A REVIEW OF REGENERATIVE ENDODONTICS

Abstract

An alternative approach for immature necrotic permanent teeth is regenerative endodontic treatment. In this method, which is based on disinfection of the root canal system and periapical region without damaging the existing cells, the aim is to assist in the formation of new tissue within the canal after the stem cells are transported to the root canal and to induce further root development. Studies on stem cells, scaffold and signalling molecules which is triad of regenerative endodontic treatments concept are increasing nowadays thanks to intensive progress of regenerative medicine and tissue engineering. This review outlines the clinical protocols currently used and studies in regenerative endodontic procedures

Keywords

• regenerative endodontic treatment
• stem cells
• calcium hydroxide
• immature teeth
• pulp necrosis

A REVIEW OF REGENERATIVE ENDODONTICS

Abstract

İmmatür nekrotik daimi dişler için sunulan alternatif bir yaklaşım şekli de rejeneratif endodontik tedavidir. Kök kanalı sistemininde ve periapikal bölgede mevcut hücrelere zarar vermeden dezenfeksiyon hedeflenen bu yöntemde amaç, kök hücrelerin kök kanalına taşınmasıdır. Bu sayede kanal içinde yeni doku oluşumu indüklenerek kök gelişiminin devamlılığı hedeflenmektedir. Rejeneratif tıp ve doku mühendisliği alanındaki gelişmeler sayesinde rejeneratif endodontinin temel aldığı kök hücre, doku iskelesi ve büyüme sinyalleri triadı üzerine çalışmalar son dönemde ağırlık kazanmıştır. Bu derlemede rejeneratif endodontik tedavinin güncel protokol ve çalışmalarına yer verilmiştir.

Keywords

• rejeneratif endodontik tedavi
• kök hücre
• kalsiyum hidroksit
• kök gelişimi tamamlanmamış dişler
• pulpa nekrozu

References

1. 1. Mendoza AM, Reina ES, Garcia-Godoy F. Evolution of apical formation on immature necrotic permanent teeth. Am J Dent. 2010;23(5):269-74.
2. 2. Kleier DJ, Barr ES. A study of endodontically apexified teeth. Endod Dent Traumatol. 1991;7(3):112-7.
3. 3. El-Meligy OA, Avery DR. Comparison of apexification with mineral trioxide aggregate and calcium hydroxide. Pediatr Dent. 2006;28(3):248-53.
4. 4. Uslu G. Rejeneratif endodontik tedavi ile açık apeksli dişlerin tedavisi The international magazine of roots endodontics. 2019;22(1):26-30.
5. 5. Diogenes A, Simon S, Law AS. Regenerative Endodontics. ed. Hargreaves KM, Diogenes AR. Cohen’s Pathways of the Pulp. 11, edi Elsevier; 2016. 447-8 p.
6. 6. Ding RY, Cheung GS, Chen J, Yin XZ, Wang QQ, Zhang CF. Pulp revascularization of immature teeth with apical periodontitis: a clinical study. J Endod. 2009;35(5):745-9.
7. 7. Murray PE, Garcia-Godoy F, Hargreaves KM. Regenerative endodontics: a review of current status and a call for action. J Endod. 2007;33(4):377-90.
8. 8. Lin LM, Kahler B. A review of regenerative endodontics: current protocols and future directions. J Istanb Univ Fac Dent. 2017;51(3 Suppl 1):S41-S51.

9. 9. Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM. Replantation of 400 avulsed permanent incisors. 2. Factors related to pulpal healing. Endod Dent Traumatol. 1995;11(2):59-68.
10. 10. Lenzi R, Trope M. Revitalization procedures in two traumatized incisors with different biological outcomes. J Endod. 2012;38(3):411-4.
11. 11. Huang GT, Lin LM. Letter to the editor: comments on the use of the term "revascularization" to describe root regeneration. J Endod. 2008;34(5):511; author reply -2.
12. 12. Diogenes A, Henry M, Teixeira F. An update on clinical regenerative endodontics.. 2013.
13. 13. Jeeruphan T, Jantarat J, Yanpiset K, Suwannapan L, Khewsawai P, Hargreaves KM. Mahidol study 1: comparison of radiographic and survival outcomes of immature teeth treated with either regenerative endodontic or apexification methods: a retrospective study. J Endod. 2012;38(10):1330-6.
14. 14. Ostby BN. The role of the blood clot in endodontic therapy. An experimental histologic study. Acta Odontol Scand. 1961;19:324-53.
15. 15. Iwaya SI, Ikawa M, Kubota M. Revascularization of an immature permanent tooth with apical periodontitis and sinus tract. Dent Traumatol. 2001;17(4):185-7.
16. 16. Banchs F, Trope M. Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol? J Endod. 2004;30(4):196-200.
17. 17. Law AS. Considerations for regeneration procedures. Pediatr Dent. 2013;35(2):141-52.
18. 18. Wang X, Thibodeau B, Trope M, Lin LM, Huang GT. Histologic characterization of regenerated tissues in canal space after the revitalization/revascularization procedure of immature dog teeth with apical periodontitis. J Endod. 2010;36(1):56-63.
19. 19. Yamauchi N, Nagaoka H, Yamauchi S, Teixeira FB, Miguez P, Yamauchi M. Immunohistological characterization of newly formed tissues after regenerative procedure in immature dog teeth. J Endod. 2011;37(12):1636-41.
20. 20. Shimizu E, Jong G, Partridge N, Rosenberg PA, Lin LM. Histologic observation of a human immature permanent tooth with irreversible pulpitis after revascularization/regeneration procedure. J Endod. 2012;38(9):1293-7.
21. 21. Martin G, Ricucci D, Gibbs JL, Lin LM. Histological findings of revascularized/revitalized immature permanent molar with apical periodontitis using platelet-rich plasma. J Endod. 2013;39(1):138-44.
22. 22. American Association of Endodontists 2016. August [Available from: https://www.aae.org/specialty/wpcontent/uploads/sites/2/2017/06/currentregenerativeendodonticconsiderations.pdf.
23. 23. Huang GT, Yamaza T, Shea LD, Djouad F, Kuhn NZ, Tuan RS, et al. Stem/progenitor cell-mediated de novo regeneration of dental pulp with newly deposited continuous layer of dentin in an in vivo model. Tissue Eng Part A. 2010;16(2):605-15.
24. 24. Diogenes A.R RNB. Irrigation in Regenerative Endodontic Procedures.Endodontic Irrigation. B. B, editor: Springer, Cham; 2015. 301-12 p.
25. 25. Lin LM, Shimizu E, Gibbs JL, Loghin S, Ricucci D. Histologic and histobacteriologic observations of failed revascularization/revitalization therapy: a case report. J Endod. 2014;40(2):291-5.
26. 26. Diogenes AR, Ruparel NB, Teixeira FB, Hargreaves KM. Translational science in disinfection for regenerative endodontics. J Endod. 2014;40(4 Suppl):S52-7.
27. 27. Taweewattanapaisan P, Jantarat J, Ounjai P, Janebodin K. The Effects of EDTA on Blood Clot in Regenerative Endodontic Procedures. J Endod. 2019;45(3):281-6.
28. 28. Galler KM, Buchalla W, Hiller KA, Federlin M, Eidt A, Schiefersteiner M, et al. Influence of root canal disinfectants on growth factor release from dentin. J Endod. 2015;41(3):363-8.
29. 29. Martin DE HM, Almeida JFA, Teixeira FB,, Hargreaves KM DA. Effect of sodium hypochlorite on the odontoblastic phenotype differentiation of SCAP in cultured organotype human roots. . J Endod. 2012;38.
30. 30. Zeng Q, Nguyen S, Zhang H, Chebrolu HP, Alzebdeh D, Badi MA, et al. Release of Growth Factors into Root Canal by Irrigations in Regenerative Endodontics. J Endod. 2016;42(12):1760-6.
31. 31. Gowda L, Das UM. Effect of various concentrations of sodium hypochlorite on primary dentin: an in vitro scanning electron microscopic study. J Clin Pediatr Dent. 2012;37(1):37- 43.
32. 32. Nassar M, Hiraishi N, Tamura Y, Otsuki M, Aoki K, Tagami J. Phytic acid: an alternative root canal chelating agent. J Endod. 2015;41(2):242-7.
33. 33. Deniz Sungur D, Aksel H, Ozturk S, Yilmaz Z, Ulubayram K. Effect of dentine conditioning with phytic acid or etidronic acid on growth factor release, dental pulp stem cell migration and viability. Int Endod J. 2019;52(6):838-46.
34. 34. Trevino EG, Patwardhan AN, Henry MA, Perry G, Dybdal-Hargreaves N, Hargreaves KM, et al. Effect of irrigants on the survival of human stem cells of the apical papilla in a platelet-rich plasma scaffold in human root tips. J Endod. 2011;37(8):1109-15.
35. 35. Ashraf F. Fouad AN. Pulp regeneration in previously infected root canal space. Endodontic Topics. 2013;28(1):24-37.
36. 36. Soares Ade J, Lins FF, Nagata JY, Gomes BP, Zaia AA, Ferraz CC, et al. Pulp revascularization after root canal decontamination with calcium hydroxide and 2% chlorhexidine gel. J Endod. 2013;39(3):417-20.
37. 37. Adl A, Hamedi S, Sedigh Shams M, Motamedifar M, Sobhnamayan F. The ability of triple antibiotic paste and calcium hydroxide in disinfection of dentinal tubules. Iran Endod J. 2014;9(2):123-6.
38. 38. Siqueira JF, Jr., Lopes HP. Mechanisms of antimicrobial activity of calcium hydroxide: a critical review. Int Endod J. 1999;32(5):361-9.
39. 39. Mohammadi Z, Jafarzadeh H, Shalavi S, Yaripour S, Sharifi F, Kinoshita JI. A Review on Triple Antibiotic Paste as a Suitable Material Used in Regenerative Endodontics. Iran Endod J. 2018;13(1):1-6.
40. 40. Sato I, Ando-Kurihara N, Kota K, Iwaku M, Hoshino E. Sterilization of infected root-canal dentine by topical application of a mixture of ciprofloxacin, metronidazole and minocycline in situ. Int Endod J. 1996;29(2):118-24.
41. 41. Kim JH, Kim Y, Shin SJ, Park JW, Jung IY. Tooth discoloration of immature permanent incisor associated with triple antibiotic therapy: a case report. J Endod. 2010;36(6):1086-91.
42. 42. Shokraneh A, Farhad AR, Farhadi N, Saatchi M, Hasheminia SM. Antibacterial effect of triantibiotic mixture versus calcium hydroxide in combination with active agents against Enterococcus faecalis biofilm. Dent Mater J. 2014;33(6):733-8.
43. 43. Ruparel NB, Teixeira FB, Ferraz CC, Diogenes A. Direct effect of intracanal medicaments on survival of stem cells of the apical papilla. J Endod. 2012;38(10):1372-5.
44. 44. Chuensombat S, Khemaleelakul S, Chattipakorn S, Srisuwan T. Cytotoxic effects and antibacterial efficacy of a 3-antibiotic combination: an in vitro study. J Endod. 2013;39(6):813-9.
45. 45. Yassen GH, Eckert GJ, Platt JA. Effect of intracanal medicaments used in endodontic regeneration procedures on microhardness and chemical structure of dentin. Restor Dent Endod. 2015;40(2):104-12.
46. 46. Wongwatanasanti N, Jantarat J, Sritanaudomchai H, Hargreaves KM. Effect of Bioceramic Materials on Proliferation and Odontoblast Differentiation of Human Stem Cells from the Apical Papilla. J Endod. 2018;44(8):1270-5.
47. 47. Zanini M, Sautier JM, Berdal A, Simon S. Biodentine induces immortalized murine pulp cell differentiation into odontoblast-like cells and stimulates biomineralization. J Endod. 2012;38(9):1220-6.
48. 48. Camilleri J. Staining Potential of Neo MTA Plus, MTA Plus, and Biodentine Used for Pulpotomy Procedures. J Endod. 2015;41(7):1139-45.
49. 49. Aldakak MM, Capar ID, Rekab MS, Abboud S. Single-Visit Pulp Revascularization of a Nonvital Immature Permanent Tooth Using Biodentine. Iran Endod J. 2016;11(3):246-9.
50. 50. Attik GN, Villat C, Hallay F, Pradelle-Plasse N, Bonnet H, Moreau K, et al. In vitro biocompatibility of a dentine substitute cement on human MG63 osteoblasts cells: Biodentine versus MTA((R)). Int Endod J. 2014;47(12):1133-41.
51. 51. He L, Zhong J, Gong Q, Cheng B, Kim SG, Ling J, et al. Regenerative Endodontics by Cell Homing. Dent Clin North Am. 2017;61(1):143-59.
52. 52. Eramo S, Natali A, Pinna R, Milia E. Dental pulp regeneration via cell homing. Int Endod J. 2018;51(4):405-19.
53. 53. Kim SG, Zheng Y, Zhou J, Chen M, Embree MC, Song K, et al. Dentin and dental pulp regeneration by the patient's endogenous cells. Endod Topics. 2013;28(1):106-17.
54. 54. Cevat Erişken HA. Pulpa Canlılığının Yeniden Kazandırılmasında (Pulpa Rejenerasyonunda) Kullanılan Doku İskeleleri. Türkiye Klinikleri Journal of Endodontics-Special Topics. 2017.
55. 55. Kim JY, Xin X, Moioli EK, Chung J, Lee CH, Chen M, et al. Regeneration of dental-pulp-like tissue by chemotaxis-induced cell homing. Tissue Eng Part A. 2010;16(10):3023-31.
56. 56. Xuan K, Li B, Guo H, Sun W, Kou X, He X, et al. Deciduous autologous tooth stem cells regenerate dental pulp after implantation into injured teeth. Sci Transl Med. 2018;10(455).