Different Approaches to the Regeneration of Dental Tissues in Regenerative Endodontics

(1) Background: The regenerative procedure has established a new approach to root canal therapy, to preserve the vital pulp of the tooth. This present review aimed to describe and sum up the different approaches to regenerative endodontic treatment conducted in the last 10 years; (2) Methods: A literature search was performed in the PubMed and Cochrane Library electronic databases, supplemented by a manual search. The search strategy included the following terms: “regenerative endodontic protocol”, “regenerative endodontic treatment”, and “regenerative endodontics” combined with “pulp revascularization”. Only studies on humans, published in the last 10 years and written in English were included; (3) Results: Three hundred and eighty-six potentially significant articles were identified. After exclusion of duplicates, and meticulous analysis, 36 case reports were selected; (4) Conclusions: The pulp revascularization procedure may bring a favorable outcome, however, the prognosis of regenerative endodontics (RET) is unpredictable. Permanent immature teeth showed greater potential for positive outcomes after the regenerative procedure. Further controlled clinical studies are required to fully understand the process of the dentin–pulp complex regeneration, and the predictability of the procedure.

Download Full-text

Histologic Outcomes of Uninfected Human Immature Teeth Treated with Regenerative Endodontics: 2 Case Reports

Journal of Endodontics ◽

10.1016/j.joen.2015.05.004 ◽

2015 ◽

Vol 41 (10) ◽

pp. 1725-1729 ◽

Cited By ~ 32

Author(s):

Ali Nosrat ◽

Alireza Kolahdouzan ◽

Farzaneh Hosseini ◽

Ehsan A. Mehrizi ◽

Prashant Verma ◽

...

Keyword(s):

Case Reports ◽

Regenerative Endodontics ◽

Immature Teeth

Download Full-text

Regenerative Endodontic Treatment of Immature Permanent Teeth with Necrotic Pulp: Two Case Reports

Turkiye Klinikleri Journal of Dental Sciences ◽

10.5336/dentalsci.2020-79273 ◽

2021 ◽

Vol 27 (3) ◽

pp. 526-530

Author(s):

Tamer TAŞDEMİR ◽

Tuğba KOŞAR ◽

Esra BALTACIOĞLU ◽

Davut ÇELİK

Keyword(s):

Case Reports ◽

Endodontic Treatment ◽

Permanent Teeth ◽

Regenerative Endodontic Treatment

Download Full-text

From Endodontic Therapy to Regenerative Endodontics: New Wine in Old Bottles

Current Stem Cell Research & Therapy ◽

10.2174/1574888x15999201116162256 ◽

2020 ◽

Vol 15 ◽

Author(s):

Ghee Seong Lim ◽

Mang Chek Wey ◽

Noor Hayati Azami ◽

Nora Sakina Mohd Noor ◽

May Nak Lau ◽

...

Keyword(s):

Stem Cells ◽

Root Canal ◽

Case Reports ◽

Clinical Signs ◽

Mineral Trioxide Aggregate ◽

Signs And Symptoms ◽

Regenerative Endodontics ◽

Immature Teeth ◽

Clinical Signs And Symptoms ◽

The 1960S

: The concept of regenerative endodontics wherein one can replace damaged pulp structures and recuperate the functionality in erstwhile necrotic and infected root canal systems has been a cutting-edge technology. Though the notion started as early as the 1960s even before the discovery of stem cells and regenerative medicine, it was in the 2000s, this procedure gained momentum. Ever since then, researchers continue to discover its essential benefit to immature teeth and its ability to overcome the caveats of endodontic therapy which is commonly known as root canal treatment. Further, through this therapy, one can redevelop root even in immature teeth with necrotic pulps which overall helps in maintaining skeletal and dental development. Past literature indicates that regenerative endodontic procedures seem to be successful especially when compared with other conventional techniques such as Mineral Trioxide Aggregate apexification. Besides, many clinicians have begun to apply regenerative endodontic procedures to mature teeth in adult patients with several clinical case reports that have shown complete resolution of signs and symptoms of pulp necrosis. Generally, three most desirable outcomes anticipated by clinicians from this procedure namely resolution of clinical signs and symptoms, root maturation and redevelopment of neurogenesis process. Despite this, whether these objectives and true regeneration of the pulp/dentin complex are achieved is still a question mark. Following the discovery that regenerative endodontics indeed is a stem cell-based treatment, addressing the fundamental issue surrounding stem cells might assist in achieving all identified clinical outcomes, while favoring tissue formation that closely resembles pulp-dentin complex.

Download Full-text

625 EFFICACY OF MYOTOMY IN PATIENTS WITH SIGMOID MEGAESOPHAGUS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Diseases of the Esophagus ◽

10.1093/dote/doab052.625 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Marina Orlandini ◽

Maria Carolina Serafim ◽

Letícia Datrino ◽

Clara Santos ◽

Luca Tristão ◽

...

Keyword(s):

Systematic Review ◽

Heller Myotomy ◽

Selection Process ◽

Case Reports ◽

Meta Analysis ◽

Case Series ◽

Cochrane Library ◽

Cross Sectional ◽

Manual Search ◽

The Mean

Abstract Megaesophagus progress to sigmoid megaesophagus (SM) in 10–15% of patients, presenting tortuosity and sigmoid colon aspect. Esophagectomy is the choice treatment but is associated with high complications and mortality rates. To avoid the esophagectomy inherent morbidity, several authors recommend Heller myotomy (HM) with pull-down technique for SM, mainly for patients with comorbidities and the elderly. This systematic review and meta-analysis is the first to analyze the effectiveness of HM for treating SM. Methods A systematic review was conducted in PubMed, Embase, Cochrane Library Central, Lilacs (BVS), and manual search of references. Inclusion criteria were: a) clinical trials, cohort studies, case series; b) patients with SM and esophageal diameter ≥ 6 cm; and c) patients undergoing primary myotomy. The exclusion criteria were: a) reviews, case reports, cross-sectional studies, editorials, letters, congress abstracts, full-text unavailability; b) animal studies, c) previous surgical treatment for achalasia; and d) pediatric studies. There were no restrictions on language or date of publication, and no filters were applied for the selection process. Random model and a 95% confidence interval (CI) were used. Results Sixteen articles were selected, encompassing 231 patients. The mean age ranged from 36 to 61 years old, and the mean follow-up ranged from 16 to 109 months. The analyzed outcomes include mortality, complications (pneumonia, pneumothorax, gastroesophageal reflux), need for reintervention (remyotomy, dilation and esophagectomy), and results classified as ‘good’ and ‘excellent’. Mortality rate was 0.035 (CI: 0.017–0.07; p < 0.01). Complications rate was 0.08 (CI: 0.04–0.153; p = 0.01). Need for retreatment rate was 0.161 (CI: 0.053–0.399; p < 0.01). Probability of good or excellent outcomes after myotomy was 0.762 (CI: 0.693–0.819; p < 0,01). Conclusion Heller myotomy is an option for avoiding esophagectomy in achalasia, with a low morbimortality rate and good results. It is effective for most patients but will fail in a minority of patients and demand retreatment, be it a remyotomy, endoscopic treatment or esophagectomy.

Download Full-text

Regenerative Endodontic Treatment versus Apical Plug in Immature Teeth: Three-Year Follow-Up

Journal of Clinical Pediatric Dentistry ◽

10.17796/1053-4628-40.5.356 ◽

2016 ◽

Vol 40 (5) ◽

pp. 356-360 ◽

Cited By ~ 13

Author(s):

Saeed Asgary ◽

Mahta Fazlyab ◽

Ali Nosrat

Keyword(s):

Endodontic Treatment ◽

Treatment Protocols ◽

Anterior Maxilla ◽

Periapical Lesions ◽

Cem Cement ◽

Immature Teeth ◽

Tooth Discoloration ◽

History Of ◽

The Right ◽

Regenerative Endodontic Treatment

This report compares and evaluates the treatment outcomes of regenerative endodontic treatment and apical plug as two accepted treatment protocols in a pair of necrotic immature maxillary central incisors of a 12-year old female. The patient was referred complaining of a dull pain and swelling in her upper lip area. She had a history of trauma to the anterior maxilla two years earlier. Both teeth were clinically diagnosed with pulp necrosis and periapical radiographs revealed that separate periapical radiolucent lesions surrounded the immature apices of both teeth. The left and right incisors were treated with apical plug and regenerative endodontic treatment, respectively, using calcium-enriched mixture (CEM) cement. The patient was followed-up for three years. During this period, both teeth were clinically asymptomatic and showed complete radiographic healing of the periapical lesions. The right central incisor showed root development. No tooth discoloration was evident. Apexification by apical plug placement and pulp regeneration are both reliable treatments for immature non-vital teeth. In order to choose the right treatment the advantages of either technique should be weighed against its drawbacks. CEM cement can be successfully applied for both purposes. This biomaterial causes less discoloration of the tooth.

Download Full-text

12-Year Follow-Up of Regenerative Endodontic Treatment of Immature Permanent Upper Incisors with Acute Abscess

Brazilian Dental Journal ◽

10.1590/0103-6440202003663 ◽

2020 ◽

Vol 31 (6) ◽

pp. 680-684

Author(s):

Claudio Maniglia-Ferreira ◽

Eduardo Diogo Gurgel Filho ◽

Fabio de Almeida Gomes ◽

Sthefanny Amaral Reis ◽

Fernanda Geraldo Pappen

Keyword(s):

Clinical Success ◽

Glass Ionomer Cement ◽

Mineral Trioxide Aggregate ◽

Endodontic Treatment ◽

Treatment Access ◽

Root Canals ◽

Immature Teeth ◽

The Right ◽

Regenerative Endodontic Treatment

Abstract This case report discusses the endodontic treatment of a 7-year-old girl who suffered trauma (intrusion) to the immature upper central incisors secondary to a fall from a bicycle. Thirty days after the accident the patient was brought by her mother for clinical and radiographic assessment with a chief complaint of swelling and tenderness to percussion and palpation. Acute apical abscess associated with immature teeth were diagnosed. A decision was made to perform regenerative endodontic treatment. Access cavities were made and the root canals were disinfected by irrigation with 2.5% sodium hypochlorite. Final irrigation was performed with 17% EDTA. Due to pain and presence of secretions, 2% chlorhexidine gel was applied as an intracanal medicament. Seven days later, at the second visit, the root canals were once again disinfected and the canals of the right and left permanent upper central incisors were filled with double antibiotic paste (metronidazole/ciprofloxacin) and calcium hydroxide paste, respectively. Zinc oxide was mixed in both pastes. At the third visit, after 21 more days, the pastes were removed and the periapical areas were stimulated with a #80 K-file to encourage clot formation within the pulp cavities. A mineral trioxide aggregate (MTA) paste cervical plug was placed and the teeth were restored with glass ionomer cement. Radiographs and CBCT scans demonstrated complete root formations. The patient has been followed for 12 years, with evidence of clinical success throughout.

Download Full-text