Effectiveness of endodontic tissue engineering in treatment of apical periodontitis: A systematic review

Abstract

Background: Regenerative endodontics has evolved in recent years with tissue engineering concepts in particular appearing promising. Endodontic tissue engineering (ETE) describes the various approaches based on the orthograde introduction of scaffolds or biomaterials (with or without cells) into the root canal to achieve pulp tissue regeneration. There are currently no systematic reviews investigating whether ETE is a suitable method for the treatment of endodontic disease in both mature and immature permanent teeth. Objectives:The purpose of this systematic review was to determine the effectiveness of ETE in permanent teeth with pulp necrosis in comparison with conventional endodontic treatment. Methods:We searched MEDLINE, Embase and the Cochrane Library for published reports as well as Google Scholar for grey literature up to November 2021. Included were studies of patients with permanent immature or mature teeth and pulp necrosis with or without signs of apical periodontitis (P) comparing ETE (I) with calcium hydroxide apexification, apical plug and root canal treatment (C) in terms of tooth survival, pain, tenderness, swelling, need for medication (analgesics and antibiotics), radiographic evidence of reduction in apical lesion size, radiographic evidence of normal periodontal ligament space, function (fracture and restoration longevity), the need for further intervention, adverse effects (including exacerbation, restoration integrity, allergy and discolouration), oral health-related quality of life (OHRQoL), presence of sinus tract and response to sensibility testing (O). An observation period of at least 12 months was mandatory (T) and the number of patients in human experimental studies or longitudinal observational studies had to be at least 20 (10 in each arm) at the end (S). Risk of bias was appraised using the Cochrane risk-of-bias (RoB 2) tool. Two authors independently screened the records, assessed full texts for eligibility and evaluated risk of bias. Heterogeneity of outcomes and limited body of evidence did not allow for meta-analysis.Results: Two randomized clinical trials investigating cell transplantation approaches with a total of 76 participants (40 treated immature teeth and 36 treated mature teeth) were included for qualitative analysis. Both studies had moderate

Next generation antibacterial strategies for regenerative endodontic procedures: A scoping review

“…These conclusions corroborate the previous work of Matoug‐Elwerfelli, stating that more appropriate in vitro and in vivo studies are necessary to ensure a predictable clinical outcome of REPs (Matoug‐Elwerfelli et al, 2021). These lackings also echo findings from reviews of clinical studies on REPs, where a lack of evidence is concluded by Ribeiro et al (2020) and Widbiller et al (2022) who state that further, well designed studies, both pre‐clinical and clinical that include comparison of classical procedures and NGAS are necessary to assess the efficacy of alternatives to CAS for REP (Widbiller et al, 2022).…”

Treatment of pulpal and apical disease: The European Society of Endodontology (ESE) S3‐level clinical practice guideline

“…For this guideline, a total of 14 systematic reviews (SRs) were conducted to support the guideline development process (Bucchi et al, 2022; Bürklein & Arias, 2022; Corbella et al, 2022; Donnermeyer et al, 2022; Hilmi et al, 2023; Jakovljevic et al, 2022; Meire et al, 2022; Meschi et al, 2022; Pirani & Camilleri, 2022; Plotino et al, 2022; Rossi‐Fedele & Ng, 2022; Rossi‐Fedele & Rödig, 2022; Tomson et al, 2022; Widbiller et al, 2022). Each SR has two designated senior reviewers, who were from different countries and institutions and were not established collaborators, to work together on each review.…”

The dimethyloxalylglycine-functionalized nanofibers for in situ regeneration of infected developing dental roots

“…Navigating the intricacies of infected developing teeth presenting necrotic pulp and apical periodontitis demands a sophisticated comprehension of inflammatory mechanisms and the dynamics between bioactive signals and the inflammatory milieu within the root canal system. This approach underscores the importance of integrating biomaterials science principles to facilitate targeted therapeutic interventions [6][7][8] . Caused by anaerobic polymicrobial infection, the pathoses results in a halt in root development and the formation of osteolytic apical lesions, including damage to associated periapical tissues such as cementum, periodontal ligament, and alveolar bone, leading to early tooth loss [9] .…”