Статті в журналах: "Regenerative endodontics, revascularization procedure"

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Adhikari, Bhawana, Sanjeeb Chaudhary, Bibek Khanal, Nisha Acharya, and Jwolan Khadka. "Knowledge, Attitude and Practice on Regenerative Endodontics among Endodontists of Nepal." MedS Alliance Journal of Medicine and Medical Sciences 2, no. 3 (August 20, 2022): 18–23. http://dx.doi.org/10.3126/mjmms.v2i3.47656.

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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.

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Krupińska, Anna M., Katarzyna Skośkiewicz-Malinowska, and Tomasz Staniowski. "Different Approaches to the Regeneration of Dental Tissues in Regenerative Endodontics." Applied Sciences 11, no. 4 (February 14, 2021): 1699. http://dx.doi.org/10.3390/app11041699.

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(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.

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Padmawar, Neeta Surendra, Viddyasagar Prabhakar Mopagar, Vinay Hanumantrao Vadvadgi, Sourabh Ramesh Joshi, and Meghna J. Padubidri. "Immature to Mature - A Predictable Outcome of Two Immature Incisors with 36 Months Follow-Up!" Journal of Evolution of Medical and Dental Sciences 10, no. 18 (May 3, 2021): 1356–60. http://dx.doi.org/10.14260/jemds/2021/286.

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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

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Kajol Relan, Manoj Chandak, Pooja Chandak, Madhulika Chandak, Chanchal Rathi, and Shruti Mishra. "Antibiotics: A changing scenario in Regenerative Endodontics." International Journal of Research in Pharmaceutical Sciences 11, SPL4 (December 21, 2020): 1453–57. http://dx.doi.org/10.26452/ijrps.v11ispl4.4321.

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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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Arshad, Sohaib, Fatima Tehreem, Muhammad Rehab khan, Fatima Ahmed, Anand Marya, and Mohmed Isaqali Karobari. "Platelet-Rich Fibrin Used in Regenerative Endodontics and Dentistry: Current Uses, Limitations, and Future Recommendations for Application." International Journal of Dentistry 2021 (December 15, 2021): 1–8. http://dx.doi.org/10.1155/2021/4514598.

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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.

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Henrique Chagas Silva, Mauro, Celso Neiva Campos, and Marcelo Santos Coelho. "Revascularization of an Immature Tooth with Apical Periodontitis Using Calcium Hydroxide: A 3-year Follow-up." Open Dentistry Journal 9, no. 1 (December 31, 2015): 482–85. http://dx.doi.org/10.2174/1874210601509010482.

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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.

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Lata, Prem, Ajay Chhabra, Varun Jindal, and Arun Thakur. "In–Vivo Clinical Evaluation of Regenerative Endodontics in Immature Necrotic Permanent Teeth With Open Apex." Dental Journal of Advance Studies 03, no. 01 (April 2015): 026–33. http://dx.doi.org/10.1055/s-0038-1672010.

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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.

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Sulakshana, Dr, Poornima P, Srinath S K, and Padmapriya S. "Revascularization of immature permanent teeth via blood clot or PRF Platelet rich fibrin: A review." RGUHS Journal of Dental Sciences 14, no. 3 (2022): 2–12. http://dx.doi.org/10.26715/rjds.14_3_2.

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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.

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Silva, Hadassa Fonsêca da, Alice Pinho André Gomes Morais, Guilherme Marinho Sampaio, Gabriel Henrique Queiroz Oliveira, Paulo Melo Júnior, Sandra Sayão Maia, and Luciano Barreto Silva. "Apice closure in Pulp Revascularization Therapy. Case report and literature review." Research, Society and Development 10, no. 9 (August 3, 2021): e21110917814. http://dx.doi.org/10.33448/rsd-v10i9.17814.

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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.

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Costa, Luis A., Noemi Eiro, Andrea Vaca, and Francisco J. Vizoso. "Towards a New Concept of Regenerative Endodontics Based on Mesenchymal Stem Cell-Derived Secretomes Products." Bioengineering 10, no. 1 (December 20, 2022): 4. http://dx.doi.org/10.3390/bioengineering10010004.

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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.

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Alsharif, Ainaa, Eatmad AlSaif, Abdulrahman Talha, Miral Alsaif, Nada Aldossari, Mala Alshamlani, Mohammed Alhazzaa, et al. "Pulp Revascularization and Regeneration: Differences, Utilization, and Outcome." Journal of Healthcare Sciences 02, no. 11 (2022): 382–88. http://dx.doi.org/10.52533/johs.2022.21108.

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Microbial, mechanical, physical, and chemical factors are strong enough to endanger tooth pulp, resulting in alterations and inflammation of its vasculature, and causing intolerable pain. Clinical and technical management of diseases of these tissues is oftentimes very difficult due to the vastly varied anatomical nature of the pulpal space. Root canal treatment has been used to scavenge the diseased pulp and allow healing of the supporting tissues. In a small proportion of teeth, the creation of the apical root structure Hertwig’s Epithelial Root Sheath may not be completed (causing an open apex) because of trauma or breach of the pulp by caries. In these scenarios, alternative techniques have been found, which regenerate a functional pulp tissue optimally. Regenerative endodontic procedures are biologically based techniques devised for predictable replacement of injured, infected, or missing structures with live viable tissues that restore the normal physiologic functions of the pulpdentine complex. Pulp revascularization is generally described as re-introduction of vascularity in the root canal system. Pulp regeneration, on the contrary, has not been accurately defined. Even though blood vessels are necessary components of dental pulp, pulpal regeneration is regarded incomplete without an odontoblastic layer bordering the dentin-pulp interface. Although the interactions with human pulp derived stem cells are still vague, it is suspected that conventional pulpal cells that resist infection can grow rapidly under the impact of Hertwig’s epithelial root sheath even during the inflammation stage; generating odontoblasts which has the ability to give rise to a tubular dentin, triggering apexogenesis. It is understood that similar and consistent outcomes in the endodontics are not always achieved. The pace of apex maturogenesis differs due to distinctive conditions of each case. A possibility of chronic necrosis my strip the pulpal tissue of remnants of viable cells and may lead to reduced capabilities to regenerate.

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Palit, M. C., K. S. Hedge, S. S. Bhat, S. S. Sargod, S. Mantha, and S. Chattopadhyay. "Tissue Engineering in Endodontics: Root Canal Revascularization." Journal of Clinical Pediatric Dentistry 38, no. 4 (July 1, 2014): 291–97. http://dx.doi.org/10.17796/jcpd.38.4.j5285857278615r1.

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Root canal revascularization attempts to make necrotic tooth alive by the use of certain simple clinical protocols. Earlier apexification was the treatment of choice for treating and preserving immature permanent teeth that have lost pulp vitality. This procedure promoted the formation of apical barrier to seal the root canal of immature teeth and nonvital filling materials contained within root canal space. However with the success of root canal revascularization to regenerate the pulp dentin complex of necrotic immature tooth has made us to rethink if apexification is at the beginning of its end. The objective of this review is to discuss the new concepts of tissue engineering in endodontics and the clinical steps of root canal revascularization.

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Velmurugan, N. "Revascularization of Necrotic Immature Permanent Teeth: An Update." Journal of Operative Dentistry & Endodontics 1, no. 1 (2016): 18–24. http://dx.doi.org/10.5005/jp-journals-10047-0006.

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ABSTRACT In the recent years, there is a paradigm shift in the management of necrotic immature permanent teeth, with most of these teeth being treated by revascularization rather than conventional apexification procedure. Current regenerative endodontic protocols (REP) emphasizes the need to have a disinfection protocols that will enable good disinfection without causing damage to stem cells. The current available evidence suggest that true pulp-dentin complex is not being formed after REP, nevertheless it can result in continued root development that will enable such tooth to survive for a long time. This article highlights the recent trends in revascularization procedures. How to cite this article Velmurugan N. Revascularization of Necrotic Immature Permanent Teeth: An Update. J Oper Dent Endod 2016;1(1):18-24.

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Naz, Fariha, Muhammad Qasim, Nadia Munir, Abdul Samad Khan, Sana Chaudhry, Manal Hussain Alshahrani, and Sara Ali Alshahrani. "Knowledge of Female Dental Students of KKU Regarding Pulp Revascularization Treatment." Pakistan Journal of Medical and Health Sciences 16, no. 8 (August 31, 2022): 748–50. http://dx.doi.org/10.53350/pjmhs22168748.

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Aim: To assess the knowledge of female dental students of KKU about pulp revascularization procedure. Methods: A self-administered questionnaire was distributed to female students of 5th and 6th year and to dental interns. Collected data were analysed with descriptive statistics using SPSS (V19). Results: 137 contributors filled the proforma. Highest percentage of students (35%) considered pulp revascularization as the best treatment for immature necrotic permanent teeth in terms of tooth survival and 45.3% believed to have strongest tooth structure with this procedure as compared to other options. 68.6% of the participants had never attempted this procedure. 53.3% of the students were not sure about the outcome of the treatment. Only 31.4% of the students were aware of need of post and core as a contraindication forprocedure. 52.6% participants chose the option of little instrumentation with sodium hypochlorite irrigation for canal cleaning and 27.7% considered CaOH as a best intracanal medicament. According to majority of students (44.5%) continued root development with absence of signs and symptoms were the best indications of successful treatment. Conclusion: Majority of the students had the knowledge of regenerative endodontics as a viable treatment option for immature permanent teeth with necrotic pulps but were unaware of the details of the procedure and case selection criterion. Students should be given detailed clinical knowledge of this procedure so that in their future clinical practice they consider it among other options either for treatment or do case selection for referrals to specialists. Keywords: pulp revascularization; knowledge; dental students.

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Marques, Eduardo Fernandes, Gabriel Sousa e. Silva, Victor Talarico Leal Vieira, Eduardo Fagury Videira Marceliano, Diana Rodrigues Leão Frota, Wania Christina Figueiredo Dantas, and Marilia Fagury Videira Marceliano-Alves. "Revascularization in a maxillary lateral incisor using bioceramic sealer: case report." Brazilian Journal of Development 8, no. 9 (September 16, 2022): 62655–67. http://dx.doi.org/10.34117/bjdv8n9-147.

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Revascularization is a regenerative endodontic dental procedure, which aims to stimulate the penetration of periradicular tissue inside the root canal, allowing vascularization of necrotic teeth, leading to a tissue repair and regeneration. Currently, Biodentine cement has been used to perform this procedure. The aim of this study was to report a clinical case about the revascularization of a maxillary lateral incisor with incomplete root formation using Biodentine. The patient, male, 10 years old, attended the multidisciplinary clinic of CEULP/ULBRA accompanied by the responsible, asymptomatic, reporting trauma to element 22, sensitivity and vertical percussion tests were performed with negative results. Through periapical radiography, incomplete root formation and a radiolucent area in the periapical region were observed. The revascularization technique was performed, aiming to stimulate the root formation. In the first session, instrumentation with K-type instruments at working length and intracanal medication were performed. After 15 days, the revascularization procedure was performed with a 25/0.02 K file led beyond the working length to stimulate periapical bleeding, so the canal was filled with blood up to the cervical third. Blood clotting was awaited, Biodentine was placed, and the definitive restoration was performed with composite resin. Follow-up up to 1 year and four months was carried out and the root development was observed. Thus, in the reported case, the revascularization technique proved to be efficient, allowing the continuity of the root formation a compromised tooth.

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Jung, Chanyong, Sangwan Kim, Taeuk Sun, Yong-Bum Cho, and Minju Song. "Pulp-dentin regeneration: current approaches and challenges." Journal of Tissue Engineering 10 (January 2019): 204173141881926. http://dx.doi.org/10.1177/2041731418819263.

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Regenerative endodontic procedures for immature permanent teeth with apical periodontitis confer biological advantages such as tooth homeostasis, enhanced immune defense system, and a functional pulp-dentin complex, in addition to clinical advantages such as the facilitation of root development. Currently, this procedure is recognized as a paradigm shift from restoration using materials to regenerate pulp-dentin tissues. Many studies have been conducted with regard to stem/progenitor cells, scaffolds, and biomolecules, associated with pulp tissue engineering. However, preclinical and clinical studies have evidently revealed several drawbacks in the current clinical approach to revascularization that may lead to unfavorable outcomes. Therefore, our review examines the challenges encountered under clinical conditions and summarizes current research findings in an attempt to provide direction for transition from basic research to clinical practice.

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Nivedhitha, M. S., Benoy Jacob, and Aishwarya Ranganath. "Concentrated Growth Factor: A Novel Platelet Concentrate for Revascularization of Immature Permanent Teeth—A Report of Two Cases." Case Reports in Dentistry 2020 (August 17, 2020): 1–8. http://dx.doi.org/10.1155/2020/1329145.

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This article elucidates the utilization of a novel platelet concentrate-concentrated growth factor (CGF) for rapid and successful healing outcome in regenerative endodontics. This case report focusses on two cases: 23-year-old and 21-year-old patients with incomplete root formation and periapical lesion. Case 1 and case 2 are classified as stage IV and stage II, respectively, in accordance with Cvek’s classification of open apex and had varied outcomes. The extent of open apex, root dentin thickness, and lesion were assessed using periapical radiograph and CBCT. Revascularization procedure was carried out after obtaining patient consent. Following bleeding induction, CGF was prepared, placed, and condensed using pluggers in the root canal space, followed by the placement of mineral trioxide aggregate (MTA) up to the level of CEJ. At 1-year follow-up, apical closure with increased root dentin thickness and reduced periapical radiolucency was evident.

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Hashem, Sara N., and Maha Adel Elhousiny. "Microhardness and Fracture Resistance of Radicular Dentin Treated with Different Concentrations of Calcium Hydroxide in Endodontic Regeneration Procedures." Open Access Macedonian Journal of Medical Sciences 9, no. D (December 23, 2021): 324–29. http://dx.doi.org/10.3889/oamjms.2021.7803.

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Purpose: to reveal the effect of different concentrations of prepared calcium hydroxide pastes (70%, 50%, and 30%) used in regenerative endodontic on microhardness and fracture resistance of radicular dentin. Material and methods: Different concentrations of calcium hydroxide (Ca(OH)2) were prepared with measured pH, then forty eight single rooted teeth were prepared and randomized into three groups according to Ca(OH)2 paste concentrations (12 samples each) and 12 samples were availed as control group. Group I: root canal contained 30% Ca(OH)2 paste. Group II: root canal contained 50% Ca(OH)2 paste. Group III: root canal contained 70% Ca(OH)2 paste. Samples were stored at 37 0C with 100% humidity for four weeks for subsequent microhardness and fracture resistance tests. Results: There was a statistically significant reduction of microhardness and fracture resistance between test groups and control group (P≤ 0.05), group III showed a significant reduction in both microhardness and fracture resistance compared to group I. However, there was no significant difference in pH between different concentration of Ca(OH)2. Conclusion: Increasing concentration of Ca(OH)2 paste can negatively affect microhardness and fracture resistance of radicular dentin in revascularization procedure.

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Alagl, Adel, Sumit Bedi, Khalid Hassan, and Jehan AlHumaid. "Use of platelet-rich plasma for regeneration in non-vital immature permanent teeth: Clinical and cone-beam computed tomography evaluation." Journal of International Medical Research 45, no. 2 (February 23, 2017): 583–93. http://dx.doi.org/10.1177/0300060517692935.

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Objective This study was performed to assess the clinical and radiological outcomes of a revascularization procedure in immature teeth with apical periodontitis using platelet-rich plasma (PRP). The PRP protocol and conventional revascularization protocol, which used a blood clot as the scaffold, were compared. Methods Thirty non-vital immature permanent teeth were randomly categorized into two groups. After disinfecting the root canal space with triple antibiotic paste (1:1:1 ciprofloxacin, metronidazole, and cefaclor), a tissue scaffold was created using either PRP or a blood clot (control) and covered with white mineral trioxide aggregate. All cases were followed up clinically and radiographically for 12 months. Differences in bone density, root length, and lesion size were calculated using preoperative and postoperative computed tomography images. The means of the differences in individual parameters in the blood clot and PRP groups were compared using the Mann–Whitney U test. Results After 5 months, sensitivity tests (cold and electric pulp tests) elicited a delayed positive response in 23 sites. At 12 months, cone-beam computed tomography revealed resolution or a decrease in lesion size and an increase in bone density in all 30 (100%) teeth. Additionally, continued root development was observed in 22 (73%) teeth and early root growth was observed in the test group (mineral trioxide aggregate with PRP). Conclusions The results of this study suggest that PRP can serve as a successful scaffold for regenerative endodontic treatment. With the exception of a significant increase in root length, the results of treatment with PRP were not significantly different from those of the conventional protocol using a blood clot as the scaffold.

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Dhaimy, Said, Sara Dhoum, Hind Amarir, Hafsa El Merini, Sellama Nadifi, and Amal El Ouazzani. "Pulpo-Periodontal Regeneration: Management of Partial Failure Revascularization." Case Reports in Dentistry 2017 (2017): 1–5. http://dx.doi.org/10.1155/2017/8302039.

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The aim of this work is to present a case of management of an open apex on a lower molar by using tissue engineering, with two endodontic procedures in the same tooth. We had to resort to pulp regeneration on the distal root and apexification with MTA on the mesial roots after the failure of regenerative therapy on those ones. The management consisted in scheduling regular follow-ups combined with X-rays. After 24 months, the radiological control has shown pulpo-periodontal regeneration associated with walls thickening and distal root elongation and periapical ad integrum healing.

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Feigin, Kristina, and Bonnie Shope. "Regenerative Endodontics." Journal of Veterinary Dentistry 34, no. 3 (August 16, 2017): 161–78. http://dx.doi.org/10.1177/0898756417722022.

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Regenerative endodontics has been defined as “biologically based procedure designed to replace damaged structures, including dentin and root structures, as well as cells of the pulp–dentin complex.” This is an exciting and rapidly evolving field of human endodontics for the treatment of immature permanent teeth with infected root canal systems. These procedures have shown to be able not only to resolve pain and apical periodontitis but continued root development, thus increasing the thickness and strength of the previously thin and fracture-prone roots. In the last decade, over 80 case reports, numerous animal studies, and series of regenerative endodontic cases have been published. However, even with multiple successful case reports, there are still some remaining questions regarding terminology, patient selection, and procedural details. Regenerative endodontics provides the hope of converting a nonvital tooth into vital one once again.

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Oliveira, Lilian Vieira, Anahi de Paula Melo, Priscilla Barbosa Ferreira Soares, Juliane Maria Guerreiro Tanomaru, Carlos José Soares, and Camilla Christian Gomes Moura. "Modified revascularization technique in permanent molars. A case series." Research, Society and Development 10, no. 5 (May 4, 2021): e20810514532. http://dx.doi.org/10.33448/rsd-v10i5.14532.

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There are few reports of regenerative endodontic procedures in molars, and most using manual root canal preparation. This case series describes a modified revascularization technique used in permanent molars (five patients between 9 and 16 years old). Patients were referred by an emergency service and a diagnostic hypothesis was made based on the patient's reports. At the first appointment, coronal preparation was performed using Hedstroem files and Gates Glidden drills, followed by complete root canal preparation with rotary NiTi files. Calcium hydroxide (Ca(OH)2) paste was used as intracanal medication. At the second appointment, intracanal medication was removed, followed by final irrigation with EDTA under ultrasonic agitation, and the clot was promoted. The entrances of the canals were sealed using a mineral trioxide aggregate sealer (MTA) and provisionally restored with a light-cured glass ionomer. All teeth were finally restored using direct composite resin restoration and were followed for up to 18 months, checking pain, edema, and fistula during clinical evaluation. Radiographic examinations were performed to assess apical repair until 15 months, where root apex closure and canal reduction were observed. After 6 months, evidence of healing was observed in all cases. It was possible to confirm that endodontic regeneration after mechanized root canal preparation, use of a MTA sealer, and direct composite resin restoration in molars is a promising option for maintaining permanent molars in adolescents.

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Patel, Suhag, Salwa Zafar, Abhishek Singh, Neetika Jain, and Ronak Choudhary. "A revitalization protocol lead to different outcomes in adjacent teeth." Journal of Research in Dentistry 3, no. 5 (March 21, 2016): 808. http://dx.doi.org/10.19177/jrd.v3e52015808-813.

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Regenerative Endodontic Procedures can be defined as biologically based procedures designed to replace damaged structures including dentin and cells of the pulp – dentin complex. The term revascularization is more commonly employed with regenerative procedures and describes reintroduction of vasculature in the root canal system. This case report describes the treatment of two nonvital immature teeth with infected pulp. Revitalization was attempted in two adjacent teeth by the same operator following similar protocol. In one of the teeth, revitalization was successful with continued root wall thickening, root lengthening and closure of the apex whereas in the adjacent tooth though root lengthening could not be achieved, a definite apical closure with irregular root wall thickening could be obtained.

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Virda, Maryam, Muhammad Bader Munir, Nighat Shafi, Haroon Asghar Ginai, Mamoona Ali, and Mahrukh Anwar. "Regenerative Endodontics Procedure in Treatment of Permanent Immature Teeth with Necrotic Pulp." Pakistan Journal of Medical and Health Sciences 15, no. 8 (August 25, 2021): 1899–902. http://dx.doi.org/10.53350/pjmhs211581899.

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Aim: To evaluate the radiographical success of Regenerative endodontics procedure in permanent immature teeth with necrotic pulp. Methods: This Descriptive case series was conducted at the Department of Operative Dentistry, de’Montmorency College of Dentistry/ Punjab Dental Hospital, Lahore from November 2015 to November 2016. A total of 30 cases were included using non-probability consecutive sampling. Patients of both genders with age range from 9 to 14 years were considered. Performance of procedure and evaluation of success was done in terms of root development on periapical radiographs. . Data was entered and analysed with IBM SPSS 20. Level of significance was kept at p-value ≤ 0.05 Results: Out of 30 patients, 13 were females and 17 were males. Mean age of patients included in this study was 11.5±1.737. Follow up at 12 months showed 90% success, with 27 cases showed root development on periapical radiograph. There was no significant relation of success with age and gender of patient with p- value greater than 0.05. Conclusion: It is concluded from current study that Regenerative Endodontics procedure in permanent immature teeth is encouraging and can be recommended for the treatment of permanent immature teeth with necrotic pulp. Further research studies are required for evaluation of root development in regenerative endodontics procedure. Key words: Regenerative Endodontics, Permanent Immature teeth, Root development

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Dali, Mamta, and Laleet Rajbanshi. "Regenerative endodontics: Changes, chances, and challenges of revascularization in pediatric dentistry." SRM Journal of Research in Dental Sciences 5, no. 3 (2014): 186. http://dx.doi.org/10.4103/0976-433x.138743.

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Karthick, Arumugam, Tamizharasan Sangavi, Venkatachalam Prakash, and Newbegin Selvakumar Gold Pearlin Mary. "Regenerative Endodontics-Clinical Procedure and Tooth Discolouration: A Review." Indian Journal of Public Health Research & Development 10, no. 8 (2019): 1648. http://dx.doi.org/10.5958/0976-5506.2019.02344.1.

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Syeda Abeerah Tanveer, Zainab Haji, and Robia Ghafoor. "Clinical applications and novel approaches in stem cell: an insight to dental pulp regeneration." Journal of the Pakistan Medical Association 73, no. 2 (February 7, 2023): S40—S46. http://dx.doi.org/10.47391/jpma.akus-07.

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Objectives: The aim of the review is to present the currently applied tissue regeneration through stem cells technology in regenerative endodontics. This review also summarises the various preclinical models used for the evaluation of stem cell-based therapies, their limitations, recent advances and challenges related to clinical applications of human stem cells. Methodology: A literature survey from 2010 to August 2022 was carried out in various electronic databases to identify the articles required for review on Pulp Regeneration through Stem Cells Technology. MeSH terms/keywords such as “Pulp regeneration,” “Pulp Revascularization,” “Pulp revitalization,” “Regenerative Endodontics” were used to search in the electronic databases comprised of PubMed database, SCOPUS, COCHRANRE library, EMBASE, CINAHL, ICTRP, Science Direct and a manual search was also done using the cross references and textbooks. Results: The searches revealed 299 articles. After reading the full text articles and applying the inclusion and exclusion criteria 15 articles were selected for the review fulfilling the criteria of the study. Conclusion: Currently in regenerative endodontics, there is a broad consent that the final tissue acquired is more likely to bone-like tissue mixed with connective tissue rather than the pulp-dentin complex. Moreover, re-innervation from sensory axons in regenerated tissue, is still to date, difficult to achieve. Keywords: Endodontics, Biocompatible, Pulp, Stem Cells, Tissue, Dentin, Axons

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Kotha, RavichandraSekhar, RaviGummaraju Raghunath, Sayesh Vemuri, and ChaitanyaRam Kandregula. "Root canal revascularization via blood clotting in regenerative endodontics: Essentials and expectations." Journal of Dr. NTR University of Health Sciences 2, no. 4 (2013): 235. http://dx.doi.org/10.4103/2277-8632.122156.

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Aljifan, Mohammad Khaled, Abdulrhman Ali Alshuwayi, Abdulaziz Saeed Almatrafi, Abdulelah Mohammed Shukr, Khalid Abdullah Alshahrani, Abdullah Abdulelah Almuhanna, Mohammed Abdullah AlMuhanna, et al. "The role of stem cell therapy in endodontics and its future." International Journal Of Community Medicine And Public Health 9, no. 2 (January 28, 2022): 1029. http://dx.doi.org/10.18203/2394-6040.ijcmph20220074.

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Regenerative therapy has been introduced in the literature for a long time and is currently being practiced in different fields, including dentistry and endodontics. Many applications have been reported in the literature for stem cell therapy. However, many complications and adverse events were reported in this context. The present literature review sheds more light on the clinical applications of stem cell therapy in regenerative endodontics and the future perspectives in this field. There are no doubts that there are many questions to be answered despite the huge advances in this field. In response to tissue injury, it has been shown that stem cell therapy can strengthen the efficacy of physiological response to these events and improve tissue regeneration. They can be used for managing cases of reversible pulpitis. Moreover, evidence indicates that they can enhance the revascularization of necrotic pulp tissues. Accordingly, these outcomes can significantly change the perspectives of clinical endodontic practice, and current root canal management modalities and perhaps draws researchers into discovering further future applications for other currently untreatable conditions. However, further future investigations are still needed to understand more about the mechanisms of these modalities and improve their clinical applicability.

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Zbańska, Justyna, Katarzyna Herman, Piotr Kuropka, and Maciej Dobrzyński. "Regenerative Endodontics as the Future Treatment of Immature Permanent Teeth." Applied Sciences 11, no. 13 (July 5, 2021): 6211. http://dx.doi.org/10.3390/app11136211.

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The regenerative endodontic procedure (REP) is an alternative solution for endodontic treatment of permanent teeth with incomplete root apex development. It results in angiogenesis, reinnervation, and further root formation. Indications for REP include immature permanent teeth with necrotic pulp and inflammatory lesions of the periapical tissues. The main contraindications comprise significant destruction of the tooth tissues and a lack of patient cooperation. We distinguish the following stages of this procedure: disinfection of the canal, delivery of the REP components, closure of the cavity, and follow-up appointments. For effective canal disinfection, the use of both rinsing agents and intracanal medicaments is suggested. Sodium hypochlorite and triple antibiotic paste are used most commonly. Light-activated disinfection is proposed as an alternative method. The prerequisite for the regeneration process of the pulp is the supply of its essential components: stem cells, growth factors, and scaffolds to the canal lumen. Blood clotting, platelet-rich plasma, and platelet-rich fibrin are used for this purpose. For a proper course of REP, it is also necessary to close the tooth canal tightly. For this purpose, mineral trioxide aggregate (MTA), tricalcium silicate (Biodentine), or types of glass ionomer cement are employed. The patient should attend regularly scheduled follow-up appointments and each time undergo a thorough interview, physical and radiological examination. The most important indicator of a successful REP is the continued growth of the root in length and thickness and the closure of the root apex visible on X-rays. Many different proposals for a management protocol have been published; the following paper proposes the authors’ original scheme. Regenerative endodontics is the future of the endodontic treatment of immature permanent teeth; however, it still requires a lot of research to refine and standardize the treatment protocol. The application of tissue engineering methods seems to be promising, also for mature teeth treatment.

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Fagogeni, Irini, Joanna Metlerska, Tomasz Falgowski, Maciej Górski, Mariusz Lipski, and Alicja Nowicka. "Effectiveness of Teeth Whitening after Regenerative Endodontics Procedures: An In Vitro Study." Journal of Clinical Medicine 11, no. 23 (November 28, 2022): 7016. http://dx.doi.org/10.3390/jcm11237016.

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Discolouration resulting from regenerative endodontic procedures may have a negative impact on the quality of life of treated patients; therefore, it is recommended to minimize this risk by selecting appropriate scaffolds and barrier materials, and if discolouration occurs, the use of a simple, cost-effective and minimally invasive technique, such as whitening, should be considered. This in vitro study aimed to evaluate tooth discolouration after two- and single-visit regenerative endodontic procedures and the effectiveness of subsequent whitening procedures with carbamide peroxide. Two hundred bovine incisors were included in this study and divided into twenty groups based on the tested material combinations. Two groups were control groups, one with saline and the other group with blood. In the 12 groups, the experiment was designed to be consistent with the two-visit regenerative endodontic procedures. Triple antibiotic paste or calcium hydroxide were placed in the root canal, and then scaffolds (e.g., blood or platelet-rich fibrin) and barrier materials (Biodentine, OrthoMTA or MTA Repair HP) were applied after rinsing the disinfectant pastes. In the six groups that corresponded to the single-visit regenerative endodontic procedure, the use of a disinfectant paste was omitted. Subsequently, the specimens were bleached twice with carbamide peroxide at a 7-day interval. Colour change measurements were performed using a spectrophotometer (VITA Easyshade Compact 5.0, VITA Zahnfabrik, Bad Säckingen, Germany). Statistical analysis was performed with the Kruskal–Wallis H test, the independent t-test and t-test for related samples. Tooth discolouration was noticed after two- and single-visit regenerative endodontic procedures, except for the platelet-rich fibrin+MTA Repair HP group. After the first and second whitening procedures, all of the tested two- and single-visit regenerative endodontic procedures groups showed a change in the colour of the crown, which was noticeable to the naked eye (∆E > 3.3). When analysing the ∆E value between the first and second bleaching procedures, no changes in the colour of teeth were visually noticed in the calcium hydroxide and platelet-rich fibrin +MTA Repair HP groups (∆E < 3.3). Single-visit regenerative endodontic procedures are suggested if possible; however, if two-visit regenerative endodontic procedures are performed, it is recommended to use calcium hydroxide as the disinfectant paste because of the lower staining potential. In the context of discolouration, platelet-rich fibrin is advisable for use as a scaffold. The whitening procedure is worth considering, but does not guarantee a return to the original tooth colour, especially when triple antibiotic paste is used.

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Castro-Gutiérrez, María Eugenia Marcela, Liliana Argueta-Figueroa, Gisela Fuentes-Mascorro, Adriana Moreno-Rodríguez, and Rafael Torres-Rosas. "Novel Approaches for the Treatment of Necrotic Immature Teeth Using Regenerative Endodontic Procedures: A Systematic Review and Meta-Analysis." Applied Sciences 11, no. 11 (June 3, 2021): 5199. http://dx.doi.org/10.3390/app11115199.

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The induction of a blood clot allowing apical revascularization with a subsequent apical closure was reported several decades ago. Recent research has been focused on examining different scaffolds for regenerative endodontic procedures (REPs). The aim of this study was to analyze the main outcomes in novel REP reported in the literature. The search was conducted using six databases. Only clinical trials aiming at the study of scaffolds for REP in the treatment of necrotic immature teeth were included. The risk of bias was assessed by the Risk of Bias 2 tool. Additionally, the quality of the included studies was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. A summary of individual studies and a meta-analysis were performed. Relative risks of data from clinical success and root length changes were used from the studies, and these were combined using a random-effects meta-analysis. The meta-analysis results reveal that the main outcomes showed no differences between the patients who received REP with scaffolds or only REP. Limitations include that the certainty of evidence was low and that there was significant heterogeneity in the scaffolds used in the included studies. The data suggest that the blood clot remains as the gold standard for REP.

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Suresh, Nandini, Buvaneshwari Arul, Dinesh Kowsky, and Velmurugan Natanasabapathy. "Successful Regenerative Endodontic Procedure of a Nonvital Immature Permanent Central Incisor Using Amniotic Membrane as a Novel Scaffold." Dentistry Journal 6, no. 3 (August 2, 2018): 36. http://dx.doi.org/10.3390/dj6030036.

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Successful regenerative endodontic procedure was performed in nonvital immature permanent central incisor (Stage-4 root development) using human amniotic membrane (HAM) as a novel scaffold. The treatment was performed according to the American Association of Endodontics guidelines with minimal canal instrumentation, 1% Sodium hypochlorite as irrigant and calcium hydroxide as intracanal medicament. During the second appointment, HAM was placed as a scaffold and Biodentine™ was layered over the HAM with glass ionomer cement and resin composite as coronal seal. Preoperative and post-operative cone beam computed tomography (at three years) was taken to assess the treatment outcome. The resolution of disease process and increase in canal width, as well as positive response to pulp sensitivity tests, were observed by the end of three years. There was approximately 78–86% reduction in the volume of periapical lesion size. This case report confirms that HAM can be used as a scaffold material for successful regenerative endodontic procedure (REP).

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Wikström, A., M. Brundin, M. F. Lopes, M. El Sayed, and G. Tsilingaridis. "What is the best long-term treatment modality for immature permanent teeth with pulp necrosis and apical periodontitis?" European Archives of Paediatric Dentistry 22, no. 3 (January 8, 2021): 311–40. http://dx.doi.org/10.1007/s40368-020-00575-1.

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Abstract Purpose To evaluate and assess the current knowledge about apexification and regenerative techniques as a meaningful treatment modality and to map the scientific evidence for the efficacy of both methods for the management of traumatised immature teeth with pulp necrosis and apical periodontitis. Methods This systematic review searched five databases: PubMed, Web of Science, Cochrane Library, Ovid (Medline), and Embase. Published articles written in English were considered for inclusion. The following keywords were used: Regenerative endodontic treatment OR regenerat* OR revital* OR endodontic regeneration OR regenerative endodontics OR pulp revascularization OR revasculari* OR ‘traumatized immature teeth’. Only peer-reviewed studies with a study size of at least 20 cases followed up for 24 months were included. Eligibility assessment was performed independently in a blinded manner by three reviewers and disagreements were resolved by consensus. Subgroup analyses were performed on three clinical outcomes: survival, success, and continued root development. Results Seven full texts out of 1359 citations were included and conventional content analysis was performed. Most of the identified citations were case reports and case series. Conclusions In the present systematic review, the qualitative analysis revealed that both regenerative and apexification techniques had equal rates of success and survival and proved to be effective in the treatment of immature necrotic permanent teeth. Endodontic regenerative techniques appear to be superior to apexification techniques in terms of stimulation of root maturation, i.e. root wall thickening and root lengthening. Knowledge gaps were identified regarding the treatment and follow-up protocols for both techniques.

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Gabriella Djuanda, Anastasia, Eska Dianti, Radixtio Auzan Fepiosandi, Daniyal Lazuardi Ramadhan, Dian Agustin Wahjuningrum, and Setyabudi. "Pulp tissue regeneration in the treatment of immature premolars accompanied by infection: A case report." Conservative Dentistry Journal 12, no. 2 (December 2, 2022): 95–99. http://dx.doi.org/10.20473/cdj.v12i2.2022.95-99.

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Background: Young permanent teeth are one of the challenges in performing endodontic treatment. Revascularization is a good yet simple treatment option for pulp tissue regeneration to stimulate periapical lesion healing, continue root growth and restore pulp tissue function. Purpose: This case report describes management of pulp tissue regeneration in teeth with infection. Case: Female, 16 years old, came complaining of pain in the left lower back tooth accompanied by recurrent swelling. Radiograph showed an open apex with apical lesion on tooth 35. The diagnosis was pulpal necrosis accompanied by a chronic apical abscess. Case management: The treatment plan was revascularization and direct composite restoration. After accessing the cavity, the teeth were prepared, irrigated, and medicated with TAP, which was repeated for 2 visits. On the next visit, after the root canal was cleaned, over instrumentation was performed for bleeding and Collaplug was placed over the blood clot, covered with MTA, and composite resin for coronal sealing. Follow up was carried out for up to 9 months and was asymptomatic. Radiographs show healing of the lesion accompanied by closure of the root canal. Conclusion: Regenerative endodontics has been shown the successful in stimulating root canal closure to treat immature teeth

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Srinivasan, Manali R., and Cruz Nishanthine. "Endodontic Surgery: Is it an Obsolete Clinical Procedure?" Journal of Operative Dentistry & Endodontics 2, no. 1 (2017): 40–44. http://dx.doi.org/10.5005/jp-journals-10047-0032.

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ABSTRACT Endodontic surgery has developed the perception as an unnecessary procedure, with the emergence of implants. This opinion has been based on endodontic surgery being performed using obsolete concepts and techniques that compromised the potential for clinical success, frequently resulting in the persistence of patient symptoms, periapical pathology, and, ultimately, extraction of the treated tooth. With the emerging concepts of magnification, advanced principles of soft and hard tissue management, use of tissue regenerative root-end filling materials, and enhanced principles of wound closure, surgical endodontics has emerged as a highly predictable and comparatively painless procedure. Periapical surgery should be regarded as the method of choice when orthograde endodontic therapy cannot be performed. The present study describes indications of endodontic surgery and a few cases successfully managed using endodontic surgery. How to cite this article Srinivasan MR, Nishanthine C. Endodontic Surgery: Is it an Obsolete Clinical Procedure? J Oper Dent Endod 2017;2(1):40-44.

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Carlsen, R. C., D. Kerlin, and S. D. Gray. "Regeneration and revascularization of a nerve-intact skeletal muscle graft in the spontaneously hypertensive rat." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 270, no. 1 (January 1, 1996): R153—R161. http://dx.doi.org/10.1152/ajpregu.1996.270.1.r153.

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Skeletal muscles in hypertensive subjects develop an increased resistance to insulin that reduces their ability to incorporate glucose and synthesize glycogen. Insulin is an anabolic hormone in muscle, and muscle insulin receptors bind the growth factor, insulin-like growth factor I (IGF-I), an important contributor to muscle development and regeneration. An increase in insulin resistance in hypertensive subjects might produce muscle atrophy and weakness or limit regenerative growth after injury. Regenerative muscle growth was assessed in 24-to 26-wk-old spontaneously hypertensive rats (SHR) and Wistar-Kyoto (WKY) rats by subjecting extensor digitorum longus (EDL), an ankle flexor, to a nerve-intact graft procedure. The procedure produces extensive muscle fiber and capillary degeneration, but has little effect on the muscle nerve. Muscle morphology and contractile function were examined in intact and regenerating EDL at 21, 42, and 63 days postgraft. Muscle revascularization was assessed histologically at the same time points. Severe established hypertension did not prevent the reestablishment of a structurally normal capillary network in injured muscles. SHR muscle fiber regeneration and maturation, however, were significantly depressed compared with WKY grafts. The reduced regenerative recovery of SHR EDL in adult animals with severe hypertension does not appear to be due to a failure to restore the muscle nerve or capillary network, but may reflect a reduced anabolic response to insulin or IGF-I.

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Moura, Rodrigo Queiroga de, Lorenna Mendes Temóteo Brandt, Raíssa Lima Toscano, Daliana Queiroga de Castro Gomes, and Kátia Simone Alves dos Santos. "Regeneração Pulpar: um Desafio Clínico." ARCHIVES OF HEALTH INVESTIGATION 11, no. 2 (October 18, 2021): 260–65. http://dx.doi.org/10.21270/archi.v11i2.5411.

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A regeneração pulpar implica a resolução da inflamação crônica e restauração do tecido dentoalveolar danificado. O sucesso dela requer efeitos do controle da infecção, biomateriais e células-tronco. Este trabalho apresenta uma visão clínica da regeneração pulpar, abordando protocolos, vantagens e limitações. Realizou-se uma busca eletrônica na Bireme e Pubmed utilizando os termos: pulp revascularization, regenerative endodontics, regeneração, endodontia em associação ao operador AND. Foram incluídos apenas relatos de caso, séries de caso e ensaios clínicos. Ao final, 18 artigos satisfizeram os critérios de elegibilidade. Nenhum artigo foi excluído. Viu-se que a maioria dos dentes submetidos são imaturos, irrigados com hipoclorito de sódio, utilizam como medicação intracanal a pasta tri-antibiótica, são feitos com indução de coágulo, fazem uso do MTA como barreira coronal juntamente com cimento de ionômero de vidro, tendo resultado positivo da terapia imposta. A regeneração endodôntica é uma terapia promissora, mas apresenta alto custo, incerteza do sucesso terapêutico, possibilidade de pigmentação coronária e calcificação.

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Sandra, Ferry, Andri Sutanto, Widya Wulandari, Reynaldo Lambertus, Maria Celinna, Nurrani Mustika Dewi, and Solachuddin Jauhari Arief Ichwan. "Crucial Triad in Pulp-Dentin Complex Regeneration: Dental Stem Cells, Scaffolds, and Signaling Molecules." Indonesian Biomedical Journal 15, no. 1 (February 23, 2023): 25–46. http://dx.doi.org/10.18585/inabj.v15i1.2265.

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BACKGROUND: Pulp damage can lead to dentinogenesis impairment, irreversible pulpitis, or pulp necrosis. Despite being the most used endodontic procedure to treat damaged pulp, root canal therapy only results in nonvital teeth which are prone to fractures and secondary infection. Pulp-dentin regeneration has a potential to regenerate structure similar to normal pulp-dentin complex, and can be achieved by combining dental stem cells, scaffold, and signaling molecules. This article reviews the role of various types of dental stem cells, scaffolds, signaling molecules, and their combinations in regenerating pulp-dentin complex.CONTENT: Dental pulp stem cell (DPSC), stem cell from human exfoliated deciduous teeth (SHED), and dental follicle stem cell (DFSC) were reported to regenerate pulp-dentin complex in situ. SHED might be more promising than DPSCs and DFSCs for regenerating pulp-dentin complex, since SHED have a higher proliferation potential and higher expression levels of signaling molecules. Scaffolds have characteristics resembling extracellular matrix, thus providing a suitable microenvironment for transplanted dental stem cells. To accelerate the regeneration process, exogenous signaling molecules are often delivered together with dental stem cells. Scaffolds and signaling molecules have different regenerative potential, including induction of cell proliferation and migration, formation of pulp- and/or dentin-like tissue, as well as angiogenesis and neurogenesis promotion.SUMMARY: Combinations of dental stem cells, scaffold, and signaling molecules are important to achieve the functional pulp-dentin complex formation. Current trends and future directions on regenerative endodontics should be explored. The right combination of dental stem cells, scaffold, and signaling molecules could be determined based on the patients’ characteristics. Incomplete pulp-dentin regeneration could be overcome by applying dental stem cells, scaffold, and/or signaling molecules in multiple visits.KEYWORDS: pulp-dentin regeneration, regenerative endodontics, dental stem cells, scaffold, signaling molecules

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Alipour, Mahdieh, Zahra Aghazadeh, Mehdi Hassanpour, Marjan Ghorbani, Roya Salehi, and Marziyeh Aghazadeh. "MTA-Enriched Polymeric Scaffolds Enhanced the Expression of Angiogenic Markers in Human Dental Pulp Stem Cells." Stem Cells International 2022 (February 21, 2022): 1–9. http://dx.doi.org/10.1155/2022/7583489.

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Revascularization of the pulp tissue is one of the fundamental processes and challenges in regenerative endodontic procedures (REPs). In this regard, the current study is aimed at synthesizing the mineral trioxide aggregate- (MTA-) based scaffolds as a biomaterial for REPs. Poly (ε-caprolactone) (PCL)/chitosan (CS)/MTA scaffolds were constructed and evaluated by FTIR, SEM, XRD, and TGA analyses. Proliferation and adhesion of human dental pulp stem cells (hDPSCs) were assessed on these scaffolds by scanning electron microscopy (SEM) and MTT assays, respectively. The expression of angiogenic markers was investigated in gene and protein levels by real-time PCR and western blotting tests. Our results indicated that the obtained appropriate physicochemical characteristics of scaffolds could be suitable for REPs. The adhesion and proliferation level of hDPSCs were significantly increased after seeding on PCL/CS/MTA scaffolds. The expression levels of VEGFR-2, Tie2, and Angiopoietin-1 genes were statistically increased on the PCL/CS/MTA scaffold. In support of these findings, western blotting results showed the upregulation of these markers at protein levels in PCL/CS/MTA scaffold ( P < 0.05 ). The current study results suggested that PCL/CS/MTA scaffolds provide appropriate structures for the adhesion and proliferation of hDPSCs besides induction of the angiogenesis process in these cells.

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Sedani, Shweta Kishor, Anuja Dhananjay Ikhar, and Akshay Pramod Thote. "The Next Big Thing is Really Big!! Magnification in Dentistry." Journal of Evolution of Medical and Dental Sciences 10, no. 15 (April 12, 2021): 1083–87. http://dx.doi.org/10.14260/jemds/2021/231.

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BACKGROUND The advances in the magnification sector have revolutionised the endodontic treatment from tactile and radiograph based to the vision driven. Using magnification tools like loupes, microscopes, rod lens endoscopes and oroscopes in the endodontic practice enables the clinician to magnify the field of treatment further than that by naked eyes. Suitable illumination along with magnification adds to the success of any dental procedure. Dating back to 1870, surgical loupes have been used. Apotheker and Jako introduced microscope in dentistry for the first time in 1978. Carr, in 1992 highlighted the role of the surgical operating microscope in endodontics. Various applications of surgical operating microscopes include minimally invasive surgical techniques like in periodontal regenerative procedures, adhesive dentistry and various procedures in endodontics like caries detection, for hidden canals, pulp stone removal, instrument removal, surgical endodontics, retreatment, perforation seal etc. Parts of operating microscope include optical components, objective lens, binocular tubes, eyepieces, lighting unit and mounting system. Accessories include motorised / foot-controlled adjustment of focal length, mechanical optical rotating assembly (MORA) interface and beam splitter. Magnification aids assist in producing higher quality procedures due to better precision and accuracy. Using the microscope aids improved ergonomics for the operator. Using loupes or microscopes improves the clarity in treatment plan as well as its execution. The magnification aids with camera and video monitor attached, enhance the patient education and better documentation. A strong consideration should be given to adopt using the concept of magnification. This review intended to explain the use of these tools in dental procedures for better accuracy, handling and thoroughness, which will lead to fewer procedural errors. KEY WORDS Magnification, Illumination, Loupes

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Nie, Ermin, Jiali Yu, Rui Jiang, Xiangzhen Liu, Xiang Li, Rafiqul Islam, and Mohammad Khursheed Alam. "Effectiveness of Direct Pulp Capping Bioactive Materials in Dentin Regeneration: A Systematic Review." Materials 14, no. 22 (November 11, 2021): 6811. http://dx.doi.org/10.3390/ma14226811.

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Background: Regenerative endodontics aims to restore normal pulp function in necrotic and infected teeth, restoring protective functions, such as innate pulp immunity, pulp repair through mineralization, and pulp sensibility. The aim of this systematic review was to assess the dentin regeneration efficacy of direct pulp capping (DPC) biomaterials. Methods: The literature published between 2005 and 2021 was searched by using PubMed, Web of Science, Science Direct, Google Scholar, and Scopus databases. Clinical controlled trials, randomized controlled trials, and animal studies investigating DPC outcomes or comparing different capping materials after pulp exposure were included in this systematic review. Three independent authors performed the searches, and information was extracted by using a structured data format. Results: A total of forty studies (21 from humans and 19 from animals) were included in this systemic review. Histological examinations showed complete/partial/incomplete dentin bridge/reparative dentin formation during the pulp healing process at different follow-up periods, using different capping materials. Conclusions: Mineral trioxide aggregate (MTA) and Biodentine can induce dentin regeneration when applied over exposed pulp. This systematic review can conclude that MTA and its variants have better efficacy in the DPC procedure for dentin regeneration.

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Abbass, Marwa M. S., Aiah A. El-Rashidy, Khadiga M. Sadek, Sara El Moshy, Israa Ahmed Radwan, Dina Rady, Christof E. Dörfer, and Karim M. Fawzy El-Sayed. "Hydrogels and Dentin–Pulp Complex Regeneration: From the Benchtop to Clinical Translation." Polymers 12, no. 12 (December 9, 2020): 2935. http://dx.doi.org/10.3390/polym12122935.

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Dentin–pulp complex is a term which refers to the dental pulp (DP) surrounded by dentin along its peripheries. Dentin and dental pulp are highly specialized tissues, which can be affected by various insults, primarily by dental caries. Regeneration of the dentin–pulp complex is of paramount importance to regain tooth vitality. The regenerative endodontic procedure (REP) is a relatively current approach, which aims to regenerate the dentin–pulp complex through stimulating the differentiation of resident or transplanted stem/progenitor cells. Hydrogel-based scaffolds are a unique category of three dimensional polymeric networks with high water content. They are hydrophilic, biocompatible, with tunable degradation patterns and mechanical properties, in addition to the ability to be loaded with various bioactive molecules. Furthermore, hydrogels have a considerable degree of flexibility and elasticity, mimicking the cell extracellular matrix (ECM), particularly that of the DP. The current review presents how for dentin–pulp complex regeneration, the application of injectable hydrogels combined with stem/progenitor cells could represent a promising approach. According to the source of the polymeric chain forming the hydrogel, they can be classified into natural, synthetic or hybrid hydrogels, combining natural and synthetic ones. Natural polymers are bioactive, highly biocompatible, and biodegradable by naturally occurring enzymes or via hydrolysis. On the other hand, synthetic polymers offer tunable mechanical properties, thermostability and durability as compared to natural hydrogels. Hybrid hydrogels combine the benefits of synthetic and natural polymers. Hydrogels can be biofunctionalized with cell-binding sequences as arginine–glycine–aspartic acid (RGD), can be used for local delivery of bioactive molecules and cellularized with stem cells for dentin–pulp regeneration. Formulating a hydrogel scaffold material fulfilling the required criteria in regenerative endodontics is still an area of active research, which shows promising potential for replacing conventional endodontic treatments in the near future.

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Satpute, Tanvi Sanjay, Jayeeta Sidharth Verma, Jimish Rajiv Shah, and Aditya Kiran Shinde. "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, no. 11 (March 15, 2021): 845–48. http://dx.doi.org/10.14260/jemds/2021/181.

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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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Brizuela, C., D. Urrejola, G. Meza, I. Angelopoulos, and M. Khoury. "Translational pathway of scalable, allogenic encapsulated Mesenchymal Stem Cells for Dental Pulp Regeneration. RanoKure a controlled Phase I/II clinical trial designed to evaluate the survival of mature permanent teeth with apical lesion following a regenerative endodontics procedure." Cytotherapy 20, no. 5 (May 2018): S93—S94. http://dx.doi.org/10.1016/j.jcyt.2018.02.272.

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Dato, Guglielmo M. Actis, Fabrizio Sansone, Edoardo Zingarelli, Roberto Flocco, Giuseppe Punta, Francesco Parisi, Pier Giuseppe Forsennati, et al. "Pre-Operative Cytokine-Induced Mobilization of Bone Marrow-Derived Cells, Followed by Revascularization Surgery: Early and Long-Term Results of a Prospective Study in Patients with End-Stage Ischemic Cardiac Disease." Blood 118, no. 21 (November 18, 2011): 318. http://dx.doi.org/10.1182/blood.v118.21.318.318.

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Abstract Abstract 318 Introduction Coronary artery disease (CAD), along with its main complications, acute myocardial infarction (AMI) and congestive heart failure (CHF), remains a serious worldwide problem. Despite advances in medical and surgical treatments, CAD is still associated with a high mortality rate and markedly affects the quality of life of patients. The possibility to replace the scarring by inducing neoangiogenesis and possibly regeneration of injured myocardium is an attractive option to improve the prognosis of CAD patients. For this purpose, cytokine-induced mobilization of bone marrow stem cells (BMCs) into the peripheral blood might represents a potential pathway to activate the regenerative process. Some observations suggest that circulating BMCs may lodge in non-hematopoietic tissues such as muscle, liver and myocardium where the tissue injury or the local inflammation may promote stem cells migration. Thus, the association between cytokine induced BMCs migration and tissue injury, may induce tissue repair since the stem cells are usually attracted from the inflamed tissues. A phase II prospective study was performed combining BMCs migration, obtained by cytokines, and cardiac inflammation, induced by myocardial punctures. Results at early and long-term follow-up are here reported. Patients and methods BMCs mobilization was performed in 15 patients undergoing surgery for coronary artery bypass grafting (CABG) and/or mitral valve surgery and/or ventricular remodeling combined to multiple trans-myocardial punctures (Sen technique) in ungraftable non-viable fibrotic areas. BMC mobilization was induced by granulocyte colony stimulating factor (G-CSF) (Lenogastrim) given at 5 μgr/kg s.c. b.i.d. for 5 to 6 consecutive days, starting on day-3 before surgery along with granulocyte-macrophage colony stimulating factor (GM-CSF) (Molgramostim) at 2.5 μgr/kg s.c./day. Patients entered the study protocol on the basis of the following inclusion criteria: i. severe heart failure with left ventricular ejection fraction (EF) < 35%; ii. ineligibility to cardiac transplantation; iii. widespread myocardial ischemia with at least one area of akinetic and nonviable myocardium, detected by cardiac stress scintigraphy with Thallium; iv. presence of other combined surgical indications, including the requirement of surgery for CABG on areas other than nonviable scars; v. one or more previous myocardial infarction. The study protocol was approved by our local Institutional Review Board and Ethics Committee and all patients signed the informed written consent. Results Cytokine administration induced a variable increase in circulating CD34+ve cells in all patients, with peak values recorded between day +4 and day +6. There were no in hospital (0–30 days) deaths. All 15 patients were discharged from the ICU after a median of 2 days, while the overall in hospital stay was 10.5+4.2 days (range 7–21) and all patients were discharged in good clinical condition. There were two sudden deaths over the mid-term, at postoperative day +32 and +45: both patients had troublesome ECC weaning without other postoperative complications. Presently, at a median follow-up of 48 mos, four patients died, 11 patients are alive, one of them after heart transplantation. Among the 10 non-transplanted long-term survivors, there was a significant improvement of the NYHA class from 2,1±0,8 to 1,3±0,5 (p<0,005) and of the Canadian Class score from 2,6±0,5 to 1,0±0,0 (p<0,005); moreover, a significant increase of the ejection fraction from 31,4±7,3% to 41,7±12,6% (p<0,05) was documented. Conclusions The study suggests that cytokine-induced BMC mobilization combined to CABG along with multiple trans-myocardial punctures: i. is an innovative and safe procedure; ii. offers some clinical benefits in patients with end-stage CAD requiring cardiac surgery. Based on these results, a randomized trial has been launched, with the aim to define the beneficial effect of pre-operative cytokine-induced BMC mobilization in patients undergoing cardiac surgery. Disclosures: Off Label Use: G-CSF + GM-CSF in CAD.

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Huang, Fangting, Lei Cheng, Jiyao Li, and Biao Ren. "Nanofibrous scaffolds for regenerative endodontics treatment." Frontiers in Bioengineering and Biotechnology 10 (December 12, 2022). http://dx.doi.org/10.3389/fbioe.2022.1078453.

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Untreated dental caries, tooth trauma and dental anatomical variations such as dens invaginatus can result in pulpitis. However, standard root canal therapy cannot treat immature permanent teeth due to an open apical foramen and thin dentinal walls. Thus, regenerative endodontics treatment (RET) following a disinfection step with pulp regeneration has been developed. Pulp connective-tissue, dentin formation, revascularization and reinnervation can occur in this procedure which should be supplemented with intelligent biomaterials to improve repeatability and support well-coordinated regeneration. Furthermore, nanofibrous scaffolds, as one of the most commonly used materials, show promise. The purpose of this article is to highlight the advantages of nanofibrous scaffolds and discuss the future modification and application of them.

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Kumar, Jishnu Krishna, Padmapriya Surendranath, and Rajalakshmanan Eswaramoorthy. "Regeneration of immature incisor using platelet rich fibrin: report of a novel clinical application." BMC Oral Health 23, no. 1 (February 2, 2023). http://dx.doi.org/10.1186/s12903-023-02759-9.

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Abstract Background Endodontic treatment of young permanent teeth with necrotic pulp presents a clinical challenge for the dentist, and conventional endodontic treatment will result in tooth fracture along with a poor prognosis. Regenerative endodontics is a new protocol that has been advanced in the last decades for managing immature permanent teeth. Rare successful management of immature permanent incisors using platelet-rich fibrin is a technique-sensitive procedure. Case presentation A 08 years 04 months old female reported the chief complaint of pain in the upper front tooth region for one week. A blunderbuss canal was identified on radiographic examination, and revascularization using platelet-rich fibrin was planned and adopted. After the treatment, apical closure and root lengthening were noted without complications during subsequent follow-ups. Complete periapical healing with greater than 1.5 cm of dentinal thickness was noted. Conclusion Revascularization can be considered a viable treatment option for immature nonvital permanent teeth; with advancements in regenerative medicine and clinical practices, revascularization therapies could be developed as a novel mode of treatment in non-vital and dental traumatic cases.

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Cui, Dixin, Sihan Yu, Xin Zhou, Ying Liu, Lu Gan, Yue Pan, Liwei Zheng, and Mian Wan. "Roles of Dental Mesenchymal Stem Cells in the Management of Immature Necrotic Permanent Teeth." Frontiers in Cell and Developmental Biology 9 (May 19, 2021). http://dx.doi.org/10.3389/fcell.2021.666186.

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Dental caries and trauma always lead to pulp necrosis and subsequent root development arrest of young permanent teeth. The traditional treatment, apexification, with the absence of further root formation, results in abnormal root morphology and compromises long-term prognosis. Regeneration endodontics procedures (REPs) have been developed and considered as an alternative strategy for management of immature permanent teeth with pulpal necrosis, including cell-free and cell-based REPs. Cell-free REPs, including revascularization and cell homing with molecules recruiting endogenous mesenchymal stem cells (MSCs), have been widely applied in clinical treatment, showing optimistic periapical lesion healing and continued root development. However, the regenerated pulp–dentin complex is still absent in these cases. Dental MSCs, as one of the essentials of tissue engineering, are vital seed cells in regenerative medicine. Dental MSC–based REPs have presented promising potential with pulp–dentin regeneration in large animal studies and clinical trials via cell transplantation. In the present review, we summarize current understanding of the biological basis of clinical treatments for immature necrotic permanent teeth and the roles of dental MSCs during this process and update the progress of MSC-based REPs in the administration of immature necrotic permanent teeth.

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Suwartini, Tien. "Revaskularisasi gigi : Prosedur Perawatan Potensial untuk Regenerasi Gigi Nekrosis Pulpa Apeks Terbuka (Tinjauan Pustaka)." Jurnal Kedokteran Gigi Terpadu 1, no. 2 (February 6, 2020). http://dx.doi.org/10.25105/jkgt.v1i2.6392.

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Background: Endodontic treatment of young permanent (immature) necrosis teeth is often challenging because the condition of thin and short roots increases the risk of fracture during treatment. Review: The optimum healing condition for teeth with open apex necrotic pulp is to regrow functional pulp tissue and continued root development. A novel concept of revascularization of immature nonvital, infected teeth was recently introduced. Conclusions: This paper summarizes the literature supporting biological reasons for considering revascularization procedures for immature permanent teeth with pulp necrosis and the future potential of regenerating the pulp tissue as a routine dental procedure

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