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Kahler B, Lu J, Taha NA. Regenerative endodontic treatment and traumatic dental injuries. Dent Traumatol 2024. [PMID: 38989999 DOI: 10.1111/edt.12979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/07/2024] [Accepted: 06/11/2024] [Indexed: 07/12/2024]
Abstract
Pulp necrosis is the most common complication following dental trauma and is often associated with apical periodontitis. The management of these teeth is challenging in terms of large root canals, open apices, thin dentinal walls, and short roots. Over decades the conventional treatment for these teeth was calcium hydroxide apexification, a time-consuming procedure despite high success rates. Subsequently after the introduction of mineral trioxide aggregate and hydraulic calcium silicate materials single visit apical plug procedures became increasingly practiced with comparable success rates to the conventional apexification. The search continued afterward for a clinical procedure that may stimulate further root development and apical closure to avoid the long-term complication of root fracture after apexification. Regenerative procedures using stem cells derived from the apical papilla and blood clots as scaffolds were then introduced for the management of immature teeth, with variable protocols and success rates. This review will cover the evidence available and current position of regenerative endodontic procedures in traumatized immature teeth with apical periodontitis, in terms of clinical protocols, outcome, and potential prognostic factors.
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Affiliation(s)
- Bill Kahler
- Department of Restorative and Reconstructive Dentistry, School of Dentistry, University of Sydney, Camperdown, New South Wales, Australia
| | - Jing Lu
- Fujian Key Laboratory of Oral Diseases, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Nessrin A Taha
- Conservative Dentistry Department, Jordan University of Science and Technology, Irbid, Jordan
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2
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Kiaipour Z, Shafiee M, Ansari G. Role of Platelet Concentrates in Dental-Pulp Regeneration: A Systematic Review of Randomized Clinical Trials. JOURNAL OF DENTISTRY (SHIRAZ, IRAN) 2024; 25:97-107. [PMID: 38962085 PMCID: PMC11217062 DOI: 10.30476/dentjods.2023.96000.1912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/19/2022] [Accepted: 01/13/2023] [Indexed: 07/05/2024]
Abstract
Statement of the Problem Treatment of immature necrotic teeth is a problematic situation. Conventional root canal therapy is challenging and leaves a weak, fragile, and undeveloped tooth for lifetime. Purpose This review was aimed to assess the outcome of available randomized clinical trials (RCTs) on the efficacy of platelet concentrates (PC) in dentine-pulp complex regeneration. Materials and Method In this systematic review, an electronic search was conducted on MEDLINE, EMBASE, Cochrane, and Google scholar databases. A further manual search was performed on the list of related articles in order to ensure inclusion of potentially missed articles in earlier electronic search. Those proved RCTs matched with the standard criteria were included following an initial assessment of abstracts and the text independently by the reviewers. Results From the total 602 harvested articles, only 13 met the criteria and were evaluated with 11 having parallel design and 2 split mouth. Only one study featured low risk of bias, while three had moderate risk and the rest were at high risk of bias. Six studies had used platelet rich plasma (PRP), 4 employed platelet rich fibrin (PRF), one utilized injectable platelet rich fibrin (I-PRF), and three used both PRF and PRP for their experimental groups while blood clot (BC) was used as the control group for all. The success rate was reported at 87.3% judged by the absence of pathologic signs and symptoms. Conclusion Dentin wall thickening, root lengthening and apex closure were higher in PC groups, however, these differences were not statistically significant in reported studies. It can be concluded that PCs promote the pulp tissue revitalization and continuation of root development. However, a consensus on its potency for true pulp regeneration is yet to be reached.
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Affiliation(s)
- Zahra Kiaipour
- Postgraduate Student, Dept. of Pediatric Dentistry, Dental School of Shahid Beheshti University of Medical Sciences, Tehran Iran
| | - Mahdieh Shafiee
- Stem Cell Research Canter, Tissue Engineering and Regenerative Medicine Institute, Tehran Central Branch, Islamic Azad University, Tehran, Iran
| | - Ghassem Ansari
- Head of the Hospital Dentistry and Sedation Unit, Dept. of Pediatric Dentistry, Past-President of IADR-Iranian Division, Dental School Shahid Beheshti Medical University, Tehran, Iran
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Abo-Heikal MM, El-Shafei JM, Shouman SA, Roshdy NN. Evaluation of the efficacy of injectable platelet-rich fibrin versus platelet-rich plasma in the regeneration of traumatized necrotic immature maxillary anterior teeth: A randomized clinical trial. Dent Traumatol 2024; 40:61-75. [PMID: 37612879 DOI: 10.1111/edt.12881] [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: 05/05/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND/AIM This study aimed at comparing the regenerative potential of injectable platelet-rich fibrin (i-PRF) (Group 1) and platelet-rich plasma (Group 2) scaffolds. MATERIALS AND METHODS Twenty-three patients, aged from 9 to 24 years, having 24 immature traumatized necrotic maxillary anterior teeth, were enrolled. Teeth trauma was confirmed by patients' history. Preoperative three-dimensional scans were done. In the first visit, canals were irrigated with 1.5% sodium hypochlorite then medicated with calcium hydroxide. After 2 weeks, patients were randomly assigned into one of the treatment groups (n = 12). The platelet concentrate was applied after centrifuging 10 mL of autologous venous blood with respect to the centrifugation protocol for each platelet concentrate. Patients were recalled at 6 and 12 months posttreatment, during which clinical and radiographic examinations and assessment of pulp sensitivity were done. Three-dimensional scanning was done after 12 months. The increase in root length and decrease in root canal diameters were calculated at three canal levels. Statistical analysis was done using the paired t-test and the independent t-test. The significance level was set at p < .05. RESULTS There was no statistically significant difference between both groups regarding the increase in root length, decrease in coronal and middle canal diameters and the response to the electric pulp tester. Group (1) showed significantly greater decrease in apical canal diameter than Group (2) (p = .008). CONCLUSION I-PRF can be considered as a valid regenerative scaffold for clinical use and with regards to the easier preparation technique, it is more recommended than platelet-rich plasma.
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Elver A, Caymaz MG. Novel approaches to the use of platelet-rich fibrin: A literature review. Saudi Dent J 2023; 35:797-802. [PMID: 38025602 PMCID: PMC10658391 DOI: 10.1016/j.sdentj.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Atalay Elver
- Cyprus Health and Social Sciences University, Department of Oral and Maxillofacial Surgery, Güzelyurt, TRNC (Turkish Republic of North Cyprus), Mersin 10, Turkey
| | - Mehmet Gagari Caymaz
- Cyprus Health and Social Sciences University, Department of Oral and Maxillofacial Surgery, Güzelyurt, TRNC (Turkish Republic of North Cyprus), Mersin 10, Turkey
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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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B Kolcu MI, Yurdakul H, Belli S. Regenerative endodontic treatment of an immature incisor tooth with a novel platelet-rich product: A five-year follow-up case report. Niger J Clin Pract 2023; 26:1388-1392. [PMID: 37794555 DOI: 10.4103/njcp.njcp_747_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
This case report presents a five-year follow-up and the management of a necrotic, immature incisor tooth treated by a novel platelet-rich plasma/platelet extract solution and platelet-rich fibrin (PRP-PES/PRF) and the restoration by using a stress-reduced direct composite restoration (SRDC) technique. The patient with a broken maxillary lateral tooth was referred to our clinic. Extra/intra-oral examinations were within normal limits. The nonvital tooth having an apical lesion and open-apical apex was treated with a regenerative endodontic treatment procedure (REP), and further root development with continued apical closure was shown in the follow-ups up to 60 months. In conclusion, the SRDC and PRP-PES/PRF combination can be an opportunity for the teeth requiring post-restoration. In contrast to the treatment strategy susceptible to weakening or fracturing the patient's tooth root, the REP approach may lead to a better prognosis for the patient's tooth.
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Affiliation(s)
- M I B Kolcu
- Department of Medical Education and Informatics, School of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - H Yurdakul
- Batumi IVF Clinic, Batum, Adjara, Georgia, Turkey
| | - S Belli
- Department of Endodontics, Selcuk University, School of Dentistry, Konya, Turkey
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Algahtani FN, Almohareb R, Aljamie M, Alkhunaini N, ALHarthi SS, Barakat R. Application of advanced platelet-rich fibrin for through-and-through bony defect during endodontic surgery: Three case reports and review of the literature. World J Clin Cases 2023; 11:4168-4178. [PMID: 37388804 PMCID: PMC10303602 DOI: 10.12998/wjcc.v11.i17.4168] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/01/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The use of advanced platelet-rich fibrin (A-PRF) membranes for guided bone and tissue regeneration in through-and-through defects after endodontic surgery was explored in three cases.
CASE SUMMARY Herein, three patients presented to the endodontic clinic suffering from apical periodontitis, associated with large bone resorption and related to previously endodontically treated teeth. Periapical surgery was indicated in these cases and the osteotomy site was covered by A-PRF membrane. Cone-beam computed tomography (CBCT) was used to assess the cases before and after the surgery.
CONCLUSION Four months post-surgery, the recall CBCT scan showed complete obliteration of the osteotomy with newly formed bone. A-PRF membrane showed promising results and was an advantageous addition to surgical endodontic treatment.
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Affiliation(s)
- Fahda N Algahtani
- Department of Clinical Dental Sciences, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia
| | - Rahaf Almohareb
- Department of Clinical Dental Sciences, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia
| | - Manar Aljamie
- Department of Endodontics, Vision Colleges of Dentistry and Nursing, Riyadh 11671, Saudi Arabia
| | - Nouf Alkhunaini
- Department of Dental, Specialized Medical Center Hospitals, Riyadh 11671, Saudi Arabia
| | - Shatha Subhi ALHarthi
- Department of Preventive Dental Sciences, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia
| | - Reem Barakat
- Department of Clinical Dental Sciences, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia
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Swaikat M, Faus-Matoses I, Zubizarreta-Macho Á, Ashkar I, Faus-Matoses V, Bellot-Arcís C, Iranzo-Cortés JE, Montiel-Company JM. Is Revascularization the Treatment of Choice for Traumatized Necrotic Immature Teeth? A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12072656. [PMID: 37048739 PMCID: PMC10095182 DOI: 10.3390/jcm12072656] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/25/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023] Open
Abstract
Regenerative endodontic treatment (RET) has been considered a reliable procedure to treat immature necrotic teeth; however, the effect of dental trauma on the prognosis of RET is questionable. This systematic review aimed to evaluate the current level of evidence for revascularization techniques (the RET) in the management of traumatized necrotic immature permanent teeth with or without periapical radiolucent areas. Four electronic databases—PubMed, Web of Science, Scopus, and Embase—were searched until November 2022. Only randomized clinical trials, cohort studies, and case-control studies with a minimum of 10 cases and 12 months of follow-ups were included. The search identified 363 preliminary results. After discarding the duplicates and screening the titles, abstracts, and full texts, 13 articles were considered eligible. The results showed that RET techniques seemed to have high survival and success rates, 93.8% and 88.3%, respectively, in the treatment of traumatized necrotic immature permanent teeth. Root maturation with RET techniques seemed to be lower in traumatized teeth. Future studies are needed to evaluate root maturation in traumatized teeth using 3-dimensional radiographic evaluations. In addition, the lack of literature on the studies comparing RET and apexification (calcium hydroxide or an MTA) in the treatment of traumatized necrotic immature teeth highlights the necessity for high-level clinical studies comparing these treatment modalities.
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Affiliation(s)
- Mohamad Swaikat
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain
| | - Ignacio Faus-Matoses
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain
| | - Álvaro Zubizarreta-Macho
- Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, 37008 Salamanca, Spain
| | - Israa Ashkar
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain
| | - Vicente Faus-Matoses
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain
| | - Carlos Bellot-Arcís
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain
| | - José Enrique Iranzo-Cortés
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain
| | - José María Montiel-Company
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain
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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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Rahul M, Lokade A, Tewari N, Mathur V, Agarwal D, Goel S, Keshari P, Sharma S, Bansal K. Effect of Intracanal Scaffolds on the Success Outcomes of Regenerative Endodontic Therapy - A Systematic Review and Network Meta-analysis. J Endod 2023; 49:110-128. [PMID: 36410623 DOI: 10.1016/j.joen.2022.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/12/2022] [Accepted: 11/12/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The scaffolds used in regenerative endodontic therapy (RET) provide structural support for cells so that they can adhere to the scaffolds and also are crucial for cellular proliferation and differentiation. The objective of this network meta-analysis was to compare effects of different intracanal scaffolds on success outcomes of RET. METHODS PubMed/Medline, EMBASE, Cochrane, CINAHL, Scopus, and Web of Science databases were searched. Studies evaluating and/or comparing clinical and/or radiographic success of RET using different scaffolds with a minimum of 12 months follow-up were included. The Cochrane Collaboration risk of bias (ROB) tool and appropriate tools from Joanna Briggs Institute were used for the assessment of ROB. A network meta-analysis was performed to compare the primary outcome (clinical success) and other success outcomes (root maturation, and pulpal sensibility) using different scaffolds. RESULTS Twenty-seven studies fulfilled the desired inclusion criteria of which 25 had a low ROB whereas 2 had a moderate ROB. Clinical success of RET using platelet-rich plasma (PRP), blood clot (BC), and platelet-rich fibrin (PRF) scaffolds ranged between 91.66%-100%, 84.61%-100%, and 77%-100% respectively. The different scaffolds did not show any statistically significant difference in clinical success (PRF vs BC [P = 1.000], PRP vs BC [P = 1.000], and PRF vs PRP [P = .999]), apical root closure (PRF vs BC [P = 1.000], PRP vs BC [P = .835], PRF vs PRP [P = .956]), and pulp sensibility (PRF vs BC [P = .980], PRP versus BC [P = .520], and PRF vs PRP [P = .990]). CONCLUSION The intracanal scaffolds used during RET did not result in significant differences in regard to clinical success, root maturation, and pulpal sensibility.
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Affiliation(s)
- Morankar Rahul
- Division of pedodontics and preventive dentistry, Centre for Dental Education and Research, AIIMS, New Delhi, India.
| | - Amolkumar Lokade
- Division of pedodontics and preventive dentistry, Centre for Dental Education and Research, AIIMS, New Delhi, India
| | - Nitesh Tewari
- Division of pedodontics and preventive dentistry, Centre for Dental Education and Research, AIIMS, New Delhi, India
| | - Vijay Mathur
- Division of pedodontics and preventive dentistry, Centre for Dental Education and Research, AIIMS, New Delhi, India
| | - Deepali Agarwal
- Division of Public Health Dentistry, Centre for Dental Education and Research, AIIMS, New Delhi, India
| | - Shubhi Goel
- Department of Public Health Dentistry, Postgraduate Institute of Dental Sciences, Rohtak, Haryana, India
| | | | - Sidhartha Sharma
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, AIIMS, New Delhi, India
| | - Kalpana Bansal
- Division of pedodontics and preventive dentistry, Centre for Dental Education and Research, AIIMS, New Delhi, India
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Tang Q, Jin H, Lin S, Ma L, Tian T, Qin X. Are platelet concentrate scaffolds superior to traditional blood clot scaffolds in regeneration therapy of necrotic immature permanent teeth? A systematic review and meta-analysis. BMC Oral Health 2022; 22:589. [PMID: 36494711 PMCID: PMC9733063 DOI: 10.1186/s12903-022-02605-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The effectiveness of platelet concentrates in promoting root development of necrotic immature permanent teeth is unclear. The present study evaluated whether the platelet concentrate protocol was superior to the traditional blood clot protocol in regeneration therapy. METHODS We searched Electronic databases, such as PubMed, Cochrane Library, ClinicalTrials and EMBASE. Randomized controlled trial studies, cohort studies, case-control studies and cross-sectional studies were included, in which platelet-rich concentrates were tested for periapical healing and root development, with the blood clot treatment protocol as the control group. Clinical and radiographic outcomes were considered. Selected articles were assessed for risk of bias. Pooled risk ratios (risk ratio, RR) were calculated for clinical success, responses to cold and electric pulp tests, periapical lesions, apex closure, root lengthening, and thickening of the dentin walls. Subgroup meta-analysis were conducted according to the type of platelet concentrate used. RESULTS Of the 1272 screened studies, 13 randomized controlled studies, 2 case-control studies and 1 cohort study were selected, in which 465 immature necrotic permanent teeth, particularly incisors and premolars, were treated. Of these 465 teeth, 457 (98.2%) in both the control and experimental groups remained clinically asymptomatic for the entire study duration, whereas eight (1.8%) showed signs and symptoms of failure, including spontaneous pain, sensitivity to percussion or reinfection. Compared with control teeth, teeth treated with PRP achieved better apical healing than BC group (RR 1.13, 95% CI 1.01-1.26, P = 0.03), and teeth treated with platelet concentrates showed improved apical closure (RR 1.04, 95% CI 0.86-1.25, P = 0.69), root lengthening (RR 1.01, 95% CI 0.74-1.39, P = 0.93), and thickening of the dentin walls (RR 1.35, 95% CI 0.95-1.93, P = 0.09), although these differences were not statistically significant. CONCLUSIONS Platelet concentrates can be used as successful scaffolds for regenerative endodontic treatment of necrotic immature permanent teeth, and PRP as a scaffold may achieve better periapical healing of teeth with periapical inflammation, although they did not differ significantly from conventional blood clot scaffolds in development of the root.
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Affiliation(s)
- Qianwei Tang
- grid.256607.00000 0004 1798 2653College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, Guagnxi China
| | - Hua Jin
- grid.19373.3f0000 0001 0193 3564Department of Stomatology, Harbin Institute of Technology Hospital, Harbin, HeiLongjiang China
| | - Song Lin
- Department of Pediatric Dentistry, Jinan Stomatology Hospital, Jinan, 250001 Shandong Province China
| | - Long Ma
- Department of Pediatric Dentistry, Jinan Stomatology Hospital, Jinan, 250001 Shandong Province China
| | - Tingyu Tian
- Department of Pediatric Dentistry, Jinan Stomatology Hospital, Jinan, 250001 Shandong Province China
| | - Xiurong Qin
- Department of Pediatric Dentistry, Jinan Stomatology Hospital, Jinan, 250001 Shandong Province China
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12
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Evaluation of the Effectiveness of Laser-Assisted Bleaching of the Teeth Discolored due to Regenerative Endodontic Treatment. Int J Dent 2022; 2022:3589609. [PMID: 35847349 PMCID: PMC9279097 DOI: 10.1155/2022/3589609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/04/2022] [Accepted: 06/20/2022] [Indexed: 11/18/2022] Open
Abstract
Regenerative endodontic treatments (RETs) as a valuable treatment option to save the immature necrotic teeth, have been reported to be associated with discoloration which is an inevitable unfavorable outcome. The present study aimed to compare three laser-assisted protocols with conventional walking bleaching in terms of bleaching efficacy. Seventy-two human incisor teeth underwent regenerative treatment. A triple antibiotic paste containing minocycline, ciprofloxacin, and metronidazole was used as an intracanal medicament. A human blood clot was applied as a scaffold and capped by a hydraulic calcium silicate-based cement. Ten weeks after the RET procedure, a four-session bleaching course started. Teeth were assigned to four groups: (1) 35% hydrogen peroxide gel, (2) 35% hydrogen peroxide gel + Nd: YAG laser, (3) 35% hydrogen peroxide gel + 980 nm diode laser, and (4) 35% hydrogen peroxide gel + 810 nm diode laser. The color changes (ΔE) were measured before and after bleaching sessions. The data were analyzed using Kruskal-Wallis nonparametric test. The statistical significance level was set at 0.05. Significant discoloration, exceeding the perceptibility threshold (ΔE > 3.7) was observed in all of the samples ten weeks after RET. There was no significant difference between groups in terms of RET-induced discoloration values (p > 0.05). Bleaching either by using 35% hydrogen peroxide or 35% hydrogen peroxide activated by different lasers used in this study resulted in significant tooth whitening (p < 0.05). There was no statistically significant difference among the groups in terms of bleaching efficacy (p > 0.05). Internal bleaching by using 35% hydrogen peroxide is as effective as laser-assisted protocols for correction of crown discoloration in teeth that have undergone RET.
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Panda P, Mishra L, Govind S, Panda S, Lapinska B. Clinical Outcome and Comparison of Regenerative and Apexification Intervention in Young Immature Necrotic Teeth-A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11133909. [PMID: 35807193 PMCID: PMC9267570 DOI: 10.3390/jcm11133909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 12/12/2022] Open
Abstract
This systematic review aimed to evaluate interventions individually and compare the clinical outcome of young, immature teeth treated with regenerative endodontic therapy (RET) and apexification procedure. The protocol was registered with PROSPERO (International Prospective Register of Systematic Reviews), bearing the registration number CRD42021230284. A bibliographic search in the biomedical databases was conducted in four databases—PubMed, CENTRAL, EMBASE and ProQuest—using searching keywords and was limited to studies published between January 2000 and April 2022 in English. The search was supplemented by manual searching, citation screening and scanning of all reference lists of selected paper. The study selection criteria were randomized clinical trial, prospective clinical studies and observational studies. The search found 32 eligible articles, which were included in the study. The quality assessment of the studies was performed using the Cochrane risk of bias tool for randomized control trials and non-randomized clinical studies. The meta-analysis was performed using Review Manager software (REVMAN, version 5). The results indicated that a clinicians’ MTA apexification procedure was more successful compared to calcium hydroxide. In RET, apical closure and overall success rate is statistically same for both apical platelet concentrates (APCs) and blood clots (BC). Both interventions have similar survival rates; however, RET should be preferred in cases where the root development is severely deficient, there is insufficient dentine and the tooth’s prognosis is hopeless even with an apexification procedure.
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Affiliation(s)
- Pratima Panda
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, Odisha, India; (P.P.); (S.G.)
| | - Lora Mishra
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, Odisha, India; (P.P.); (S.G.)
- Correspondence: (L.M.); (B.L.); Tel.: +91-889-526-6363 (L.M.); +85-42-675-74-61 (B.L.)
| | - Shashirekha Govind
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, Odisha, India; (P.P.); (S.G.)
| | - Saurav Panda
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, Odisha, India;
| | - Barbara Lapinska
- Department of General Dentistry, Medical University of Lodz, 92-213 Lodz, Poland
- Correspondence: (L.M.); (B.L.); Tel.: +91-889-526-6363 (L.M.); +85-42-675-74-61 (B.L.)
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Treatment Outcomes of Regenerative Endodontic Procedures in Traumatized Immature Permanent Necrotic Teeth: A Retrospective Study. J Endod 2022; 48:1129-1136. [DOI: 10.1016/j.joen.2022.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 12/11/2022]
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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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