed Asgary
- Iranian Centre for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran;
| | - Sayna Shamszadeh
- Iranian Centre for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran;
| | - Ali Nosrat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA;
- Private practice, Centreville Endodontics, Centreville, VA, USA;
| | - Anita Aminoshariae
- Department of Endodontics, CWRU School of Dental Medicine, Cleveland, OH, USA;
| | - Mohammad Sabeti
- Department of Preventive and Restorative Dental Sciences, Advanced Specialty Program in Endodontics, University of California, San Francisco, USA
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Smoczer C, Yuth KR, Askar MA, Young LA, Paurazas SB. Growth Factors Released from Advanced Platelet-Rich Fibrin in the Presence of Calcium-Based Silicate Materials and Their Impact on the Viability and Migration of Stem Cells of Apical Papilla. Dent J (Basel) 2023; 11:220. [PMID: 37754340 PMCID: PMC10530054 DOI: 10.3390/dj11090220] [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: 08/10/2023] [Revised: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023] Open
Abstract
Advanced platelet-rich fibrin (A-PRF) provides the scaffold and growth factors necessary for stem cells to proliferate and differentiate in successful regenerative endodontic procedures. This study investigates the release of transforming growth factor-β1 (TGF-β1), platelet-derived growth factor (PDGF), and vascular endothelial growth factor (VEGF) from A-PRF in cell culture media in the presence and absence of mineral trioxide aggregate (MTA) or Biodentine. Additionally, this research assesses the viability and migration of stem cells of the apical papilla (SCAP) in previously conditioned media. A-PRF obtained from 14 participants were incubated for 7 days in cell culture media alone or via layering with MTA or Biodentine discs and the release of selected growth factors in the media was evaluated using ELISA. The viability of SCAP grown in conditioned media was measured using the CCK8 assay, while SCAP migration was assessed via a transwell assay by counting migrated cells. The release of TGF-β1, PDGF, and VEGF was significantly higher in media with A-PRF alone than in the presence of either calcium-based silicate material (p < 0.05), which showed no difference from the no-A-PRF control (p < 0.05). None of the tested growth factors released in the A-PRF-conditioned media correlated with clot weight. A-PRF-conditioned media, both with and without calcium-based silicate materials, did not impact SCAP viability and migration (p > 0.05). This study shows that SCAP behavior is not impacted by the decrease in growth factor released in the presence of calcium-based silicate materials and that their role in REPs warrants further investigation.
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Affiliation(s)
- Cristine Smoczer
- Division of Integrated Biomedical Sciences, University of Detroit Mercy School of Dentistry, Detroit, MI 48208, USA; (C.S.)
| | - Kenneth R. Yuth
- Graduate Endodontics, University of Detroit Mercy School of Dentistry, Detroit, MI 48208, USA (M.A.A.)
| | - Mazin A. Askar
- Graduate Endodontics, University of Detroit Mercy School of Dentistry, Detroit, MI 48208, USA (M.A.A.)
| | - Laura A. Young
- Division of Integrated Biomedical Sciences, University of Detroit Mercy School of Dentistry, Detroit, MI 48208, USA; (C.S.)
| | - Susan B. Paurazas
- Graduate Endodontics, University of Detroit Mercy School of Dentistry, Detroit, MI 48208, USA (M.A.A.)
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Thakkar S, Naik S, Nadig B, Bellal S, Thaliyil A. A comparative clinico-radiographic analysis of regenerative endodontic procedure on immature necrotic permanent teeth using blood clot and PRF as scaffold: A retrospective study. Saudi Dent J 2023; 35:753-759. [PMID: 37823081 PMCID: PMC10562131 DOI: 10.1016/j.sdentj.2023.05.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/24/2023] [Accepted: 05/28/2023] [Indexed: 10/13/2023] Open
Abstract
Objectives To evaluate the clinical and radiographic success rate of blood clot and platelet rich fibrin (PRF) as a scaffold system in regenerative endodontic procedure in immature traumatized necrotic teeth.. Materials and methods This retrospective study examined the records of 28 subjects with necrotic immature open apex due to trauma treated with blood clot or PRF as a scaffold in regenerative endodontic procedure. The disinfection was carried out with calcium hydroxide as an intra-canal medicament. The clinical outcome was recorded using a binary variable of presence or absence of pain and intra-oral swelling. The radiographic outcome was recorded for periapical healing using Ørstavik's Periapical Index and apical response using Chen and Chen index. Comparison of frequencies of categories of variables with groups was done using the chi-square test. The pairwise comparison of time intervals was done using Wilcoxon Signed Ranks Test. Results Intra-group comparison of pain and intra-oral swelling had highly significant (p = 0.000) results for both groups over a period of 12 months. Inter-group comparison for clinical outcomes was insignificant. For the radiographic outcome, there was a statistically non-significant difference for periapical healing and apical response for both intra-group and inter-group comparisons. Conclusion Both PRF and blood clot have a favourable outcome for a regenerative endodontic procedure with a disinfectant protocol using calcium hydroxide as intracanal medicament. Considering the cumbersome procedure involved in procuring PRF scaffold, especially in children, inducing bleeding can be considered a recommended method for a regenerative endodontic procedure.
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Affiliation(s)
- Shruti Thakkar
- Department of Pedodontics and Preventive Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka, India
| | - Saraswathi Naik
- Department of Pedodontics and Preventive Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka, India
| | - Basappa Nadig
- Department of Pedodontics and Preventive Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka, India
| | - Shivani Bellal
- Department of Pedodontics and Preventive Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka, India
| | - Akshaya Thaliyil
- Department of Pedodontics and Preventive Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka, India
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11
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Dadpe AM, Shah DY, Natanasabapathy V, Sureshbabu NM, Hindlekar AN, Modi K. Regenerative Endodontic Procedures in Teeth with Root Resorption: A Systematic Review. Eur Endod J 2023; 8:170-186. [PMID: 37257034 PMCID: PMC10244915 DOI: 10.14744/eej.2023.77486] [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: 11/16/2022] [Revised: 02/21/2023] [Accepted: 03/14/2023] [Indexed: 04/09/2023] Open
Abstract
The purpose of this systematic review was to critically evaluate the available clinical literature on the use of regenerative endodontic therapy (RET) for the treatment of root resorption. All case reports, case series and clinical studies documenting the management of root resorption in mature or immature permanent teeth using RET were included. Review articles, animal studies, and RET in teeth showing developmental anomalies were excluded. A literature search was conducted in electronic databases MEDLINE, Scopus, Cochrane, and Google Scholar from 2001 to January 2022. The JBI Critical Appraisal Checklist Quality was used to appraise the included case reports and case series. The Methodological item for non-randomised studies (MINORS) tool was used to appraise the clinical study critically. After applying the inclusion and exclusion criteria, the search resulted in 14 studies (12 case reports, 1 case series, and 1 clinical study) accounting for root resorption in 34 teeth from 29 patients treated with RET. Despite the wide variation in RET protocols, the arrest of root resorption and resolution of symptoms was seen in all teeth except one (failure after 27 months). The clinical study's cone beam computed tomography (CBCT) imaging evalu- ation documented a significant volumetric decrease in resorptive and periapical lesions after RET. The clinical study was deemed as good quality using the MINORS scale. The JBI critical appraisal tool showed that the case series was of poor quality; 11 of the case reports were of good quality, while 1 case report was of fair quality. This systematic review revealed a low-to-moderate level of evidence for the use of RET in resorption cases. However, further well-designed, long-term clinical studies are required to recommend it as an alternative treatment option for root resorption management. Funding: None. The systematic review was registered in PROSPERO (CRD42021274569). (EEJ-2022-11-136).
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Affiliation(s)
- Ashwini Manish Dadpe
- Department of Conservative Dentistry and Endodontics, Sinhgad Dental College & Hospital, Pune, India
| | - Dipali Yogesh Shah
- Department of Conservative Dentistry and Endodontics, Sinhgad Dental College & Hospital, Pune, India
| | - Velmurugan Natanasabapathy
- Department of Conservative Dentistry and Endodontics, MeenakshiAmmal Dental College and Hospital, Chennai, India
| | | | - Ajit Narayan Hindlekar
- Department of Conservative Dentistry and Endodontics, Dr. D. Y. Patil Dental College & Hospital, Pune, India
| | - Kajal Modi
- Department of Conservative Dentistry and Endodontics, MeenakshiAmmal Dental College and Hospital, Chennai, India
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12
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Wu Z, Lin Y, Xu X, Chen Z, Xiang Y, Yang L, Zhang W, Xiao S, Chen X. Clinical observation of autologous platelet rich fibrin assisted revascularization of mature permanent teeth. Head Face Med 2023; 19:9. [PMID: 36922821 PMCID: PMC10015916 DOI: 10.1186/s13005-023-00350-9] [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: 07/15/2022] [Accepted: 02/09/2023] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVE To investigate the clinical observation of autologous platelet-rich fibrin (PRF) assisting the revascularization of mature permanent teeth. METHODS Twenty patients with mature permanent teeth were divided into experimental group and control group. The control group was treated with classic revascularization, and the experimental group was treated with PRF-assisted mature permanent tooth revascularization. RESULTS After treatment, the total effective rate of the experimental group (100.00%) was higher than that of the control group (50.00%); the thickness of the root canal wall of the experimental group was higher than that of the control group, and the crown root length was lower than that of the control group; The bite degree, chewing function, color, overall aesthetic score, and satisfaction rate of the patients were higher, and the difference was statistically significant (P < 0.05). CONCLUSION Autologous PRF assists in revascularization of mature permanent teeth, which can achieve ideal results, and promote pulp regeneration.
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Affiliation(s)
- Zhaojun Wu
- Department of Endodontics, Stomatological Hospital of Xiamen Medical College, Huli District, No.1309, Lvling Road, Xiamen, 361008, Fujian, China.,Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Fujian, 361008, China
| | - Yao Lin
- Department of Endodontics, Stomatological Hospital of Xiamen Medical College, Huli District, No.1309, Lvling Road, Xiamen, 361008, Fujian, China.,Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Fujian, 361008, China
| | - Xuehong Xu
- Department of Endodontics, Stomatological Hospital of Xiamen Medical College, Huli District, No.1309, Lvling Road, Xiamen, 361008, Fujian, China.,Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Fujian, 361008, China
| | - Zhiqun Chen
- Department of Endodontics, Stomatological Hospital of Xiamen Medical College, Huli District, No.1309, Lvling Road, Xiamen, 361008, Fujian, China.,Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Fujian, 361008, China
| | - Yan Xiang
- Department of Endodontics, Stomatological Hospital of Xiamen Medical College, Huli District, No.1309, Lvling Road, Xiamen, 361008, Fujian, China.,Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Fujian, 361008, China
| | - Lvli Yang
- Department of Endodontics, Stomatological Hospital of Xiamen Medical College, Huli District, No.1309, Lvling Road, Xiamen, 361008, Fujian, China.,Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Fujian, 361008, China
| | - Wei Zhang
- Department of Endodontics, Stomatological Hospital of Xiamen Medical College, Huli District, No.1309, Lvling Road, Xiamen, 361008, Fujian, China.,Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Fujian, 361008, China
| | - Suli Xiao
- Department of Endodontics, Stomatological Hospital of Xiamen Medical College, Huli District, No.1309, Lvling Road, Xiamen, 361008, Fujian, China.,Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Fujian, 361008, China
| | - Xiaoling Chen
- Department of Endodontics, Stomatological Hospital of Xiamen Medical College, Huli District, No.1309, Lvling Road, Xiamen, 361008, Fujian, China. .,Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Fujian, 361008, China.
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13
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Murray PE. Review of guidance for the selection of regenerative endodontics, apexogenesis, apexification, pulpotomy, and other endodontic treatments for immature permanent teeth. Int Endod J 2023; 56 Suppl 2:188-199. [PMID: 35929348 DOI: 10.1111/iej.13809] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/30/2022]
Abstract
This review guidance is a work in progress because the limitations of regenerative endodontics are still being discovered. The endodontic treatments for immature permanent teeth with a necrotic pulp can vary considerably among endodontic practitioners. Whereas, regenerative endodontic treatments are growing in popularity and are creating ever more complex treatment protocols, involving revascularization and/or autologous platelet-rich plasma and scaffolds to elicit host stem cell de novo tissue formation to reestablish the vitality of immature teeth for the purpose of continuing root maturation. Despite much evolving controversy about their potential benefits, risks, prognosis, and contraindications, this review is aimed to discuss how to ensure that regenerative endodontic treatments are successful, by strictly adhering to case selection criteria, and following precise steps to accomplish and monitor the success of the treatment. A review of the endodontic literature was performed, together with practical observations of the problems and outcomes of performing regenerative endodontic treatments. Traditionally, apexification has long been the treatment of choice provided to immature teeth with a necrotic pulp. Regenerative endodontics may be provided as an alternative to apexification, if the tooth and patient meet all the case selection criteria, and if there are no contraindications. Regenerative endodontics has the unique potential advantage of being able to continue the root development in immature permanent teeth, thereby potentially saving the teeth for the lifetime of the patient. Whereas, conventional endodontic root canal treatment, Cvek partial pulpotomy, apexogenesis, and apexification, should always be provided when these treatments are more likely to benefit the patient because they can be more successful than regenerative endodontics.
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14
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Regenerative Endodontic Management of an Immature Necrotic Premolar Using Advanced Platelet-Rich Fibrin. Case Rep Dent 2023; 2023:1135413. [PMID: 36762288 PMCID: PMC9904919 DOI: 10.1155/2023/1135413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/16/2022] [Accepted: 01/19/2023] [Indexed: 02/04/2023] Open
Abstract
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.
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15
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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] [Grants] [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
| | - Biao Ren
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, Sichuan, China
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16
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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.
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17
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VanZweden E, Tolsma R, Hung V, Awad P, Sawyer R, Li Y. The advances of blood clots used as biomaterials in regenerative medicine. Regen Med 2022; 17:957-969. [DOI: 10.2217/rme-2022-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The physiologic process of blood clot formation is well understood and occurs naturally in the setting of tissue injury to achieve hemostasis and begin the process of wound healing. While the investigation of blood clots as a biomaterial is still in the early stages, there has been some research with similar biomaterials made of the components of blood clots that support the innovative idea of using an autologous blood clot as a scaffold or delivery method for therapeutic agents. Here, we review the physiology of blood clots in wound healing and how using blood clots as a biomaterial and delivery system can potentially promote wound healing, provide targeted therapeutic agent delivery and use it as an innovative tool in regenerative medicine.
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Affiliation(s)
| | - Rachael Tolsma
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI 49008, USA
| | - Victor Hung
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI 49008, USA
| | - Peter Awad
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI 49008, USA
| | - Robert Sawyer
- Department of General Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI 49008, USA
| | - Yong Li
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI 49008, USA
- Department of Orthopaedic Surgery, Biomedical Engineering, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI 49008, USA
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18
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Caviedes-Bucheli J, Muñoz-Alvear HD, Lopez-Moncayo LF, Narvaez-Hidalgo A, Zambrano-Guerrero L, Gaviño-Orduña JF, Portigliatti R, Gomez-Sosa JF, Munoz HR. Use of scaffolds and regenerative materials for the treatment of immature necrotic permanent teeth with periapical lesion: Umbrella review. Int Endod J 2022; 55:967-988. [PMID: 35821587 DOI: 10.1111/iej.13799] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Current treatment of immature necrotic permanent teeth with a periapical lesion is regenerative endodontics, which is based on tissue engineering under the triade of stem cells, scaffolds and bioactive molecules. OBJECTIVES This Umbrella Review was aimed to evaluate the success of scaffold and regenerative materials used for the treatment of these teeth, in terms of apical closure, tooth length increase, widening of root canal walls, tissue vitality and periapical lesion repair. METHODS An extensive literature research was carried out in the Medline, ISI Web of Science, and Scopus databases for relevant systematic reviews matching the keyword search strategy. Based on inclusion and exclusion criteria, reviewers independently rated the quality of each study to determine their level of evidence. Methodological quality assessment of each article was obtained using A Measurement Tool to Assess Systematic Reviews (AMSTAR)-2 tool, and risk of bias was assessed with the Risk of Bias in Systematic Reviews (ROBIS) tool. RESULTS After removing duplicates, 155 articles were found; from which 133 were excluded for being non-relevant and 15 other due to exclusion criteria. One more was discarded after methodological quality evaluation, for a total of six articles remaining. The most common scaffold used was the blood clot, others used were poly lactic-co-glycolic acid and platelet-rich fibrin matrix. The most common regeneration material used was Mineral Trioxide Aggregate (MTA), followed by Biodentine. An increase in tooth length and widening of root canal walls were reported in all selected studies with different proportions, as well as periapical lesion repair. ROBIS analysis showed that only one article had low bias, two were classified as unclear bias, while the remaining three had high risk of bias. DISCUSSION An exhaustive literature search was carried out applying language filters, high-quality indexed journals, year of publication, which ensures the best quality articles were included. Blood clot was the most used scaffold as is the most easy to place inside the canal and does not require to extract blood from the patient. The use of MTA and Biodentine as sealing materials has been associated with thickening of canal walls, apical closure and reduced signs and symptoms of apical periodontitis. However, most of the included reviews assessed were case reports and only in a few of them were clinical trials included. There is also a lack of risk of bias analysis in most reviews. CONCLUSION The blood clot is the most common scaffold used for inducing regeneration during the treatment of immature necrotic teeth. Tooth length increase and widening of root canal walls are the most common criteria used in the studies as success indicators. MTA and Biodentine did not show differences in the results analysed. Quality assessment and bias risk evaluation showed that it is necessary to design better studies with rigorous methodology to recommend a trustable and predictable protocol for the treatment of immature necrotic permanent teeth with periapical lesions. REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) CRD42021248404.
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Affiliation(s)
| | | | | | | | | | - José F Gaviño-Orduña
- Odonto-Stomatology Department, School of Dentistry, Universidad de Barcelona, Barcelona, Spain
| | | | - Jose F Gomez-Sosa
- Endodontics Department, Universidad Central de Venezuela, Caracas, Venezuela
| | - Hugo R Munoz
- Endodontics Department, Universidad de San Carlos de Guatemala, Guatemala City, Guatemala
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19
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Vidán-Estévez J, Escalante-Barrigón F, Sánchez-Herráez S, Seco-Calvo J. Platelet-derived growth factors from a single donor by apheresis and one freeze-thaw cycle for treating medication-related osteonecrosis of the jaw. Regen Med 2022; 17:915-929. [PMID: 36169261 DOI: 10.2217/rme-2022-0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Aim: To assess whether the use of allogeneic platelet-derived growth factors could serve as a feasible, effective and safe biological therapy for the treatment of medication-related osteonecrosis of the jaw (MRONJ). Materials & methods: Patients with multiple myeloma and MRONJ were included and treated with allogeneic platelet-rich plasma, continued for between 6 and 18 weeks (mean: 9). Results: We observed a treatment success rate of 87.5% (p < 0.05). Assessing the association between healing and treatment duration, we observed a statistically significant relationship (χ2 = 8.00; p = 0.018; Cramer's V = 1), confirming that healing was very closely related to the duration of the treatment. Conclusion: Allogeneic platelet-rich plasma could be a recommended treatment for MRONJ. Future research with a large sample to validate our findings is required.
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Affiliation(s)
- Julia Vidán-Estévez
- Transfusion, Hematology & Hemotherapy Unit, Complejo Asistencial Universitario de León (CAULE), León, 24071, Spain
| | - Fernando Escalante-Barrigón
- Transfusion, Hematology & Hemotherapy Unit, Complejo Asistencial Universitario de León (CAULE), León, 24071, Spain
| | - Sergio Sánchez-Herráez
- Department of Traumatology & Orthopedic Surgery, Complejo Asistencial Universitario de León (CAULE), León, 24071, Spain
| | - Jesús Seco-Calvo
- Department of Physical Therapy, Institute of Biomedicine (IBIOMED), University of León, León, 24071, Spain.,Visiting Professor & Researcher of Department of Physiology, University of the Basque Country, Leioa, 48940, Spain
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20
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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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21
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Efficacy of Platelet Rich Plasma and Platelet Rich Fibrin for Direct Pulp Capping in Adult Patients with Carious Pulp Exposure- A Randomised Controlled Trial. Eur Endod J 2022; 7:114-121. [PMID: 35786576 PMCID: PMC9285992 DOI: 10.14744/eej.2021.04834] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE This study evaluated the effectiveness of Platelet Rich Plasma (PRP), Platelet Rich Fibrin (PRF) and Mineral Trioxide Aggregate (MTA) as direct pulp capping materials in patients with carious pulp exposure using cone beam computed tomography. METHODS This parallel, triple blinded, randomised trial was done on 30 permanent posterior teeth chosen as candidates for direct pulp capping based on stringent inclusion and exclusion criteria. The samples were allocated based on sequentially numbered opaque sealed envelope method into three groups: MTA, PRP and PRF for direct pulp capping. The treated teeth were restored with Glass Ionomer cement liner and light-cured resin composite. Patients were followed up for a period of 12 months. Statistical analyses were performed with statistical software SPSS version 25. Data were analysed for normality using Shapiro Wilk's test. Dentine bridge volume analysis across the groups were done using Kruskal Wallis test with the significance level at P=0.05. As the test revealed a significant difference, post hoc analysis was done with Dunn test. RESULTS CBCT analysis revealed that the volume of dentine bridge formed by PRP and PRF was significantly higher than the volume of dentine bridge formed by MTA (P<0.001; CI: 90%). There was no significant difference in the efficacy between the three direct pulp capping agents based on clinical assessment. A total of 27 teeth (90%) showed positive response to pulp sensibility testing and evidence of dentine bridge formation in radiograph at 12 months. No adverse events were encountered.
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22
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Histological Evaluation of Restylane Lyft Used as a Scaffold for Dental Pulp Regeneration in Non-Infected Immature Teeth in Dogs. MATERIALS 2022; 15:ma15124095. [PMID: 35744154 PMCID: PMC9228365 DOI: 10.3390/ma15124095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 12/15/2022]
Abstract
Commercially available hyaluronic acid dermal fillers used as a scaffold in regenerative endodontic procedures (REPs) have demonstrated attractive potentials. This study aimed to histologically evaluate the outcome of REPs using Restylane Lyft (HA) as a scaffold. REPs were performed on pulpless, immature roots in dogs (n = 69). The roots were divided into four groups: blood clot (BC), Restylane Lyft (BC + HA), negative control, and positive control. At 13 weeks postoperatively, hard tissue formation, vascularization, the presence of vascularized soft connective tissue and collagen fibers, the degree of inflammation within pulp spaces and/or periapical tissues, and apical closure were evaluated histologically. The vascularization and formation of loosely arranged collagen fibers within the regenerated soft connective tissues were observed significantly more in the BC+HA group (85% and 40%, respectively; p < 0.05) compared to the BC group (54.6% and 9.1%, respectively; p < 0.05). The degree of inflammation was significantly higher in the HA group than in the BC group; moderate to severe inflammatory cell infiltration was seen in 45% and 13.6% of the cases, respectively. The results of the present study suggest that Restylane Lyft combined with a blood clot used as a scaffold may improve the outcomes of REPs in non-infected, pulpless, immature teeth in dogs.
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23
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AlHowaish NA, AlSudani DI, AlMuraikhi NA. Evaluation of a hyaluronic acid hydrogel (Restylane Lyft) as a scaffold for dental pulp regeneration in a regenerative endodontic organotype model. Odontology 2022; 110:726-734. [PMID: 35471745 DOI: 10.1007/s10266-022-00710-y] [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: 03/01/2022] [Accepted: 04/11/2022] [Indexed: 12/14/2022]
Abstract
Scaffolds are crucial elements for dental pulp regeneration. Most of the currently used scaffolds in regenerative endodontic procedures (REPs) are unsuitable for chairside clinical use. This study aimed to evaluate the effect of an injectable synthetic scaffold (Restylane Lyft) on human bone marrow mesenchymal stem cell (hBMSC) viability, proliferation, and osteo/dentinogenic differentiation in a regenerative endodontic organotype model (REM). hBMSC were loaded in an REM either alone (hBMSC group) or mixed with the Restylane Lyft scaffold (Restylane/hBMSC group) and cultured in basal culture medium (n = 9/group). hMSC on culture plates served as controls. Cell viability and proliferation were measured using AlamarBlue assay. The loaded REM was cultured in an osteogenic differentiation medium to measure alkaline phosphatase activity (ALP) and examine the expression of the osteo/dentinogenic markers using real-time reverse transcriptase polymerase chain reaction. Cell viability in all groups increased significantly over 5 days. The Restylane/hBMSC group showed significantly higher ALP activity and dentin sialophosphoprotein, osteocalcin, and bone sialoprotein genes expression than the hBMSC and the control groups. Restylane Lyft, a hyaluronic acid (HA) injectable, FDA-approved hydrogel, maintained cell viability and proliferation and promoted osteo/dentinogenic differentiation of hBMSC when cultured in an REM. Henceforth, it could be a promising chairside scaffold material for REPs.
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Affiliation(s)
- Norah A AlHowaish
- Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh, 11612, Saudi Arabia
| | - Dina I AlSudani
- Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh, 11612, Saudi Arabia.
| | - Nihal A AlMuraikhi
- Stem Cell Unit, Department of Anatomy, College of Medicine, King Saud University, Riyadh, 11461, Saudi Arabia
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Araújo LD, Goulart TS, Gil ACK, Schuldt DPV, Coelho BS, Figueiredo DDR, Garcia LDFR, Almeida JD. Do alternative scaffolds used in regenerative endodontics promote better root development than that achieved with blood clots? Braz Dent J 2022; 33:22-32. [PMID: 35508033 PMCID: PMC9645157 DOI: 10.1590/0103-6440202204746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 02/25/2022] [Indexed: 02/08/2023] Open
Abstract
The aim of this integrative review was to identify whether alternative scaffolds
used in regenerative endodontics contribute to better root development, in
relation to the increase in root length and thickness of dentin walls, compared
with blood clot (BC) scaffolds. The literature search was conducted in PubMed,
SciELO and Lilacs databases, using descriptors related to the topic. After
applying the eligibility criteria, 11 articles were selected and analyzed
according to the proposed aim. Five clinical and six in vivo
studies, conducted in animals, compared different types of alternative scaffolds
with BCs, with emphasis on platelet-rich plasma (PRP) and platelet-rich fibrin
(PRF). All scaffolds, alternative or BC, promoted an increase in root length and
dentin wall thickness, with varying percentages of increase between studies. In
general, there was a significant increase in root length and dentin thickness
promoted by PRF and PRP scaffolds, compared with BC. It was concluded that the
majority of the scaffolds tested contributed to the increase in root length and
thickness of dentin walls, with emphasis on PRF and PRP.
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Affiliation(s)
| | - Taynara Santos Goulart
- University of Southern Santa Catarina, Brazil; Federal University of Santa Catarina, Brazil
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Saxena N, Hugar SM, Soneta SP, Joshi RS, Dialani PK, Gokhale N. Evaluation of the Treatment Protocols in the Management of Pulpally Involved Young Permanent Teeth in Children: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2022; 15:S103-S113. [PMID: 35645501 PMCID: PMC9108820 DOI: 10.5005/jp-journals-10005-2218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background In children with young permanent teeth, dental caries and traumatic injuries are the most common problems leading to pulp necrosis. Since, root development is completed in two to three years after eruption of the tooth into the oral cavity, loss of pulp vitality in young permanent tooth creates distinctive problems. In spite of exceeding availability of treatment procedures there is a need to search for a substantial procedure to treat young permanent teeth effectively. Aim The aim of this systematic review was to evaluate the treatment protocols in the management of pulpally involved young permanent teeth in children. Method Systematic search was conducted on databases PubMed, Cochrane, and Google Scholar among studies published from 1st January 2010 till 31st May 2020. Studies meeting the inclusion criteria were included in the review and were then assessed for quality with the help of predetermined criteria which categorized studies into high, medium, and low. Results Search strategy yielded 4,846 articles. After screening through titles and abstracts, 33 articles remained which were further screened for full text. At the end, 14 articles were included in systematic review. Furthermore, the included articles were statistically evaluated by meta-analysis. Conclusion In apexogenesis and apexification procedures, newer biomimetic materials like mineral trioxide aggregate and biodentine have more success rate than conventionally used calcium hydroxide. Among regenerative endodontic procedures platelet-rich plasma and platelet- rich fibrin showed better results. Clinical significance To amend clinician perceptions towards acceptance of the newer regenerative procedures and their effectiveness in management of young permanent tooth. How to cite this article Saxena N, Hugar SM, Soneta SP, et al. Evaluation of the Treatment Protocols in the Management of Pulpally Involved Young Permanent Teeth in Children: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2022;15(S-1):S103–S113.
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Affiliation(s)
- Nivedita Saxena
- Department of Pediatric and Preventive Dentistry, Kaher's KLE VK Institute of Dental Sciences, Belgaum, Belagavi, Karnataka, India
| | - Shivayogi M Hugar
- Department of Pedodontics and Preventive Dentistry, Kaher's KLE VK Institute of Dental Sciences, Belgaum, Belagavi, Karnataka, India
- Shivayogi M Hugar, Department of Pedodontics and Preventive Dentistry, Kaher's KLE VK Institute of Dental Sciences, Belgaum, Belagavi, Karnataka, India, Phone: +91 9986436448, e-mail:
| | - Sanjana P Soneta
- Department of Pedodontics and Preventive Dentistry, Kaher's KLE VK Institute of Dental Sciences, Belgaum, Belagavi, Karnataka, India
| | - Riddhi S Joshi
- Department of Pedodontics and Preventive Dentistry, Kaher's KLE VK Institute of Dental Sciences, Belgaum, Belagavi, Karnataka, India
| | - Pooja K Dialani
- Department of Pediatric and Preventive Dentistry, Kaher's KLE VK Institute of Dental Sciences, Belgaum, Belagavi, Karnataka, India
| | - Niraj Gokhale
- Department of Pedodontics and Preventive Dentistry, Kaher's KLE VK Institute of Dental Sciences, Belgaum, Belagavi, Karnataka, India
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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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Youssef A, Ali M, ElBolok A, Hassan R. Regenerative Endodontic Procedures for the Treatment of Necrotic Mature Teeth: A Preliminary Randomised Clinical Trial. Int Endod J 2022; 55:334-346. [PMID: 35030270 DOI: 10.1111/iej.13681] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/11/2022] [Indexed: 11/26/2022]
Abstract
AIM This preliminary randomised, prospective, controlled trial aimed to compare the clinical and radiographic outcomes of two regenerative endodontic procedures (REPs), revitalisation and a platelet-rich fibrin (PRF)-based technique, in the treatment of mature permanent teeth with necrotic pulps. METHODOLOGY The trial has been reported according to the Preferred Reporting Items for Randomised Trials in Endodontics 2020 guidelines. The study protocol was registered at the clinical trial registry (ClinicalTrials.gov) with identifier number NCT04158232. Twenty patients with mature necrotic anterior teeth with large periapical lesions were randomly allocated into two groups (n=10): group I, treated with revitalisation with the blood clot (BC) technique, and Group II, treated with a PRF-based technique. The follow-up was for 12 months. Periradicular healing was assessed using standardised radiographs taken at baseline, and at 6 and 12 months after treatment. An electric pulp tester was used to assess whether pulp sensibility had been regained during the follow-up period. Statistical analysis was conducted using Mann-Whitney test and Wilcoxon test for non-parametric data. For parametric data, repeated measures analysis of variance was used. The significance level was set at P≤0.05. RESULTS There was a significant increase in periradicular healing in both groups at 6 and 12 months, compared to that at baseline, with no significant difference between the studied groups after 12 months (P=0.143). There was a significant difference between the tooth sensibility readings at baseline, 6-month, and 12-month follow-up timepoints (P<0.001). CONCLUSIONS The findings of this preliminary trial indicate the potential for using REPs, such as revitalisation or PRF-based techniques, as treatment options for mature teeth with necrotic pulps. A higher level of evidence obtained through adequately powered clinical trials and longer follow-up periods are required to conclusively validate the different outcomes of REPs.
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Affiliation(s)
- Ahmed Youssef
- Assistant Lecturer, Department of Endodontic, Faculty of Dentistry, Minia University
| | - Magdy Ali
- Professor of Endodontics, Faculty of Dentistry, Beni Suif University, 2
| | - Amr ElBolok
- Professor of Oral Pathology, Faculty of Dentistry, 3
| | - Reham Hassan
- Associate Professor of Endodontics, Faculty of Dentistry.,Head of Endodontic Department, Faculty of Dentistry, The Egyptian Russian University
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Markandey S, Das Adhikari H. Evaluation of blood clot, platelet-rich plasma, and platelet-rich fibrin–mediated regenerative endodontic procedures in teeth with periapical pathology: a CBCT study. Restor Dent Endod 2022; 47:e41. [DOI: 10.5395/rde.2022.47.e41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/19/2021] [Accepted: 01/03/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- Swati Markandey
- Department of Conservative Dentistry and Endodontics, Dr. R. Ahmed Dental College and Hospital, Kolkata, India
| | - Haridas Das Adhikari
- Department of Conservative Dentistry and Endodontics, Dr. R. Ahmed Dental College and Hospital, Kolkata, India
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Rojas-Gutiérrez WJ, Pineda-Vélez E, Agudelo-Suárez AA. Regenerative Endodontics Success Factors and their Overall Effectiveness: An Umbrella Review. IRANIAN ENDODONTIC JOURNAL 2022; 17:90-105. [PMID: 36704087 PMCID: PMC9869004 DOI: 10.22037/iej.v17i3.32703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/10/2022] [Accepted: 07/18/2022] [Indexed: 01/28/2023]
Abstract
Introduction Regenerative endodontics is a developing field of dentistry and aims to recover the physiological and anatomical functions of the tooth for cases of severe dental caries, pulpal pathologies and dental trauma. Materials and Methods This umbrella review seeks to discover the scientific evidence on the effectiveness and the factors result in successful regenerative endodontic therapies in teeth with necrotic pulps and with incomplete root development. The study was conducted following the PRISMA Guidelines. There were no restrictions regarding search period. A comprehensive literature search was carried out in EMBASE, LILACS, PubMed, Cochrane, Scopus, and Google Scholar. A quality evaluation was conducted by using AMSTAR-2. A descriptive analysis of the included systematic reviews and meta-analysis were conducted. Results Thirteen descriptive systematic reviews and 7 meta-analyses were included. Three articles evidenced low methodological quality according to AMSTAR-2 tool. Overall success rates for the endodontic regeneration procedures ranged from 50% to 98% and the survival rates were between 94% and 100%. Pulp regeneration had a high success rate, evidenced by factors such as the resolution of symptoms, healing, increased root length, dentin thickening and recovery of sensitivity. Follow-up varied from 1 to 48 months for the original studies included in the systematic reviews and meta-analyses. Conclusions Endodontic practice offers the clinician a good treatment option in case of necrotic pulp with immature roots such as the endodontic regeneration, that is supported by high and moderate quality scientific literature.
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Gupta S, Mittal N, Baranwal HC, Rath C, Shankari T, Gupta S. Comparative evaluation of bioglass nanofiber, dexamethasone-coated bioglass nanofiber, and platelet-rich fibrin, as scaffolds in regenerative endodontic treatment of immature necrotic teeth: A randomized controlled trial. J Conserv Dent 2022; 25:561-568. [PMID: 36506625 PMCID: PMC9733549 DOI: 10.4103/jcd.jcd_264_22] [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: 05/05/2022] [Revised: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 12/15/2022] Open
Abstract
Aim The aim of this study was to evaluate and compare the regenerative endodontic potential of dexamethasone-coated bioglass nanofiber (Dex-BGnf), bioglass nanofiber (BGnf), and platelet-rich fibrin (PRF) for inducing regeneration in necrotic immature permanent teeth. Materials and Methods A total of 36 (n = 12) immature necrotic teeth with or without evidence of periapical lesion were included in the study. Patients were randomly allocated into three groups, based on the scaffolds used: Group I (PRF), II (BGnf), and III (Dex-BGnf). The clinical (electric pulp test) and radiographic evaluations (percentage increase in apical diameter, root length, root dentin thickness, and periapical healing) were compared at 6 and 12 months after the procedure with baseline records. Statistical Analysis One-way ANOVA, post hoc Tukey analysis, and Kruskal-Wallis test were used for evaluating the data. A 6- and 12-month improvement analysis was done using paired t-test and Friedman test. Results Clinically, all the 36 teeth were asymptomatic, but none gave a positive response to Electric Pulp Test (EPT) in time interval of 12 months. Dex-BGnf showed a statistically significant improvement in terms of increase in root length (P = 0.020) and root dentinal thickness (P = 0.001) when compared to PRF after 12 months. Conclusion The study has shown that Dex-BGnf yielded significantly better results than PRF for inducing apexogenesis in necrotic immature teeth.
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Affiliation(s)
- Sakshi Gupta
- Department of Conservative Dentistry and Endodontics, FODS, BHU, Varanasi, Uttar Pradesh, India,Address for correspondence: Dr. Sakshi Gupta, JRIII, Department of Conservative Dentistry and Endodontics, FODS, IMS, BHU, Varanasi, Uttar Pradesh, India. E-mail:
| | - Neelam Mittal
- Department of Conservative Dentistry and Endodontics, FODS, BHU, Varanasi, Uttar Pradesh, India
| | - Harakh Chand Baranwal
- Department of Conservative Dentistry and Endodontics, FODS, BHU, Varanasi, Uttar Pradesh, India
| | - Chandana Rath
- Department of Materials Science, IIT, BHU, Varanasi, Uttar Pradesh, India
| | - Thivya Shankari
- Department of Conservative Dentistry and Endodontics, FODS, BHU, Varanasi, Uttar Pradesh, India
| | - Supriya Gupta
- Department of Conservative Dentistry and Endodontics, FODS, BHU, Varanasi, Uttar Pradesh, India
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Shaik I, Gaddam B, Patel A, Deshmukh R, Bhavana M, M. Sunku M, Minnikanti A. Success rate of growth factors for existing periapical lesions in failed endodontically treated teeth in adult population: A systematic review and meta-analysis. J Pharm Bioallied Sci 2022; 14:S200-S202. [PMID: 36110583 PMCID: PMC9469373 DOI: 10.4103/jpbs.jpbs_139_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 01/30/2022] [Accepted: 02/28/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction: In this study, we investigated the success rate of growth factors for existing periapical lesions in failed endodontically treated teeth in an adult population by systematic review and meta-analysis. Materials and Methods: We conducted an online data search based on preferred reporting items for systematic reviews and meta analyses (PRISMA), from databases PUBMED, MEDLINE, and EMBASE, for the application of various types of growth factors in endodontically failed teeth with periapical lesions in adults. These included the “platelet-rich plasma (PRP) and platelet-rich fibrin (PRF),” blood, etc. The data were meta-analyzed using MetaXL 5.3, and GRADE was used to assess the certainty. Results: We observed that success of 0.95 was achieved by the end of a year's follow-up with the application of growth factors for periodontal lesions. We also observed that the teeth responded to thermal tests, indicating regeneration; however, studies were with bias and lower sensitivity. Discussion: \ Similar to regeneration in immature teeth, growth factors also showed greater success in the treatment of periapical lesions in the failed endodontic teeth in adults.
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32
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Zhang Q, Yang T, Zhang R, Liang X, Wang G, Tian Y, Xie L, Tian W. Platelet lysate functionalized gelatin methacrylate microspheres for improving angiogenesis in endodontic regeneration. Acta Biomater 2021; 136:441-455. [PMID: 34551330 DOI: 10.1016/j.actbio.2021.09.024] [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: 04/19/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 02/06/2023]
Abstract
Rapid angiogenesis is one of the challenges in endodontic regeneration. Recently, tailored polymeric microsphere system that loaded pro-angiogenic growth factors (GFs) is promising in facilitating vascularization in dental pulp regeneration. In addition, the synergistic effect of multiple GFs is considered more beneficial, but combination usage of them is rather complex and costly. Herein, we aimed to incorporate human platelet lysate (PL), a natural-derived pool of multiple GFs, into gelatin methacrylate (GelMA) microsphere system (GP), which was further modified by Laponite (GPL), a nanoclay with efficient drug delivery ability. These hybrid microspheres were successfully fabricated by electrostatic microdroplet technique with suitable size range (180∼380 µm). After incorporation of the PL and Laponite with GelMA, the Young's modulus of the hybrid hydrogel increased up to about 3-fold and the swelling and degradation rate decreased simultaneously. The PL-derived GFs continued to release up to 28 days from both the GP and GPL microspheres, while the latter released relatively more slowly. What's more, the released GFs could effectively induce tubule formation of human umbilical endothelial cells (HUVECs) and also promote human dental pulp stem cells (hDPSCs) migration. Additionally, the PL component in the GelMA microspheres significantly improved the proliferation, spreading, and odontogenic differentiation of the encapsulated hDPSCs. As further verified by the subcutaneous implantation results, both of the GP and GPL groups enhanced microvascular formation and pulp-like tissue regeneration. This work demonstrated that PL-incorporating GelMA microsphere system was a promising functional vehicle for promoting vascularized endodontic regeneration. STATEMENT OF SIGNIFICANCE: Polymeric microsphere system loaded with pro-angiogenic growth factors (GFs) shows great promise for regeneration of vascularized dental pulp. Herein, we prepared a functional GelMA microsphere system incorporated with human platelet lysates (PL) and nanoclay Laponite by the electrostatic microdroplet method. The results demonstrated that the GelMA/PL/Laponite microspheres significantly improved the spreading, proliferation, and odontogenic differentiation of the encapsulated hDPSCs compared with pure GelMA microspheres. Moreover, they also enhanced microvascular formation and pulp-like tissue regeneration in vivo. This hybrid microsphere system has great potential to accelerate microvessel formation in regenerated dental pulp and other tissues.
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Bao MZ, Liu W, Yu SR, Men Y, Han B, Li CJ. Application of platelet-rich fibrin on mandibular third molar extraction: systematic review and Meta-analysis. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2021; 39:605-611. [PMID: 34636211 DOI: 10.7518/hxkq.2021.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study aims to analyze the effectiveness of platelet-rich fibrin (PRF) in mandibular third molar extraction and provide suggestions for alleviating postoperative complications. METHODS Pubmed, EMBASE, Web of Science, and SinoMed were searched electronically on February 2020. Randomized controlled trials focusing on PRF usage in mandibular third molar extraction were included. Reviewers assessed the risk of bias in the included literature and extracted data independently using the criteria recommended by the Cochrane Collaboration. Meta-analysis was performed using RevMan 5.3 and STATA 13.0. RESULTS Twenty-one studies were included, comprising 991 patients who had mandibular third molar extraction. The topical application of PRF effectively reduced pain after extraction [MD=-12.06, 95%CI (-21.42, -2.71), P=0.01], attenuated post-extraction swelling [MD=-1.42, 95%CI (-2.41, -0.44), P=0.005], and promoted soft tissue hea-ling [MD=0.66, 95%CI (0.34, 0.99), P<0.000 1]. PRF significantly reduced trismus and alveolar osteitis (P<0.05). However, data could not prove whether PRF has any significant positive effect on bone healing compared with the control group (P>0.05). CONCLUSIONS Limited clinical evidence indicates that applying PRF after mandibular third molar extraction could reduce pain, swelling, trismus and the occurrence of dry socket and promote soft tissue healing. However, the effect of PRF on bone healing requires further large-scale randomized controlled trials and unified measurement criteria.
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Affiliation(s)
- Ming-Zhe Bao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Wei Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Shu-Rong Yu
- Dept. of Stomatology, Hospital of Traditional Chinese Medicine Affiliated to Southwest Medical University, Luzhou 646000, China
| | - Yi Men
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Bo Han
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Chun-Jie Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Pietruszka P, Chruścicka I, Duś-Ilnicka I, Paradowska-Stolarz A. PRP and PRF-Subgroups and Divisions When Used in Dentistry. J Pers Med 2021; 11:jpm11100944. [PMID: 34683085 PMCID: PMC8540475 DOI: 10.3390/jpm11100944] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 12/16/2022] Open
Abstract
Blood derivates, such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), are autogenous sources of many growth factors that are involved in the healing and regeneration of tissues, and for this reason, are used in dentistry treatments. This fact also contributes to the growing interest in these biomaterials in regenerative personalized medicine. The multitude of platelet-rich forms creates many possibilities for their use. This semi-systematic review describes and compares the methods of obtaining properties and potential uses of these materials in personalized treatments.
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Affiliation(s)
- Paulina Pietruszka
- Faculty of Dentistry, Wroclaw Medical University, ul. Krakowska 26, 52-425 Wrocław, Poland; (P.P.); (I.C.)
| | - Izabela Chruścicka
- Faculty of Dentistry, Wroclaw Medical University, ul. Krakowska 26, 52-425 Wrocław, Poland; (P.P.); (I.C.)
| | - Irena Duś-Ilnicka
- Department of Oral Pathology, Wroclaw Medical University, ul. Krakowska 26, 52-425 Wrocław, Poland
- Correspondence: ; Tel.: +48-71784-0140; Fax: +48-71784-0380
| | - Anna Paradowska-Stolarz
- Department of Dentofacial Anomalies, Department of Orthodontics and Dentofacial Orhopedics, Wroclaw Medical University, Krakowska 26, 52-524 Wrocław, Poland;
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Qian B, Yang Q, Wang M, Huang S, Jiang C, Shi H, Long Q, Zhou M, Zhao Q, Ye X. Encapsulation of lyophilized platelet-rich fibrin in alginate-hyaluronic acid hydrogel as a novel vascularized substitution for myocardial infarction. Bioact Mater 2021; 7:401-411. [PMID: 34466741 PMCID: PMC8379365 DOI: 10.1016/j.bioactmat.2021.05.042] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 12/23/2022] Open
Abstract
Cardiovascular diseases such as myocardial infarction (MI) are among the major causes of death worldwide. Although intramyocardial injection of hydrogels can effectively enhance the ventricular wall, this approach is limited because of its restriction to the poor vascularization in the infarcted myocardium. Here, we reported a new type of hydrogel composed of alginate (ALG) and hyaluronic acid (HA) with lyophilized platelet-rich fibrin (Ly-PRF) for releasing abundant growth factors to realize their respective functions. The results of in vitro studies demonstrated favorable mechanical property and release ability of ALG-HA with Ly-PRF. When injected into the infarcted myocardium, this composite hydrogel preserved heart function and the Ly-PRF within the hydrogel promoted angiogenesis and increased vascular density in both infarcted and border zone, which rescued the ischemic myocardium. These beneficial effects were also accompanied by macrophage polarization and regulation of myocardial fibrosis. Moreover, the autologous origin of Ly-PRF with ALG-HA hydrogel offers myriad advantages including safety profile, easiness to obtain and cost-effectiveness. Overall, this study demonstrated the versatile therapeutic effects of a novel composite hydrogel ALG-HA with Ly-PRF, which optimizes a promising vascularized substitution strategy for improving cardiac function after MI.
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Key Words
- ALG, alginate
- BZ, border zone
- Drug delivery
- HA, hyaluronic acid
- IZ, infarcted zone
- Injectable hydrogel
- LVEDd, left ventricular end-diastolic diameter
- LVEF, left ventricular ejection fractions
- LVESd, left ventricular end-systolic diameter
- LVFS, left ventricular fractional shortening
- Ly-PRF, lyophilized platelet-rich fibrin
- Lyophilized platelet-rich fibrin
- MI, myocardial infarction
- Myocardial infarction
- PET-CT, positron emission tomography-computerized tomography
- PRF, platelet-rich fibrin
- PRP, platelet rich plasma
- SUV, standardized uptake value
- TUNEL, terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling
- Vascularization
- iNOS, inducible nitric oxide synthase
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Affiliation(s)
- Bei Qian
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Qi Yang
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Mingliang Wang
- Department of Cardiology, Putuo People's Hospital, Tongji University, Shanghai, 200060, China
| | - Shixing Huang
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Chenyu Jiang
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Hongpeng Shi
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Qiang Long
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Mi Zhou
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Qiang Zhao
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Xiaofeng Ye
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
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Plasma Rich in Growth Factors in the Treatment of Endodontic Periapical Lesions in Adult Patients: Case Reports. Int J Mol Sci 2021; 22:ijms22179458. [PMID: 34502364 PMCID: PMC8431603 DOI: 10.3390/ijms22179458] [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: 08/04/2021] [Revised: 08/19/2021] [Accepted: 08/30/2021] [Indexed: 12/17/2022] Open
Abstract
Platelet-rich fibrin (PRF) is an autologous blood concentrate obtained without anticoagulants by centrifugation of patients’ peripheral venous blood. PRF is considered to enhance the formation of new bone. The aim of this manuscript was to present two case reports of permanent teeth with closed apexes with periapical lesions, treated endodontically with the use of PRF. The root canals were mechanically cleaned and shaped with NiTi files and irrigated with 5.25% sodium hypochlorite (NaOCl), 40% citric acid (CA), and triple distillated water. Before the canal systems were obturated, A-PRF was used as a scaffold and was placed below the cementodentinal junction with hand pluggers. Cone beam computerized tomography (CBCT) was used to assess the resolutions of periapical radiolucencies. After 6 months, the measurements of both periapical lesions were significantly reduced. Although the performed root canal treatments (RCTs) can definitely be recognized as successful, it must be emphasized that mechanical shaping and cleaning of the root canals with special disinfecting solutions significantly affect the clinical efficacy of RCT. It seems impossible to state that PRF played a leading role in the healing process of the presented periapical lesions. Further studies must be performed to assess whether RCT of mature teeth with an additional PRF application is superior to RCT performed alone.
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Nageh M, Ibrahim LA, AbuNaeem FM, Salam E. Management of internal inflammatory root resorption using injectable platelet-rich fibrin revascularization technique: a clinical study with cone-beam computed tomography evaluation. Clin Oral Investig 2021; 26:1505-1516. [PMID: 34387731 DOI: 10.1007/s00784-021-04123-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/30/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The current study evaluated clinically and radiographically the management of internal inflammatory root resorption (IIRR) in permanent anterior teeth with or without periapical lesions using injectable platelet-rich fibrin (i-PRF) regenerative approach. METHODS Ten systemically healthy patients, with thirteen anterior mature teeth diagnosed with IIRR were selected for the study. At the first visit, the tooth was anesthetized, access cavity opened, root canals were mechanically prepared then medicated with calcium hydroxide and temporarily sealed. After 2-4 weeks, regenerative endodontic procedures were performed by preparing and applying i-PRF inside the canal, then a freshly prepared PRF membrane was placed over it. White mineral trioxide aggregate was placed over the PRF matrix, and the tooth was restored with a glass ionomer cement base and resin composite restoration. The patients were recalled for clinical and radiographic evaluation and follow-up every 3 months for 12 months. Cone-beam computed tomography (CBCT) imaging was performed preoperatively and after 12 months. RESULTS Clinical evaluation results showed resolution of signs and symptoms through the follow-up period in all of the cases. Both CBCT imaging readings of IIRR lesions and periapical lesions revealed a volumetric significant difference (p = 0.00) between the preoperative and the 12-month follow-up period. CONCLUSIONS Usage of i-PRF could arrest and allow for healing of IIRR in permanent mature teeth and allow for periapical healing with successful clinical results. CLINICAL RELEVANCE i-PRF revascularization technique proved to be a successful REP in the treatment of the IIRR, reducing the number of appointments and increasing patient compliance.
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Affiliation(s)
- Mohamed Nageh
- Department of Endodontics, Faculty of Dentistry, Fayoum University, Batal Al-Salam Street, Al bahary, Fayoum, Egypt.
| | - Lamiaa A Ibrahim
- Department of Endodontics, Faculty of Dentistry, Fayoum University, Batal Al-Salam Street, Al bahary, Fayoum, Egypt
| | - Fatma M AbuNaeem
- Department of Endodontics, Faculty of Dentistry, Cairo University, 11 Sarya el Manyal Street, Manyal, Cairo, Egypt
| | - Engy Salam
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Fayoum University, Batal Al-Salam Street, Al bahary, Fayoum, Egypt
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Jansen EE, Braun A, Jansen P, Hartmann M. Platelet-Therapeutics to Improve Tissue Regeneration and Wound Healing-Physiological Background and Methods of Preparation. Biomedicines 2021; 9:biomedicines9080869. [PMID: 34440073 PMCID: PMC8389548 DOI: 10.3390/biomedicines9080869] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 12/18/2022] Open
Abstract
Besides their function in primary hemostasis, platelets are critically involved in the physiological steps leading to wound healing and tissue repair. For this purpose, platelets have a complex set of receptors allowing the recognition, binding, and manipulation of extracellular structures and the detection of pathogens and tissue damage. Intracellular vesicles contain a huge set of mediators that can be released to the extracellular space to coordinate the action of platelets as other cell types for tissue repair. Therapeutically, the most frequent use of platelets is the intravenous application of platelet concentrates in case of thrombocytopenia or thrombocytopathy. However, there is increasing evidence that the local application of platelet-rich concentrates and platelet-rich fibrin can improve wound healing and tissue repair in various settings in medicine and dentistry. For the therapeutic use of platelets in wound healing, several preparations are available in clinical practice. In the present study we discuss the physiology and the cellular mechanisms of platelets in hemostasis and wound repair, the methods used for the preparation of platelet-rich concentrates and platelet-rich fibrin, and highlight some examples of the therapeutic use in medicine and dentistry.
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Affiliation(s)
- Ellen E. Jansen
- Clinic for Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University, 52074 Aachen, Germany; (E.E.J.); (A.B.); (P.J.)
| | - Andreas Braun
- Clinic for Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University, 52074 Aachen, Germany; (E.E.J.); (A.B.); (P.J.)
| | - Patrick Jansen
- Clinic for Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University, 52074 Aachen, Germany; (E.E.J.); (A.B.); (P.J.)
| | - Matthias Hartmann
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Universität Duisburg-Essen, 45122 Essen, Germany
- Correspondence:
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Liang Y, Ma R, Chen L, Dai X, Zuo S, Jiang W, Hu N, Deng Z, Zhao W. Efficacy of i-PRF in regenerative endodontics therapy for mature permanent teeth with pulp necrosis: study protocol for a multicentre randomised controlled trial. Trials 2021; 22:436. [PMID: 34229752 PMCID: PMC8261915 DOI: 10.1186/s13063-021-05401-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/25/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Dental pulp necrosis, a common health problem, is traditionally treated with root canal therapy; however, it fails in restoring the vitality of damaged pulp. Most studies regarding regenerative endodontic therapy (RET) are limited to the treatment of immature necrotic teeth. Given that injectable platelet-rich fibrin (i-PRF) has shown great potential in regenerative medicine as a novel platelet concentration, this study is designed to explore whether i-PRF can serve as a biological scaffold, extending the indications for RET and improving the clinical feasibility of RET in mature permanent teeth with pulp necrosis. METHODS This is a randomised, double-blind, controlled, multicentre clinical trial designed to evaluate the clinical feasibility of RET for mature permanent teeth with pulp necrosis and to compare the efficacy of i-PRF and blood clots as scaffolds in RET. A total of 346 patients will be recruited from three centres and randomised at an allocation ratio of 1:1 to receive RET with either a blood clot or i-PRF. The changes in subjective symptoms, clinical examinations, and imaging examinations will be tracked longitudinally for a period of 24 months. The primary outcome is the success rate of RET after 24 months. The secondary outcome is the change in pulp vitality measured via thermal and electric pulp tests. In addition, the incidence of adverse events such as discolouration, reinfection, and root resorption will be recorded for a safety evaluation. DISCUSSION This study will evaluate the clinical feasibility of RET in mature permanent teeth with pulp necrosis, providing information regarding the efficacy, benefits, and safety of RET with i-PRF. These results may contribute to changes in the treatment of pulp necrosis in mature permanent teeth and reveal the potential of i-PRF as a novel biological scaffold for RET. TRIAL REGISTRATION ClinicalTrials.gov NCT04313010 . Registered on 19 March 2020.
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Affiliation(s)
- Yuee Liang
- Department of Stomatology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Guangzhou, 510515, China
| | - Rongyang Ma
- Department of Stomatology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Guangzhou, 510515, China
| | - Lijuan Chen
- Department of Stomatology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Guangzhou, 510515, China
| | - Xingzhu Dai
- Department of Stomatology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Guangzhou, 510515, China
| | - Shiya Zuo
- Department of Stomatology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Guangzhou, 510515, China
| | - Weiyi Jiang
- Department of Stomatology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Guangzhou, 510515, China
| | - Naiming Hu
- Department of Stomatology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Guangzhou, 510515, China
| | - Zilong Deng
- Department of Stomatology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Guangzhou, 510515, China.
| | - Wanghong Zhao
- Department of Stomatology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Guangzhou, 510515, China.
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Novel Approaches for the Treatment of Necrotic Immature Teeth Using Regenerative Endodontic Procedures: A Systematic Review and Meta-Analysis. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11115199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The induction of a blood clot allowing apical revascularization with a subsequent apical closure was reported several decades ago. Recent research has been focused on examining different scaffolds for regenerative endodontic procedures (REPs). The aim of this study was to analyze the main outcomes in novel REP reported in the literature. The search was conducted using six databases. Only clinical trials aiming at the study of scaffolds for REP in the treatment of necrotic immature teeth were included. The risk of bias was assessed by the Risk of Bias 2 tool. Additionally, the quality of the included studies was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. A summary of individual studies and a meta-analysis were performed. Relative risks of data from clinical success and root length changes were used from the studies, and these were combined using a random-effects meta-analysis. The meta-analysis results reveal that the main outcomes showed no differences between the patients who received REP with scaffolds or only REP. Limitations include that the certainty of evidence was low and that there was significant heterogeneity in the scaffolds used in the included studies. The data suggest that the blood clot remains as the gold standard for REP.
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Mayya A, Bhandary S, Kolakemar A, George AM. Management of necrotic immature permanent maxillary incisors using a modified technique of revascularisation. BMJ Case Rep 2021; 14:14/3/e240203. [PMID: 33731387 PMCID: PMC7978076 DOI: 10.1136/bcr-2020-240203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The management of necrotic immature permanent teeth has always been a challenge to endodontists. Various treatment modalities have been tried and tested for achieving a successful outcome. Revascularisation is one among these treatment options, which is gaining widespread attention among endodontists. The growing body of evidence demonstrating the success of revascularisation has led to different variations of this treatment option. Clinicians have over time used different scaffolds such as blood clot, collagen, platelet-rich fibrin (PRF) and platelet-rich plasma for revascularisation. This case report outlines the management of immature maxillary central incisors with pulp necrosis and large periapical lesions in a 19-year-old female patient with a modified technique of revascularisation by combining PRF and blood clot. At the end of 12 months, the patient was completely asymptomatic along with regression of the periapical lesions.
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Affiliation(s)
- Arun Mayya
- Conservative Dentistry and Endodontics, Srinivas Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Shruti Bhandary
- Conservative Dentistry and Endodontics, AJ Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Advith Kolakemar
- Conservative Dentistry and Endodontics, AJ Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Ann Mary George
- Oral and Maxillofacial Surgery, Manipal University College Malaysia, Melaka, Malaysia
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Lu J, Sun J, Zou D, Song J, Yang S. Graphene-Modified Titanium Surface Enhances Local Growth Factor Adsorption and Promotes Osteogenic Differentiation of Bone Marrow Stromal Cells. Front Bioeng Biotechnol 2021; 8:621788. [PMID: 33511107 PMCID: PMC7835422 DOI: 10.3389/fbioe.2020.621788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/14/2020] [Indexed: 11/13/2022] Open
Abstract
Graphene coating exhibits excellent abilities of protein adsorption and cell adhesion, which might expand the osteogenic activity of titanium implant surface to adapt to the environment of low bone mass and poor bone quality. In this paper, we designed and explored the graphene-coated titanium sheet, through the surface modification of oxygen-containing functional groups, to optimize the adsorption capacity of material by improving the electrostatic interactions, and successfully adsorbed and sustained-released a variety of osteogenic related growth factors in the autologous concentrated growth factors. Compared with the pure titanium, we observed that the bone marrow stromal cells (BMSCs) on the graphene-coated titanium with concentrated growth factors showed a flat shape and expressed osteogenic related genes and proteins, while the coating surfaces promoted and accelerated the osteogenic differentiation ability of BMSCs. The results suggested that it might be a feasible alternative to improve the osteogenesis of dental implant in the early stage.
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Affiliation(s)
- Jiayu Lu
- Department of Stomatology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiayue Sun
- Department of Stomatology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Derong Zou
- Department of Stomatology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jinlin Song
- College of Stomatology, Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Medical University, Chongqing, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing Medical University, Chongqing, China
| | - Sheng Yang
- College of Stomatology, Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Medical University, Chongqing, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing Medical University, Chongqing, China
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Does the application of GaAlAs laser and platelet-rich plasma induce cell proliferation and increase alkaline phosphatase activity in human dental pulp stem cells? Lasers Med Sci 2021; 36:1289-1295. [PMID: 33459924 DOI: 10.1007/s10103-020-03239-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/25/2020] [Indexed: 01/04/2023]
Abstract
Blood extracts containing platelet products are gaining popularity in promoting healing and pulp regeneration. This study was designed to evaluate the effect of platelet-rich plasma (PRP) and gallium-aluminum-arsenide (GaAlAs) laser on proliferation and differentiation of human dental pulp stem cells (hDPSCs). In this ex vivo study, hDPSCs isolated from impacted mandibular third molars were cultured in Dulbecco's Modified Eagle's medium )DMEM(with 10% fetal bovine serum (FBS). After reaching the desired confluence, the cells were distributed into 4 groups, namely, control, PRP, laser, and PRP+laser for MTT assay and alkaline phosphatase (ALP) test. In the PRP and PRP+laser groups, 10% PRP was added to each well on the plate. In the laser and PRP+laser groups, as for the proliferation test, laser irradiation was carried out for 45 s, while 135 s was designated for ALP test. After 1, 3, and 5 days, cell proliferation and ALP activity were assessed using MTT and ALP colorimetric assay, respectively. Two-way ANOVA was utilized to analyze data. In PRP and PRP+laser groups, cell proliferation and viability increased until day 3 but began to decline afterwards until the 5th day. In the laser group, the increase in proliferation and viability was observed till day 5 which was less than the control group. Laser and control groups exhibited significantly higher cell viability and proliferation than both PRP and PRP+laser groups. ALP activity was more pronounced in PRP+laser, PRP, and laser in descending order; however, all were less than that of the control group. Only in the control group did the ALP activity augment during the 5-day period. Laser irradiation could induce pulp cell proliferation and demonstrated a better performance than PRP in this regard.
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ÇİMEN C, ŞEN S, ŞENAY E, BEZGİN T. PRF USED AS A SCAFFOLD IN PULP REGENERATION: CASE SERIES. CUMHURIYET DENTAL JOURNAL 2021. [DOI: 10.7126/cumudj.833807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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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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Yoshpe M, Kaufman AY, Lin S, Ashkenazi M. Regenerative endodontics: a promising tool to promote periapical healing and root maturation of necrotic immature permanent molars with apical periodontitis using platelet-rich fibrin (PRF). Eur Arch Paediatr Dent 2020; 22:527-534. [PMID: 33111235 DOI: 10.1007/s40368-020-00572-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/10/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE Currently, mineral trioxide aggregate (MTA) apexification is recommended as the preferred treatment for permanent anterior immature necrotic teeth. Apexification treatment does not enable further development and maturation of the teeth, resulting in short roots with thin root canal walls, that often are prone to cervical fractures. This study presents the regenerative endodontic procedure (REP) as an alternative treatment for immature necrotic molars with apical periodontitis or a chronic apical abscess. REP enables periapical healing as well as root lengthening and widening of the dentinal root canal walls. CASE SERIES RESULTS Six immature first molars teeth (five mandibular, one maxillary) with apical periodontitis or chronic apical abscess were treated with REP. Patients underwent periodic follow-up visits every 3 months the first year and twice a year thereafter. The final clinical examination revealed no symptoms, no gingival pockets, and no sensitivity to percussion. Cold sensitivity tests were negative. Radiographs revealed full periapical healing in all the treated molars, remarkable root lengthening, and dentinal wall thickening. CONCLUSION REP with PRF is feasible and may have some advantages over MTA apexification since it facilitates root elongation, dentinal thickening of the root canals walls, and narrowing of the apical foramen.
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Affiliation(s)
- M Yoshpe
- Endodontic Department, Faculty of Dental Medicine, Hebrew University-Hadassah, Jerusalem, Israel. .,Smile Medical Services Ltd., ha Prahim 28, Ashdod, Israel.
| | - A Y Kaufman
- Department of Endodontology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Endodontics, School of Graduate Dentistry, Rambam Health Care Campus, Haifa, Israel
| | - S Lin
- Department of Endodontics, School of Graduate Dentistry, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - M Ashkenazi
- Center of Oral and Dental Health, Sheba Medical Center, Tel Hashomer, Israel.,Pediatric Dentistry, Multidisciplinary Dental Clinic, Petach-Tikva, Israel
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Bakhtiar H, Rajabi S, Pezeshki-Modaress M, Ellini MR, Panahinia M, Alijani S, Mazidi A, Kamali A, Azarpazhooh A, Kishen A. Optimizing Methods for Bovine Dental Pulp Decellularization. J Endod 2020; 47:62-68. [PMID: 33049226 DOI: 10.1016/j.joen.2020.08.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/23/2020] [Accepted: 08/26/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION This study aimed to characterize the decellularization effects of different treatment protocols on the bovine dental pulp extracellular matrix (ECM) for tissue regeneration. METHODS Seven different decellularization protocols consisting of trypsin/EDTA (for 1 hour, 24 hours, or 48 hours), sodium dodecyl sulfate (SDS, for 24 hours or 48 hours), Triton X-100 (for 1 hour), and deoxyribonuclease treatments were tested on bovine dental pulp tissue. The posttreatment samples were evaluated for remaining DNA and cellular contents, structural durability, immunofluorescence analysis, and in vivo immune responses. RESULTS A complete decellularization process in all of the experimental groups was observed. The protocol that included 1 hour of Triton X-100 treatment and 12 hours of trypsin/EDTA treatment with no SDS treatment (P7 [12E-0S-1T]) showed the highest retention of glycosaminoglycan and the absence of nuclei in 4,6-diamidino-2-phenylindole. All groups showed significantly lower DNA content compared with native pulp tissue (P < .05), whereas compared with other protocols, protocols 1 (1 hour of EDTA/trypsin, 24 hours of SDS, and 1 hour of Triton X-100) and 4 (1 hour of EDTA/Trypsin, 48 hours of SDS, and no Triton X-100) resulted in the highest DNA contents (P < .05). Based on these results, P7 was further evaluated by immunofluorescence and in vivo immunogenicity. P7 specimens preserved collagen type I, whereas mononuclear cell infiltration along with neovascularization was observed in vivo. CONCLUSIONS All tested treatments displayed the potential ability to decellularize pulp tissue and are viable options for a xenogeneic dental pulp ECM scaffold. The P7 (12E-0S-1T) protocol resulted in decellularized ECM with minimal organic matrix/ultrastructural detriments and an acceptable host immune response.
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Affiliation(s)
- Hengameh Bakhtiar
- Department of Endodontics, Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Stem Cell Research Center, Tissue Engineering and Regenerative Medicine Institute, Tehran Central Branch, Islamic Azad University, Tehran, Iran
| | - Sarah Rajabi
- Department of Cell Engineering, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, Academic Center for Education, Culture and Research, Tehran, Iran
| | | | - Mohammad Reza Ellini
- Department of Endodontics, Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; Stem Cell Research Center, Tissue Engineering and Regenerative Medicine Institute, Tehran Central Branch, Islamic Azad University, Tehran, Iran
| | - Mahsa Panahinia
- Department of Endodontics, Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; Stem Cell Research Center, Tissue Engineering and Regenerative Medicine Institute, Tehran Central Branch, Islamic Azad University, Tehran, Iran
| | - Solmaz Alijani
- Department of Endodontics, Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; Stem Cell Research Center, Tissue Engineering and Regenerative Medicine Institute, Tehran Central Branch, Islamic Azad University, Tehran, Iran
| | - Amir Mazidi
- Stem Cell Research Center, Tissue Engineering and Regenerative Medicine Institute, Tehran Central Branch, Islamic Azad University, Tehran, Iran
| | - Amir Kamali
- AO Research Institute Davos, Davos, Switzerland
| | - Amir Azarpazhooh
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Clinical Epidemiology and Health Care Research, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Anil Kishen
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada.
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Panda S, Mishra L, Arbildo-Vega HI, Lapinska B, Lukomska-Szymanska M, Khijmatgar S, Parolia A, Bucchi C, Fabbro MD. Effectiveness of Autologous Platelet Concentrates in Management of Young Immature Necrotic Permanent Teeth-A Systematic Review and Meta-Analysis. Cells 2020; 9:cells9102241. [PMID: 33036462 PMCID: PMC7600252 DOI: 10.3390/cells9102241] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 12/24/2022] Open
Abstract
The use of autologous platelet concentrates (APCs) in regenerative endodontic procedures is inconsistent and unclear. The aim of this meta-analysis was to evaluate the effectiveness of autologous platelet concentrates compared to traditional blood-clot regeneration for the management of young, immature, necrotic, permanent teeth. The digital databases MEDLINE, SCOPUS, CENTRAL, Web of Science, and EMBASE were searched to identify ten randomized clinical trials. The outcomes at postoperative follow-up, such as dentinal wall thickness (DWT), increase in root length (RL), calcific barrier formation (CB), apical closure (AC), vitality response (VR), and success rate (SR), were subjected to both qualitative synthesis and quantitative meta-analysis. The meta-analysis showed that APCs significantly improved apical closure (risk ratio (RR) = 1.17; 95% CI: 1.01, 1.37; p = 0.04) and response to vitality pulp tests (RR = 1.61; 95% CI: 1.03, 2.52; p = 0.04), whereas no significant effect was observed on root lengthening, dentin wall thickness, or success rate of immature, necrotic teeth treated with regenerative endodontics. APCs could be beneficial when treating young, immature, necrotic, permanent teeth regarding better apical closure and improved response to vitality tests.
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Affiliation(s)
- Saurav Panda
- Department of Periodontics and Oral Implantology, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, India;
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milano, Italy;
| | - Lora Mishra
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, India;
| | - Heber Isac Arbildo-Vega
- Department of General Dentistry, Dentistry School, Universidad San Martín de Porres, Chiclayo 14012, Peru;
- Department of General Dentistry, Dentistry School, Universidad Particular de Chiclayo, Chiclayo 14012, Peru
| | - Barbara Lapinska
- Department of General Dentistry, Medical University of Lodz, 92-213 Lodz, Poland; (B.L.); (M.L.-S.)
| | | | - Shahnawaz Khijmatgar
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milano, Italy;
- Nitte (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences (ABSMIDS), Department of Oral Biology and Genomic Studies, Mangalore 575018, India
| | - Abhishek Parolia
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lampur 57000, Malaysia;
| | - Cristina Bucchi
- Faculty of Dentistry, CICO Research Centre, Universidad de La Frontera, Temuco 4811230, Chile;
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milano, Italy;
- Dental Clinic, IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy
- Correspondence: ; Tel.: +39-02-5031-9950; Fax: +39-02-5031-9960
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49
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Bandeira Lopes L, Paredes F, Pimenta A, Carpinteiro I. Management of an Unsuccessful Regenerative Endodontic Procedure after Tooth Fracture: A Case Report. Dent J (Basel) 2020; 8:dj8030094. [PMID: 32882788 PMCID: PMC7558519 DOI: 10.3390/dj8030094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 11/16/2022] Open
Abstract
Dental trauma is a very frequent occurrence in children and adolescents, which creates a great impact on the esthetics, functions, and phonetics. Traumatic dental injuries can range from simple enamel fractures to permanent tooth loss. This case report presents an eight-year-old patient with an uncomplicated crown fracture of tooth 21, and 30 days after trauma, it was diagnosed as necrotic pulp. The first treatment choice was a regenerative endodontic procedure (REP), however, the failure led to apexification with Mineral Trioxide Aggregate (MTA). The chosen rehabilitation was a composite veneer. Concerning the available literature and fracture enamel dentin, the treatment approach proposed for the case provided good functional and esthetic outcomes.
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Affiliation(s)
- Luísa Bandeira Lopes
- Pediatric Department, Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz Cooperativa de Ensino Superior, 2521-511 Caparica, Almada, Portugal;
- Correspondence:
| | - Francisco Paredes
- Pediatric Department, Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz Cooperativa de Ensino Superior, 2521-511 Caparica, Almada, Portugal;
| | - Andreia Pimenta
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2521-511 Caparica, Almada, Portugal;
| | - Inês Carpinteiro
- Dentistry Department, Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz Cooperativa de Ensino Superior, 2521-511 Caparica, Almada, Portugal;
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50
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Sousa MGC, Maximiano MR, Costa RA, Rezende TMB, Franco OL. Nanofibers as drug-delivery systems for infection control in dentistry. Expert Opin Drug Deliv 2020; 17:919-930. [PMID: 32401065 DOI: 10.1080/17425247.2020.1762564] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Due to the complexity of different oral infections, new anti-infective nanotechnological approaches have been emerging for dentistry in recent years. These strategies may contribute to antimicrobial molecules delivery, tissue regeneration, and oral health maintenance by acting in a more specific site and not being cytotoxic. In this context, nanofibers appear as versatile structures and might act both in the release of antimicrobial molecules and as a scaffold for new tissue formation. AREAS COVERED This review addresses the application of different nanofibers as new strategies for the delivery of antimicrobial molecules for dentistry. Here, we present the main polymers used to construct nanofibers, methods of production and mainly their antimicrobial activity against microorganisms commonly responsible for the usual dental infections. These biomaterials may be associated to restorative materials, prostheses, and mucoadhesive structures. Besides, nanofibers can be used for endodontic or periodontal therapy, or even on implant surfaces. EXPERT OPINION A wide variety of studies report the potential application of anti-infective nanofibers in the oral cavity. Although there are still several barriers between in vitro and in vivo studies, these new formulations appear as promising new therapies for dentistry.
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Affiliation(s)
- Maurício G C Sousa
- Centro de Análises Proteômicas e Bioquímicas, Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília , Brasília, Brazil
| | - Mariana R Maximiano
- Centro de Análises Proteômicas e Bioquímicas, Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília , Brasília, Brazil
| | - Rosiane A Costa
- Centro de Análises Proteômicas e Bioquímicas, Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília , Brasília, Brazil
| | - Taia M B Rezende
- Centro de Análises Proteômicas e Bioquímicas, Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília , Brasília, Brazil.,Programa de Pós-Graduação em Ciências da Saúde, Universidade de Brasília , Brasília, Brazil.,Curso de Odontologia, Universidade Católica de Brasília , Brasília, Brazil
| | - Octávio L Franco
- Centro de Análises Proteômicas e Bioquímicas, Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília , Brasília, Brazil.,Programa de Pós-Graduação em Patologia Molecular, Universidade de Brasília , Brasília, Brazil.,S-Inova Biotech, Pós-Graduação em Biotecnologia, Universidade Católica dom Bosco , Mato Grosso do Sul, Brazil
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