A scoping review of root canal revascularization: relevant aspects for clinical success and tissue formation

Abstract

The aim of this scoping study was to evaluate the survival rate and nature of tissue formed inside root canals of human immature permanent teeth with necrotic pulps (NIPT) under root canal revascularization (RCR). The search was performed in SciVerse Scopus®, PubMed/MEDLINE, Web of Science®, BIREME and in the grey literature up to November 2015. The keywords were selected using MeSH terms and DECs. Two independent reviewers scrutinized the records obtained considering specific inclusion criteria. The included studies were evaluated in accordance with a modified Arksey and O' Malley's framework. From 375 studies that were evaluated, 75 were included. A total of 367 NIPT were submitted to RCR, from which only 21 needed further endodontic treatment. The weighted mean follow-up time was 17.6 months. The data were derived mainly from case reports (69%) or small case series (15%). NaOCl [0.5-6%] was applied as the disinfecting solution in almost all studies. Triple antibiotic paste was as effective as Ca(OH) as on intracanal medicament. De novo tissue was cementum and poorly mineralized bone positive to bone sialoprotein (BSP) but negative to dentine sialoprotein (DSP). Failures were associated mainly with reinfection of the root canal. The majority of included studies reported a significant increase in both root length and width. However, as most of these data came from case reports, they must be interpreted with care, as most were focused on treatment successes (not failures). Therefore, well-designed randomized controlled trials comparing RCR with available apexification treatments are needed to address this gap in the literature.

What is the clinical applicability of regenerative therapies in dentistry?

“…The presence of stem cells in the apical papilla of teeth with incomplete rhizogenesis is the principle used in recent root canal revascularization techniques 45 . The blood clot formed acts as a scaffold where the adhesion of the stem cells migrating to that region occurs.…”

“…Root canal revascularization (maturogenesis) is a recent technique that aims to reestablish a tissue similar to pulp in the root canal of necrotic teeth with incomplete apex 45 . It is based on the stem cells of the apical papilla present at the apex of the dental elements undergoing root development.…”

“…It is based on the stem cells of the apical papilla present at the apex of the dental elements undergoing root development. Thus, decontamination of the root canal is performed with a tri-antibiotic paste (usually composed of Metronidazole, Ciprofloxacin and Cefaclor), which remains in the root canal until all the clinical signs of infection have receded 45 . The apical periodontium is then stimulated with an endodontic file until bleeding occurs at the apex of the tooth, which in turn will fill the space of the root canal.…”

“…This blood is coagulated after a few minutes, forming a natural scaffold. After blood clotting, an MTA plug is deposited on the blood clot and the tooth is restored 45 . This procedure provides for the continuation of the development of the apical portion of the tooth root and the filling of the canal with a regenerated/repaired tissue (Figure 4) 47 obtained success in 32 teeth with an average of 51 months of followup.…”

“…These results seem to indicate that the technique appears to be effective. A recent scoping review that examined 75 revascularization studies noted that the more recent studies have applied PRP or PRF as natural scaffolds in the root canal 45 . Such studies have shown excellent results with continuing development of the tooth root and deposition of mineralized tissue on the walls of the canals, observed radiographically.…”