Clinical Perspectives of Pulp Regeneration

Abstract

Introduction: A sound and vital pulp is an essential prerequisite for long-term tooth survival and preservation. However, current endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by a synthetic biomaterial. Recently, total or partial pulp regeneration has been proposed as an alternative treatment concept. The aim of this review was to evaluate the current options of pulp treatment and regenerative approaches, both for immature and mature teeth, in a clinical context. Methods: Clinical success rates of classic treatment options such as pulpotomy or root canal filling after pulpectomy or the removal of necrotic tissue are compared with recent reports on regenerative approaches like revitalization or partial and total pulp regeneration. Results: Revitalization in immature teeth with pulp necrosis is an additional treatment option besides placing an apical plug, leading to clinically acceptable outcomes, although with low predictability regarding the completion of root formation. Coronal regeneration of the amputated pulp in immature teeth constitutes a promising scientific approach, but data from clinical studies are missing. Mature teeth display a reduced potential for regeneration. Regenerative procedures using cell transplantation or cell homing are mainly in the experimental phase with only 2 clinical studies on cell transplantation. In parallel to the further development of regenerative therapies, the classification of pulp diseases should be revised, and the diagnostic tools need improvement. Conclusions: The rethinking of current concepts for biology-based treatments and improved diagnostic concepts might postpone the point of root canal filling depending on the clinical situation.

Efficacy of i-PRF in regenerative endodontics therapy for mature permanent teeth with pulp necrosis: study protocol for a multicentre randomised controlled trial

“…In this study, 20 mL of 1.0% NaClO will be used for irrigation with a side-vented needle and an ultrasonic irrigation device to minimise the possibility of extrusion of irrigates into the periapical space and to enhance the disinfection efficacy of NaClO. Following the recommendation from the AAE, NaClO should be flushed away from the root canal with saline to reduce any lingering toxicity [ 4 , 60 ]. EDTA irrigation will also be applied in this study, as EDTA has been demonstrated to promote the survival of stem cells [ 61 ], stimulate the release of growth factors embedded in the dentin matrix, and enhance the odontogenic differentiation of migrated cells and angiogenesis [ 6 ].…”

“…To date, root canal therapy (RCT) is the most acceptable treatment for pulp necrosis, based on the replacement of inflamed or necrotic pulp tissue with artificial filling materials [ 4 ]. However, this conventional therapy does not restore the vitality of damaged pulp or reconstitute the neurovascular system [ 5 , 6 ].…”

“…For mature permanent teeth, vital pulp is also of great importance in enhancing the immune system in root canals, promoting dentin deposition under chronic stimuli, and preventing discolouration [ 6 ]. But most of the reports of pulp regeneration in mature teeth are case reports or case series [ 6 , 9 , 11 , 12 ] as mature teeth have fewer stem/progenitor cells, have narrower apical pathways for cell migration, and are more difficult to disinfect [ 4 , 6 , 13 ]. Hence, it is of great urgency to develop an improved RET procedure to maximise the regeneration potential of mature teeth and extend the indications of RET.…”

External Root Resorption Management of an Avulsed and Reimplanted Central Incisor: A Case Report

“…Although in the present case report the avulsed and reimplanted immature permanent tooth underwent apexification, revitalization of necrotic open apex teeth might be considered a valid alternative treatment to the apical plug with MTA [ 2 ]. Regeneration procedures have been recently proposed also in mature permanent teeth [ 20 ], but they should be further confirmed in case of avulsion and reimplantation. In addition, a regenerative endodontic approach has been very recently suggested as a treatment strategy to arrest progressive development of root resorption of young permanent teeth, with the aim to promote new periodontal ligament attachment to ankylosed teeth [ 4 ].…”

Regenerative Endodontics Procedure in Treatment of Permanent Immature Teeth with Necrotic Pulp

“…The development of permanent immature teeth may be halted owing to various harmful stimuli such as caries, trauma, anatomic variations which leads to thin and fragile dentinal walls. The long-term survival of these teeth is conceded due to open apices, large apical diameters and short roots 1,2 . Conventional techniques of root canal filling rely on the presence of an apical constriction at the apex of the tooth.…”