Contemporary Microbial and Antimicrobial Considerations in Regenerative Endodontic Therapy

Abstract

Introduction: Regenerative endodontic therapy (RET) has gained considerable attention and wide approval. Although it is being performed routinely, the outcomes remain unpredictable, and the optimal approaches for treatment are not established. It has been shown that bacterial persistence in root canals in these cases significantly interferes with healing and root maturation. However, few objective clinical studies have evaluated the complex microflora present in the infections or the efficacy of various clinical procedures. In addition, the extent of the infection and biofilm maturation in immature teeth with necrotic pulp has been understudied. Furthermore, most models used in preclinical evaluation of these issues do not fully elucidate the complexity or variability of the clinical situation. Results and Conclusion: In this review, the main biological and clinical problems pertaining to RET will be discussed. Contemporary analysis of complex microbial communities will be reviewed with emphasis on how these types of analyses can provide clinically useful data. In addition, current and proposed approaches for the effective disinfection of the root canal environment without interference with stem cell viability or integrity of the dentin matrix in these cases will be explored. The future of research in this field, including better and more customizable approaches in RET, in light of recent technological advances and progress in endodontics, will be outlined.

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

“…The treatment of necrotic permanent immature tooth constitutes a challenge in endodontics since anatomic variation, caries, trauma, incomplete root development and other such harmful stimuli can arrest tooth development 1,3,9 . Pulp necrosis of an immature permanent tooth leads to discontinuation of tooth development causing thin dentinal walls and open apices.…”

“…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.…”

“…Conventional techniques of root canal filling rely on the presence of an apical constriction at the apex of the tooth. This presents management challenge in permanent immature teeth [1][2][3] .…”

Regenerative Endodontics and Minimally Invasive Dentistry: Intertwining Paths Crossing Over Into Clinical Translation

“…Theoretically, if we can sterilize the canal, and recreate a 3D “biological filling” in the form of regenerated vital tissues this would ensure an optimum outcome. Regenerative strategies targeting mature teeth will most likely differ from those for immature permanent teeth, due to the different challenges encountered in both situations regarding the weak natural architecture of immature teeth, in addition to, the complexity of biofilms, toxins, and antigens which could reside in the larger dentinal tubules in these teeth ( He et al, 2017 ; Verma et al, 2017 ; Almutairi et al, 2019 ; Fouad, 2020 ). Excessive removal of tooth structure accompanying a TEC especially at pulp chamber walls and around the canal orifices, may decrease the tooth resistance to fracture during function.…”

Biomaterial scaffolds for clinical procedures in endodontic regeneration

“…A plethora of challenges lie ahead for REPs for favorable clinical and histological outcomes to be achieved in the future. It has been shown that residual bacteria in the root canal adversely affect wound healing and root maturation [ 19 , 201 , 202 ]. Microbial control of necrotic immature teeth with apical periodontitis is challenging; bacterial biofilms that adhere to the uneven surface of the blunderbuss canals render conventional debridement and disinfection exorbitantly difficult in root canal systems [ 19 , 201 , 202 ].…”