Antibiotics: A changing scenario in Regenerative Endodontics

The main aim of Endodontics is to either prevent the endodontic disease or to treat it. This is achieved by maintaining the pulp health in cases of pulp inflammation. If there is pulp necrosis, pulp health can be maintained by regenerating the healthy pulp tissue. Hence various researches and the clinical studies tried to regenerate the healthy functioning pulp-dentin complex. Regenerative dentistry aims to biologically replace the dental tissues along with their supporting structures. Regenerative Endodontics can be defined as “ biologically based procedures designed to replace damaged structures such as dentin, root structures, and cells of the pulp-dentin complex.” Root canal anatomy is complex, hence even after mechanical instrumentation, there exists some portions of the root canal that remain untouched. Only instrumentation cannot completely eliminate the microbes existing into the root canal. Hence there is need to additionally irrigate the canals and also using medicaments is required to disinfect the root canal and promote healing. This article aims at focussing on various antibiotics used and role of these materials to disinfect the canals during revascularization treatment.

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Pulp Revascularisation of a Non-Vital Immature Young Permanent Tooth - A Case Report and Literature Review

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/181 ◽

2021 ◽

Vol 10 (11) ◽

pp. 845-848

Author(s):

Tanvi Sanjay Satpute ◽

Jayeeta Sidharth Verma ◽

Jimish Rajiv Shah ◽

Aditya Kiran Shinde

Keyword(s):

Case Report ◽

Root Development ◽

Root Canal ◽

Mineral Trioxide Aggregate ◽

Signs And Symptoms ◽

Permanent Tooth ◽

Duration Of Treatment ◽

Pulp Tissue ◽

Dental Tissues ◽

Immature Teeth

Traumatic injuries to an immature permanent tooth may result in cessation of dentin deposition and root maturation. Novel revascularisation endodontic procedure (REP) has been considered as an option for treatment of immature teeth with damaged pulp tissue. The continuous development of the root and the root canal has been recognised as a major advantage of this technique over traditional apexification approach. Traditional apexification procedures may resolve pathology but have not been able to prove tooth survival due to absence of continued root development and risk of root fracture. A successful REP results in resolution of signs and symptoms of pathology, radiographic signs of healing, proof of continued root development as well as presence of pulp vitality due to the regeneration of pulp tissue in the root canal. Currently, repair rather than true regeneration of the ‘pulp-dentine complex’ is achieved and further root maturation is variable. According to Glossary of Endodontic terms published by American Association of Endodontists, REP’s are biologically based procedures designed to physiologically replace damaged tooth structures, including dentin and root structures, as well as cells of the pulp-dentin complex.1,2 Apexification treatment has been a routine procedure to treat and preserve such teeth for many decades.3 Apexification is the process by which a suitable environment is created within the root canal and periapical tissue to allow for the formation of a calcific barrier across the open apex. Calcium hydroxide [Ca(OH)2] has been the material of choice for apexification as Frank reported its capacity to induce physiological closure of immature pulpless teeth in 1966.4 However, this technique has several disadvantages, including the unpredictability of apical barrier formation and the long duration of treatment, which often requires multiple visits.5 A retrospective study by Jeruphuaan et al.6 has shown a higher survival rate with regenerative endodontic treatment when compared to both mineral trioxide aggregate (MTA) and Ca(OH)2 apexification. The first evidence of regeneration of dental tissues was in 1932 by G.L. Feldman, who showed evidence of regeneration of dental pulp under certain optimal biological conditions.7 In 1971, a pioneer study in regenerative endodontics conducted by Nygaard-Ostby concluded that bleeding induced within a vital or necrotic canal led to resolution of signs and symptoms of necrotic cases and in certain cases, apical closure.8 According to Windley et al. (2005), the successful revascularisation of immature teeth with apical periodontitis is mainly dependent upon: 1. Canal disinfection 2. Scaffold placement in the canal for the growing tissues 3. Bacteria-tight sealing of the access opening.9 The purpose of this case report is to illustrate the outcome of a revascularisation endodontic procedure in a non-vital immature young permanent central incisor.

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The Role of microRNAs in Pulp Inflammation

Cells ◽

10.3390/cells10082142 ◽

2021 ◽

Vol 10 (8) ◽

pp. 2142

Author(s):

José Luis Muñoz-Carrillo ◽

Silverio Jafet Vázquez-Alcaraz ◽

Jazmín Monserrat Vargas-Barbosa ◽

Luis Guillermo Ramos-Gracia ◽

Israel Alvarez-Barreto ◽

...

Keyword(s):

Inflammatory Response ◽

Small Molecules ◽

Dental Pulp ◽

Target Genes ◽

Pulp Tissue ◽

Physical Chemical ◽

Pulp Inflammation ◽

Systematized Review ◽

Affected Tissue

The dental pulp can be affected by thermal, physical, chemical, and bacterial phenomena that stimulate the inflammatory response. The pulp tissue produces an immunological, cellular, and vascular reaction in an attempt to defend itself and resolve the affected tissue. The expression of different microRNAs during pulp inflammation has been previously documented. MicroRNAs (miRNAs) are endogenous small molecules involved in the transcription of genes that regulate the immune system and the inflammatory response. They are present in cellular and physiological functions, as well as in the pathogenesis of human diseases, becoming potential biomarkers for diagnosis, prognosis, monitoring, and safety. Previous studies have evidenced the different roles played by miRNAs in proinflammatory, anti-inflammatory, and immunological phenomena in the dental pulp, highlighting specific key functions of pulp pathology. This systematized review aims to provide an understanding of the role of the different microRNAs detected in the pulp and their effects on the expression of the different target genes that are involved during pulp inflammation.

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Internal granuloma with perforation – 2 case report

ARS Medica Tomitana ◽

10.1515/arsm-2015-0045 ◽

2015 ◽

Vol 21 (4) ◽

pp. 196-200

Author(s):

Suciu Ioana ◽

B. Dimitriu ◽

C. Varlan ◽

Cotrut Dana ◽

Cristea Diana ◽

...

Keyword(s):

Case Report ◽

Chronic Inflammation ◽

Root Canal ◽

Treatment Success ◽

Endodontic Treatment ◽

Pulp Chamber ◽

Pulp Tissue ◽

Pulp Inflammation ◽

Clinical Cases

Abstract Internal resorption was associated with long-term chronic inflammation of the pulp (chronic granulomatous pulpitis). When internal resorption is radiographically confirmed, endodontic treatment becomes a necessity. Vital teeth internal resorption appears radiographically as an oval enlargement of the pulp chamber and root canal with smooth, symmetrical outline. Internal granuloma is assumed to be an effect of the trauma, or pulp inflammation, the ailment is rare, asymptomatic and might progress rapidly, causing perforation. It is difficult to remove the pulp tissue from the resorptive defect, since this area is not easily accessible for instrumentation. The delay of the endodontic treatment may lead the internal resorption to perforation, thus decreasing the chances of treatment success. In the following paper, we present a total of two clinical cases with internal granuloma with perforation that have benefited of specific endodontic treatment.

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Biomimetics in Endodontics: A Review of the Changing Trends in Endodontics

Journal of Advanced Oral Research ◽

10.1177/2320206818816186 ◽

2018 ◽

Vol 9 (1-2) ◽

pp. 11-14

Author(s):

Jalak Patel ◽

Tejal Sheth ◽

Dhwanit Thakore ◽

Dharmesh Dhamat

Keyword(s):

Tissue Engineering ◽

Molecular Biology ◽

Root Canal ◽

Treatment Options ◽

Root Canal Treatment ◽

Technological Advancement ◽

Pulp Tissue ◽

Regenerative Endodontics ◽

Cell Culturing ◽

Changing Trends

Newer scientific technological advancement in dentistry provides an array of projects such as molecular biology, cell culturing, tissue grafting, and tissue engineering. Conventional root canal treatment, apexification with biomaterials, and extractions are the procedures of choice to treat a nonvital tooth. These treatment options do not give predictable outcomes in the regeneration of the pulp tissue. This can be easily achieved by regenerative endodontics wherein the diseased or a nonvital tooth is replaced by a healthy and functional pulp-dentin complex. The rationale for regenerative endodontics follows tissue engineering techniques. This article reviews the shift in regenerative endodontic techniques.

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Innovative Approaches to Regenerate Enamel and Dentin

International Journal of Dentistry ◽

10.1155/2012/856470 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 10

Author(s):

Xanthippi Chatzistavrou ◽

Silvana Papagerakis ◽

Peter X. Ma ◽

Petros Papagerakis

Keyword(s):

Tooth Development ◽

Cell Aggregate ◽

Molecular Control ◽

Cellular Behavior ◽

Cell Lineages ◽

Dental Tissues ◽

Tooth Mineralization ◽

Regenerative Dentistry ◽

Clinic Practice

The process of tooth mineralization and the role of molecular control of cellular behavior during embryonic tooth development have attracted much attention the last few years. The knowledge gained from the research in these fields has improved the general understanding about the formation of dental tissues and the entire tooth and set the basis for teeth regeneration. Tissue engineering using scaffold and cell aggregate methods has been considered to produce bioengineered dental tissues, while dental stem/progenitor cells, which can differentiate into dental cell lineages, have been also introduced into the field of tooth mineralization and regeneration. Some of the main strategies for making enamel, dentin, and complex tooth-like structures are presented in this paper. However, there are still significant barriers that obstruct such strategies to move into the regular clinic practice, and these should be overcome in order to have the regenerative dentistry as the important mean that can treat the consequences of tooth-related diseases.

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Regenerative Endodontics – Looking Inward

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2020/v32i730454 ◽

2020 ◽

pp. 83-98

Author(s):

Shivani Mallishery ◽

Tanvi Shah

Keyword(s):

Tissue Engineering ◽

Root Development ◽

Dental Pulp ◽

Ex Vivo ◽

Clinical Success ◽

Permanent Teeth ◽

Pulp Tissue ◽

Regenerative Endodontics ◽

Regenerative Dentistry

Regenerative endodontics has become a revolutionizing tissue engineering concept in the treatment of immature permanent teeth for over two decades. It has been described as a ‘paradigm shift’ in the treatment of immature teeth, since it fosters continued root maturation. An immature necrotic permanent tooth is usually a result of trauma or infection due to which the tooth becomes non-vital before completing root development. In such cases, the root walls are left thin and weak with an open apex. Traditional apexification procedures may resolve pathology but have not been able to prove tooth survival due to absence of continued root development and risk of root fracture. A successful regenerative endodontic procedure (REP) results in resolution of signs and symptoms of pathology, radiographic signs of healing, proof of continued root development as well as presence of pulp vitality due to the regeneration of pulp tissue in the root canal. Various stem cells, growth factors, scaffolds and suitable environment form the tetrad of elements necessary to induce regeneration of dental pulp. While there has been some success in isolating dental pulp cells with in-vitro experiments, it has been proven to be rather difficult to implement the same in a practical perspective ex vivo. Although there has been clinical success related to REP, histologically they seem to undergo guided endodontic repair rather than true regeneration of physiologic pulp tissue. This review provides an overview of components of tissue engineering, clinical protocol and predictable outcomes for REP and recent advances in regenerative dentistry.

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Application of Selected Biomaterials and Stem Cells in the Regeneration of Hard Dental Tissue in Paediatric Dentistry—Based on the Current Literature

Nanomaterials ◽

10.3390/nano11123374 ◽

2021 ◽

Vol 11 (12) ◽

pp. 3374

Author(s):

Alina Wrzyszcz-Kowalczyk ◽

Maciej Dobrzynski ◽

Iwona Grzesiak-Gasek ◽

Wojciech Zakrzewski ◽

Monika Mysiak-Debska ◽

...

Keyword(s):

Stem Cell ◽

Tissue Regeneration ◽

Paediatric Dentistry ◽

Pulp Tissue ◽

Dental Tissue ◽

Ongoing Research ◽

Dental Tissues ◽

Regenerative Dentistry ◽

Hard Dental Tissues ◽

New Research

Currently, the development of the use of biomaterials and their application in medicine is causing rapid changes in the fields of regenerative dentistry. Each year, new research studies allow for the discovery of additional possibilities of dental tissue restoration. The structure and functions of teeth are complex. They consist of several diverse tissues that need to act together to ensure the tooth’s function and durability. The integrity of a tooth’s enamel, dentin, cementum, and pulp tissue allows for successful mastication. Biomaterials that are needed in dentistry must withstand excessive loading forces, be biocompatible with the hosts’ tissues, and stable in the oral cavity environment. Moreover, each tooth’s tissue, as well as aesthetic qualities in most cases, should closely resemble the natural dental tissues. This is why tissue regeneration in dentistry is such a challenge. This scientific research focuses on paediatric dentistry, its classification of caries, and the use of biomaterials in rebuilding hard dental tissues. There are several methods described in the study, including classical conservative methods such as caries infiltration or stainless-steel crowns. Several clinical cases are present, allowing a reader to better understand the described methods. Although the biomaterials mentioned in this work are artificial, there is currently ongoing research regarding clinical stem cell applications, which have a high potential for becoming one of the most common techniques of lost dental-tissue regeneration in the near future. The current state of stem cell development is mentioned, as well as the various methods of its possible application in dentistry.

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The role of intracanal medicaments in inhibition of bacteria isolated from root canals of infected primary molars

Mustansiria Dental Journal ◽

10.32828/mdj.v14i1.766 ◽

2019 ◽

Vol 14 (1) ◽

pp. 92

Author(s):

Dr. Maha Abdul- Kareem Mahmood ◽

Dr. Huda Elias Ali ◽

Dr. Haraa Khairi Abdul-Kadher

Keyword(s):

Antimicrobial Activity ◽

Streptococcus Mutans ◽

Normal Saline ◽

Root Canal ◽

Primary Teeth ◽

Primary Molars ◽

Root Canals ◽

Etiologic Agents ◽

Micro Organisms

Microbes are considered as the primary etiologic agents in endodontic diseases.Disinfection of the root canal is obtained by the combined effect of biomechanicalpreparation, irrigation and intra canal medicament. The aim of the present study wasto assess the antimicrobial activity of intracanal medicaments (formocresol andEndosepton) against two micro organisms (Streptococcus mutans and staphylococcusaureus) isolated from 15 necrotic pulps of primary molars indicated for pulpectomyprocedure. The samples were cultured, and purified using microbiological evaluation.Broth dilution test was performed in our study by preparing test tubes containing10 ml of BHI broth (pH. 7) which then inoculated with strains of the tested bacteriaand incubated at 37 C° for 24 h. After over night incubaction, ten fold dilution weremade in test tubes containing 9 ml of normal saline by adding 1 ml of the inoculum tothe first tube . Then from dilution 10-1 , 0.1 ml of cell suspension was added to 9.9 mlof formocresol and endosepton, then 0.1 ml was taken and spread on duplicates ofBHI agar plates at different intervals and incubated aerobically for 24 h. at 37 C°.Colonies on the plates were counted after incubation and CFU/mL (colony formingunit) was calculated. Our results indicating that there were no significant differencesbetween the intracanal medicaments, but there were high significant differencesbetween the intervals time of the study. We concluded that both materials had greatantibacterial effect against the pathogens commonly isolated from necrotic pulpaltissue of primary teeth.

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Posterior Instability of the Talus: An Anatomic Evaluation

Foot & Ankle ◽

10.1177/107110078901000107 ◽

1989 ◽

Vol 10 (1) ◽

pp. 36-39 ◽

Cited By ~ 28

Author(s):

Marion C. Harper

Keyword(s):

Internal Fixation ◽

Cadaver Study ◽

Lateral Radiograph ◽

Medial Malleolus ◽

Posterior Instability ◽

Posterior Tibial ◽

Malleolar Fractures ◽

Posterior Malleolus ◽

Supporting Structures

A cadaver study was conducted to evaluate the role of the posterior tibial margin or posterior malleolus, as well as medial and lateral supporting structures, in providing posterior stability for the talus. Posterior malleolar fractures consisting of approximately 30%, 40%, and 50% of the articular margin on the lateral radiograph were created in specimens that were then subjected to posterior stressing. No posterior talar subluxation was noted in any specimen. Repeat stressing following removal of the medial malleolus again revealed no subluxation in any specimen. The lateral supporting structures, primarily the posterior fibulotalar and fibulocalcaneal ligaments, appeared to be the key structures providing posterior talar stability. If the fibula is stable in an anatomic position, feared posterior instability of the talus would not appear to be an indication for internal fixation of posterior malleolar fractures.

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Surgical Management of Compound Odontoma Associated with Unerupted Tooth

Case Reports in Dentistry ◽

10.1155/2015/902618 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Andrea Pacifici ◽

Daniele Carbone ◽

Roberta Marini ◽

Luciano Pacifici

Keyword(s):

Therapeutic Option ◽

World Health ◽

Permanent Teeth ◽

Surgical Removal ◽

Pulp Tissue ◽

World Health Organization Classification ◽

Dental Tissues ◽

Minimally Invasive Surgical ◽

Health Organization ◽

Compound Odontoma

Odontomas represent the most common type of odontogenic benign jaws tumors among patients younger than 20 years of age. These tumors are composed of enamel, dentine, cementum, and pulp tissue. According to the World Health Organization classification, two distinct types of odontomas are acknowledged: complex and compound odontoma. In complex odontomas, all dental tissues are formed, but appeared without an organized structure. In compound odontomas, all dental tissues are arranged in numerous tooth-like structures known as denticles. Compound odontomas are often associated with impacted adjacent permanent teeth and their surgical removal represents the best therapeutic option. A case of a 20-year-old male patient with a compound odontoma-associated of impacted maxillary canine is presented. A minimally invasive surgical technique is adopted to remove the least amount of bone tissue as far as possible.

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