Littérature scientifique sur le sujet « Regenerative endodontics, revascularization procedure »

INTRODUCTION: Regenerative Endodontics is one of the most fascinating development in modern dentistry. Since Endodontists are the first providers of this type of dental treatment, it is essential to learn their knowledge, attitude and practice of these procedures. Aim: This online questionnaire-based study was conducted amongst Endodontists practicing in Nepal with the aim to learn their knowledge, attitude and practice of regenerative endodontic procedures. MATERIALS AND METHODS: A cross-sectional study was conducted among Endodontists in Nepal. In total 65 Endodontists participated in this study. The questionnaire was distributed to the participants using the available electronic measures. Descriptive statistical analyses were performed on the responses given by Endodontists using SPSS Statistical Software package (version 21.0). RESULTS: A total of 20 questions were included in this study. Out of the responses analyzed, 100% (n=65) had come across the term regenerative endodontics. Respondents had good knowledge about the sources of dental stem cells (87.3%, n=55). A high percentage (98.4%, n=62) of respondents strongly recommended regenerative therapy to be incorporated into dentistry. Among the participants of this study, 87.1% (n=54) had a belief that regenerative endodontic treatment could serve as the alternative treatment option to dental implant. CONCLUSIONS: The Endodontists practicing in Nepal had sound knowledge about regenerative endodontic procedures. They were enthusiastic in practicing regenerative endodontics and interested in stem cell therapy. It’s a high time to uplift the regenerative endodontic procedure from simple revascularization via blood clotting to more advanced procedure.

(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.

Management of non-vital immature anterior permanent teeth in children remains a challenge in paediatric dentistry and endodontics. Once the tooth becomes non-vital, root development ceases, rendering the tooth weak, and unable to withstand physiological forces of mastication. This results in a high rate of root fracture with poor prognosis in the medium to long term. Despite being endodontically treated, over 50 % of such teeth will be lost in the first 10 years following trauma. Traditional endodontic treatment does not contribute to any quantitative or qualitative increase in root dimensions resulting in life-long oral disability. The advancement in the science of Endodontics - Regenerative Endodontics has revolutionized current treatment strategies in treating the immature non-vital permanent tooth which has overcome the drawbacks of traditional treatment approaches. This report provides an insight view on successful maturogenesis of immature non-vital permanent incisors by induction of intracanal bleeding along with complications endured during the process. Regenerative endodontics is defined as “biologically based procedures designed to replace damaged structures, including dentin and root structures, as well as cells of the pulp - dentin complex”.1 Continued root development and reestablishment of pulp - dentine complex can be achieved by these procedures. Two major concepts in the regenerative endodontics are guided tissue regeneration (GTR) and tissue engineering. The base of these procedures is stem cells which can differentiate into the desired tissue component, growth factors or other tissue - inducing mediators and scaffold.2 Regenerative endodontic procedure (REP) includes induction of intracanal bleeding, placement of platelet rich fibrin (PRF), and platelet rich plasma (PRP). The goals of these procedures were elimination of signs and symptoms, continued root development, apical healing, and positive response to vitality testing. But preparation of PRP and PRF requires withdrawal of blood and sight of syringe can add emotional stress to young patients. Revascularization may be defined as the invagination of undifferentiated periodontal cells from the apical region in immature teeth.3,4 The nature of tissue formed after revascularization is not certain and can be confirmed by histological evaluation. Presence of blood supply is reliable. Revascularization considers only one facet - nature of newly formed tissue thus making term revascularization inaccurate and thus many authors disagreed with this term.5

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.

Regenerative endodontics has introduced numerous procedures such as pulp implantation, revascularization, and postnatal stem cell therapy. Revascularization has been successfully implemented clinically nowadays, thus providing dentists with outrageous results. Platelet-rich fibrin (PRF) used either alone or along with bone graft promotes bone growth and vascularization. This matrix promotes migration, cell attachment, and proliferation of osteoblast that leads to bone formation. PRF consists of a packed fibrin complex consisting of leukocytes, cytokines, and glycoproteins such as thrombospondin. The usage of PRF has reported high success rates in surgical cases such as sinus lift procedures, healing of extraction sockets, and management of periapical abscesses. Compared to platelet-rich plasma, PRF is more economical, easy to prepare, and feasible to use in daily clinical practices. Revascularization compromised the induction of a blood clot into the root canal space, which emerged as a clinical triumph. This further led to platelet concentrates as an autologous scaffold on which revascularization could occur. The applications of PRF in regenerative endodontics are numerous, such as an agent for repairing iatrogenic perforation of the pulpal floor and for the revascularization of immature permanent teeth with necrotic pulps. It acts as a matrix for tissue ingrowth. Evidence of progressive thickening of dentinal walls, root lengthening, regression in the periapical lesion, and apical closure was reported. Further studies are needed to clarify the precise mechanism of action of PRF for dental pulp regeneration both in vitro and in vivo. The current review aims at the present uses of PRF in regenerative endodontics dentistry and its application with future recommendations and limitations.

Root canal treatment of teeth presenting immature development is a great challenge for both the patient and the professional. The thinness of the root canal walls of immature teeth may lead to root fracture and thus the outcomes of such treatments are uncertain. Revascularization is based on root canal decontamination followed by the induction of blood migration from the periapical tissues and the development of new vascular tissue in the canal space. The principle of disinfection in regenerative endodontics is that it should be achieved with minimum root canal instrumentation; an intracanal medication is used to inhibit bacterial growth and appropriate sealing of the coronal portion is performed. The American Association of Endodontists (AAE) considerations for regenerative endodontics include calcium hydroxide as an alternative intracanal dressing. This material has also been claimed to diminish the possibility of dental staining during revascularization procedures. The relatively new treatment protocol has been widely reported in the last few years; however it should be performed only when other alternatives are not reasonable. This case report presents a 3-year follow-up of a case of revascularization of a maxillary central incisor using calcium hydroxide as a root canal disinfection dressing.

Abstract Introduction: This study was conducted to evaluate clinical and radiographic findings induced by revascularization with and without platelet-rich plasma (PRP). Methods: Twenty patients with nonvital, immature anterior teeth were randomly categorized into 2 groups. Subsequent to minimal instrumentation of the root canal, disinfection was achieved with ledermix paste and followed by revascularization with and without PRP in groups 1 and 2, respectively. The cases were followed up clinically and radiographically at 6- and 12-month intervals. Results: Clinically, all cases were asymptomatic with complete resolution of signs and symptoms (except four cases which were considered as dropout). Radiographically, there was no significant difference in periapical healing, apical closure, and dentinal wall thickening in group I in comparison with group II. However, root lengthening was comparable for both of the procedures. Conclusions: Revascularization is a conservative and an effective method for inducing maturogenesis in nonvital, immature teeth. Supplementations with PRP can potentially improve the desired biological outcome of this regenerative procedure.

Regenerative endodontic procedure in an immature nonvital tooth is a biological treatment approach. Case reports have shown clinical and radiographic success following regenerative procedures and successful continued root development as well as strengthening of the root structure. Even though the primary goal of this treatment is to regenerate functional pulp tissue, a different outcome has been shown in histological analysis. This review discusses the conventional and Platelet rich fibrin (PRF) revascularization and also histological analysis of regenerated tissue in the root canal in animal and human studies.

Background: Endodontic Regenerative Procedures, especially pulp revascularization therapy, have become a real option for the treatment for immature permanent teeth with open apices. This sort of approach has saved many teeth that otherwise would have been extracted. The technique is simple and effective, and can be accomplished by any odontologist. Objective: This article aimed to make a literature review to give support for a case report of an Endodontic Regenerative Procedure of a twelve-year-old male patient with immature open apice of tooth 21. Methodology: Articles were researched concerning pulp revascularization to reach root end formation. On line searches were accomplished, whose database include BVS/BIREME, Web of Science, PUBMED Central, Science Direct, Higher Level Personnel Improvement Coordinator (CAPES), The Cochrane Library, and PROSPERO). Results: the articles researched showed that Endodontic Regenerative Procedures are efficient in stimulating root end formation. The case report described matched the results offered by the articles, showing an immature open apice tooth that had its root end completely formed after pulp revascularization therapy. Conclusion: Pulp revascularization therapy is an efficient and practical treatment for immature teeth with open apices.

The teeth, made up of hard and soft tissues, represent complex functioning structures of the oral cavity, which are frequently affected by processes that cause structural damage that can lead to their loss. Currently, replacement therapy such as endodontics or implants, restore structural defects but do not perform any biological function, such as restoring blood and nerve supplies. In the search for alternatives to regenerate the dental pulp, two alternative regenerative endodontic procedures (REP) have been proposed: (I) cell-free REP (based in revascularization and homing induction to remaining dental pulp stem cells (DPSC) and even stem cells from apical papilla (SCAP) and (II) cell-based REP (with exogenous cell transplantation). Regarding the last topic, we show several limitations with these procedures and therefore, we propose a novel regenerative approach in order to revitalize the pulp and thus restore homeostatic functions to the dentin-pulp complex. Due to their multifactorial biological effects, the use of mesenchymal stem cells (MSC)-derived secretome from non-dental sources could be considered as inducers of DPSC and SCAP to completely regenerate the dental pulp. In partial pulp damage, appropriate stimulate DPSC by MSC-derived secretome could contribute to formation and also to restore the vasculature and nerves of the dental pulp.

The aim of this study was to determine the trends in protocol, success rates, and consistency in follow up of revascularization procedures in a controlled environment. Patients of the Virginia Commonwealth University School of Dentistry were identified who were offered revascularization therapy as a treatment option on immature permanent teeth from January 1, 2010 to May 31, 2017. A total of 77 patients and 78 teeth were evaluated for revascularization therapy. For patients accepting treatment, records were reviewed for outcome assessment and consistency of follow up. A total of 30 patients (31 teeth) were treated following revascularization protocols, with only 20 patients (21 teeth) returning for follow up. Six of the 21 teeth needed some form of additional therapy due to patients remaining symptomatic, however 15/21 exhibited varying levels of success. Recall rate was 67.7%. With a success rate of 71.4%, revascularization therapy should continue to be considered for all patients with teeth having necrotic pulps and immature root apices. However, changes to recall protocols need to be improved in order to better monitor the status of teeth that undergo revascularization therapy.

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária
Em Medicina Dentária a taxa de incidência de patologia pulpar é elevada. Atualmente o tratamento realizado nestes casos passa pelo tratamento endodôntico não cirúrgico e obturação do sistema tridimensional de canais do dente permanente e maturo necrosado. Quando o tecido pulpar sofre necrose o prognóstico do dente está comprometido. Até então a abordagem terapêutica nestes casos passa por tratamento dos canais radiculares no caso de dentes com ápices maduros, apexificação em dentes com ápice imaturo ou extração. Apesar de estas modalidades terapêuticas apresentarem elevadas taxas de sucesso, a presença de uma polpa vital é fundamental para manter a homeostase e longevidade da peça dentária. Uma forma de terapia ideal pode consistir em abordagens regenerativas que consistem na remoção e substituição da polpa danificada ou necrosada por tecido pulpar saudável de forma a revitalizar o dente. Para atingir este objetivo os investigadores têm estudado diversas técnicas: revascularização por coágulo sanguíneo, terapia com células estaminais, implantação pulpar, implantação de scaffold, impressão tridimensional celular, scaffold injetável e terapia genética. Este tipo de tratamentos envolve combinação de desinfeção, desbridamento do canal afetado, utilização de células estaminais adultas, scaffolds e fatores de crescimento. Pode ser necessário também o alargamento apical para permitir a revascularização. Com esta revisão pretende-se compreender melhor o procedimento de revascularização pulpar no geral, vantagens e desvantagens, sua aplicabilidade na prática clinica diária e aferir sobre os resultados obtidos na literatura. Apesar de os desafios para a introdução das técnicas regenerativas como tratamento alternativo de dentes necrosados serem substancias, estas podem ser benéficas pois apresentam a possibilidade de restabelecer a funcionalidade pulpar, tornando a polpa vital capaz de promover a correta maturação apical. A inexistência de um protocolo fiável de atuação que permita a criação das condições necessárias para que ocorra a revitalização do tecido torna este tratamento pouco utilizado como tratamento alternativo na prática clinica. Assim, mais estudos são necessários para que futuramente seja possível elaborar um protocolo que possibilite a introdução das técnicas de revascularização pulpar na prática clinica diária. Dentistry in the incidence rate of pulpal pathology is high. Currently the treatment performed in these cases through the nonsurgical endodontic treatment and obturation of the three-dimensional system of permanent tooth and necrosed mature channels. When the pulp tissue undergoes necrosis prognosis of the tooth is compromised. Until then the therapeutic approach in these cases involves treatment of root canals in the case of teeth with mature apices, apexificação in teeth with immature apex or extraction. Despite these therapeutic modalities have high success rates, the presence of a vital pulp is essential to maintain homeostasis and longevity of tooth number. An ideal form of therapy might consist of regenerative approaches involving the removal and replacement of damaged or necrotic pulp by healthy pulp tissue to revitalize the tooth. To achieve this goal researchers have studied various techniques: revascularization by a blood clot, stem cell therapy, pulp, implantation of scaffold, cell dimensional printing, injectable scaffold and gene therapy. This type of treatment involves combination of disinfection, debridement of the affected channel, use of adult stem cells, scaffolds and growth factors. You may also need the apical enlargement to allow revascularization. With this revision is intended to better understand the procedure of pulp revascularization in general, advantages and disadvantages, its applicability in daily clinical practice and benchmark the results obtained in the literature. Although the challenges for the introduction of regenerative techniques as an alternative treatment of necrotic teeth are substances, these can be beneficial since they have the ability to restore functionality pulp making the vital pulp capable of promoting correct apical maturation. The absence of a reliable protocol operation that allows the creation of conditions necessary for the revitalization of the fabric makes this treatment occurs rarely used as an alternative treatment in clinical practice. Thus, further studies are needed, in future be possible to develop a protocol which would include the pulp revascularization in endodontics.

In case of necrotic and immature teeth, the regenerative endodontics procedures aim to replace damage pulp-dentin complex and normal pulpal physiologic functions that include root development and immunocompetency. These procedures are based on three principle of tissue engineering: appropriate source of stem cell; presence of growth factors for stem cell differentiation and an appropriate scaffold. The aim of the present study was to systematically analysed the Regenerative Endodontic protocols and the relative results. Methods: an electronic search was conducted in PubMed using appropriate Medical Subject Heading terms (regenerative endodontics, regenerative endodontic) covering a period until to April 2015. Additional hand searching was conducted, and reference section of each relevant articles were included in the search. In order to identified the relevant articles the scanning of titles, abstracts and ultimately full texts were scanned. Only Randomized Controlled Trials (RCTs) that reported the type of treated teeth, the causes of necrosis, a precise description of the operative protocols used, and the analysis of the results without limit on the time of follow-ups period were included for systematic review. Results: In the 51 studies selected a total of 357 treated teeth were analysed. For 20 teeth the authors (12) did not specified the type (anterior, premolar or posterior), for the remaining 337 teeth 24.3% were premolar (n°82), 2,4% were molar (n°8) and 73.3% were anterior teeth (n°247). No correlation has been recorded between the successful outcome of the therapy and the tooth type or the causes of pulp necrosis. No correlation has been observed between a satisfactory results and tooth type or causes of pulp necrosis. In conclusion, this review has several limitation: first of all the quality of the studies is very low. The section materials and methods often present bias for the description of PICOS terms. The major obstacle met has been represented by incomplete outcome data reported. RCTs adhering to the Consort guidelines could be encouraged to better guide the clinicians in the decision-making process.

A Endodontia é um ramo da Medicina Dentária que tem como principal objectivo abordar patologias relacionadas na sua génese com o interior da peça dentária, vulgo sistema tridimensional de canais e camara pulpar, provocando estes, afecção pulpar ou periradicular. O tratamento em dentes permanentes imaturos, onde se encontre a polpa necrosada e/ou infectada, com inevitável interrupção do desenvolvimento radicular, torna-se um desafio para o profissional. As técnicas convencionais são eficazes na resolução quando existe perda de função da polpa dentária. Recentemente surgiram técnicas, na Medicina Regenerativa que levam à revascularização do dente, tornando-se assim uma forma promissora no tratamento de dentes imaturos com necrose pulpar ou sintomatologia irreversível. A técnica que se abordará utiliza o coágulo sanguíneo e envolve uma desinfecção canalar eficiente, seguida da promoção de um coágulo sanguíneo e do selamento coronal do canal radicular, que tem como objectivo restabelecer a funcionalidade pulpar em dentes Endodonciados. Diversos estudos sustentam que através desta técnica, o canal irá conter os elementos necessários para ocorrer a sua regeneração. No entanto, devido à imprevisibilidade do conteúdo do coágulo, são ainda necessários mais estudos de maneira a definir um protocolo adequado, bem como, para avaliação da real taxa de sucesso associada à técnica em questão.
Endodontics is a branch of Dentistry that has as main goal to address related pathologies in its genesis with the interior of the tooth, the common three-dimensional system of canals and pulp chamber, provoking these, pulpal or periradicular affection. The treatment in immature permanent teeth, where the necrotic and / or infected pulp is found, with an inevitable interruption of root development, becomes a challenge for the professional. Conventional techniques are effective at resolution when there is loss of the function of the dental pulp. Recently there are techniques in Regenerative Medicine that lead to revascularization of the tooth, thus becoming a promising way to treat immature teeth with pulp necrosis or irreversible symptomatology. The technique that will be approach in this project use the blood clot and involves efficient canal disinfection followed by the promotion of a blood clot and coronal sealing of the root canal, which restore the pulp functionality in a Endodontic teeth. Several studies supports that with this technique, the channel will be contain the necessary elements to induce its regeneration. However, due to the unpredictability of the clot content, further studies are needed to define an adequate protocol, as well as to evaluate the actual success rate associated with this technique.

Indiana University-Purdue University Indianapolis (IUPUI)
Introduction: Regenerative endodontics (RE) is a treatment alternative for the infected immature tooth to establish an environment in the canal that enables continued root development and the growth of pulp or pulp-like tissue within the canal. A scaffold created in the canal encourages the formation of vital tissue. The porcine sub-intestinal-submucosa (SIS) membrane, Dynamatrix®, has the potential to serve as an endodontic scaffold. Research at Indiana University School of Dentistry (IUSD) has shown that Dynamatrix® can support the growth of human dental pulp stem cells (HDPSC) and human pulp fibroblasts (HPF). Positive angiogenic cytokine profiles were seen after these cells were seeded on Dynamatrix®. Endothelial cells play an important role in the formation of blood vessels and are a source of angiogenic cytokines. Exposure of these cells to DynaMatrix® may result in a positive angiogenic profile for both cytokines and matrix metalloproteinases (MMPs). Objective: The aim of this in-vitro study was to investigate if the exposure of human endothelial cells to the DynaMatrix® membrane would result in differences in the expression of cytokines and MMPs that play roles in angiogenesis. Materials and Methods: Human endothelial cells (HUVECs) were obtained from American Type Culture Collection (ATTC, Manassas, VA) and used in this study. Groups were established as follows: (a) Group 1: HUVECs seeded in culture media only, (b) Group 2: DynaMatrix® membrane incubated alone in the serum-media without any cells, and (c) Group 3: HUVECs seeded on DynaMatrix® membranes. After 72 hours of incubation, the conditioned media were collected and analyzed for the expression of 20 angiogenic cytokines and MMPs utilizing cytokine and MMP protein arrays. The density of each cytokine and MMP expressed was measured, averaged, and statistically analyzed by ANOVA. Results: Exposure of human umbilical vein endothelial cells (HUVECs) to the DynaMatrix® membrane resulted in a positive angiogenic profile for both cytokines and MMPs. Conclusion: This work furthers the evidence for the potential of DynaMatrix® to serve as a more predictable scaffold in RE.

O tratamento de dentes permanentes imaturos com comprometimento pulpar pode ser muitas vezes um desafio. Em dentes com a polpa vital, a manutenção da vitalidade pulpar é essencial, o que permitirá a continuação do desenvolvimento natural da porção radicular do elemento dentário. Já em dentes onde a polpa se encontre necrosada e/ ou infetada, há, inevitavelmente, a interrupção do desenvolvimento radicular, deixando o elemento dentário com paredes dentinárias finas e com o ápice aberto, o que torna o tratamento ainda mais desafiante, uma vez que o tratamento endodôntico convencional, baseado na preparação químico-mecânica e no preenchimento do sistema de canais radiculares com um material bioinerte, torna-se difícil ou até impossível. Atualmente, os tratamentos mais realizados para estes dentes passam pela apexificação com Hidróxido de cálcio (Ca(OH)2), ou a inserção de uma barreira apical de Agregado de Mineral Trióxido (MTA) seguidas pela obturação convencional do canal radicular. Ambas as técnicas têm um bom potencial na resolução das infeções e no encerramento apical; no entanto, não permitem a continuação do desenvolvimento radicular, o que mantém as paredes dentinárias finas e frágeis e o elemento dentário mais susceptível a fraturas. Estudos recentes têm vindo a demonstrar resultados positivos com uma nova abordagem de base biológica denominada revascularização pulpar. A técnica baseia-se na desinfeção do canal radicular e uma subsequente indução da formação de um coágulo sanguíneo no interior no canal, que servirá de base para a proliferação de um novo tecido, e uma possível regeneração do tecido pulpar. Desta forma pode-se alcançar além da resolução das infeções, a continuação do desenvolvimento radicular, o que resulta em raízes mais longas, com paredes mais espessas e no fecho apical normal. Embora a revascularização pulpar tenha vindo a demonstrar bons resultados clínicos e radiográficos, estudos histológicos demonstraram que o tecido formado no espaço pulpar pode não ser exatamente polpa. Mais estudos parecem ser necessários para que a técnica possa vir a ser executada com uma maior previsibilidade. A engenharia tecidular tem vindo a estudar diversas possibilidades para aprimorar a técnica, o que pode torná-la mais previsível no futuro.
Treatment of immature permanent teeth with affected pulp can often be a challenge. In teeth with vital pulp, the pulp vitality maintenance is essencial, which will allow the natural development of the root's portion of the tooth. However, in teeth with necrotic and/or infected pulp, there is, inevitably, the interuption of the root development, keeping the tooth with thin dentinal walls and an open apex, which turns the treatment even more challenging, once the conventional endodontic treatment, based on the chemical-mechanical preparation and filling of the root canal with a bioinert material, becomes difficult or even impossible. Currently, the most performed treatments for these clinical cases are apexification with calcium hidroxide (Ca(OH)2), or the insertion of an apical barrier of mineral trioxide aggregate (MTA) followed by the conventional obturation of the root canal. Both techniques have good potential in resolution of infections and apex closure; however, they do not allow the continuation of the root development, which keeps dentinal walls thin and fragile, and so the tooth more susceptible to fractures. Recent studies have shown positive results with a biological based new approach called pulp revascularization. This technique is based on the desinfection of the root canal and later induction of a blood clot formation into the root canal, wich will be the basis to the proliferation of a new tissue, and possibly regeneration of the pulp tissue. Thus, it is possible to get not only resolution of infections, but also the continuation of the root development, resulting in longer roots, thicker walls and normal apex closure. Although pulp revascularization has shown good clinical and radiographic results, histologic studies have shown that the tissue formed into the pulp space can be not exactly pulp. Further studies seem to be required, so that the technique can be performed more predictably. Tissue engineering has been studying many possibilities to improve this technique; wich can turn it more predictable in the future.

A taxa de incidência de patologia pulpar é elevada e o seu tratamento é efetuado principalmente por técnicas Endodônticas não cirúrgicas. Esta técnica de tratamento, embora tenha alta taxa de sucesso na reversão dos sintomas, tem desvantagens, uma vez que os dentes perdem a polpa vital, tornando-se este um problema, pois perdem também a homeostase, a sensibilidade e a estrutura dentária com a abertura da cavidade para a execução das técnicas Endodônticas. A conjugação destes fatores leva a uma diminuição da longevidade dentária, principalmente devido ao risco de fratura aumentado. Uma das formas de reverter a patologia pulpar é a revascularização pulpar. Os investigadores têm se debruçado sobre este assunto avaliando a utilização das terapias regenerativas . O objetivo desta revisão bibliográfica é compreender cada uma destas técnicas e a sua aplicabilidade tendo por base literatura publicada nos últimos 10 anos.
The incidence rate of the pulp disease is high and its treatment is mainly done by non-surgical endodontic techniques. In spite of having high success rate in reversing symptoms, this treatment technique has got its disadvantages, once the teeth lose their vital pulp, becoming this a serious problem because they also lose the homeostasis, the sensitivity and the dental structure with the opening of the cavity for the execution of the endodontic techniques. All these factors together lead to a decrease in dental longevity, mainly due to the risk of increased fracture. One way to revert the pulp pathology is the pulp revascularization. The researchers have been studying this matter by evaluating the use of regenerative therapies. The aim of this bibliographic revision is to understand what each one of these techniques means as well as its applicability according to published literature for the last 10 years.

Diversos tratamentos foram propostos para o tratamento de dentes permanentes imaturos com polpa comprometida, incluindo apexificação com Ca(OH)2 ou de criação de uma barreira apical com MTA. Contudo, estes não permitem a continuação do desenvolvimento radicular. A revascularização pulpar permite o espessamento da dentina radicular e o estabelecimento de uma correta morfologia apical, assim sendo, tornou-se parte dos tratamentos endodônticos em caso de dentes permanentes imaturos com polpa comprometida. No entanto, as análises histológicas sugerem que são necessários mais estudos para melhorar a previsibilidade dos resultados e para entender a fundo as interações biológicas entre células estaminais, scaffolds e fatores de crescimento. O objetivo deste trabalho é a avaliar o estado do conhecimento atual, entender as limitações e avaliar qual o melhor protocolo clínico. Na realização desta revisão narrativa foi efetuada uma pesquisa bibliográfica utilizando as bases de dados online Pubmed e Google Scholar incluindo apenas publicações de língua inglesa.
Several treatments have been proposed to treat irreversibly damaged pulp of immature permanent teeth, including apexification with Ca(OH)2 or creation of an apical plug of MTA. However, they don’t promote root development. Pulp revascularization promotes root dentin thickening and the establishment of a correct apical morphology, thus, it becames part of the spectrum of endodontic treatments for irreversibly damaged pulp of immature permanent teeth. However, histological analysis suggest that further studies are needed to improve the predictability of results and to understand better the biological interactions between stem cells, scaffolds and growth factors. The objective of this study is to evaluate the current state of knowledge, to understand the limitations of the technique, and to determine the best clinical protocol. To realize this narrative review, was carried out a bibliographical research using the online databases “Pubmed” and “Google Scholar” including only publications in English language.