Histological Evaluation of Restylane Lyft Used as a Scaffold for Dental Pulp Regeneration in Non-Infected Immature Teeth in Dogs

Abstract

Commercially available hyaluronic acid dermal fillers used as a scaffold in regenerative endodontic procedures (REPs) have demonstrated attractive potentials. This study aimed to histologically evaluate the outcome of REPs using Restylane Lyft (HA) as a scaffold. REPs were performed on pulpless, immature roots in dogs (n = 69). The roots were divided into four groups: blood clot (BC), Restylane Lyft (BC + HA), negative control, and positive control. At 13 weeks postoperatively, hard tissue formation, vascularization, the presence of vascularized soft connective tissue and collagen fibers, the degree of inflammation within pulp spaces and/or periapical tissues, and apical closure were evaluated histologically. The vascularization and formation of loosely arranged collagen fibers within the regenerated soft connective tissues were observed significantly more in the BC+HA group (85% and 40%, respectively; p < 0.05) compared to the BC group (54.6% and 9.1%, respectively; p < 0.05). The degree of inflammation was significantly higher in the HA group than in the BC group; moderate to severe inflammatory cell infiltration was seen in 45% and 13.6% of the cases, respectively. The results of the present study suggest that Restylane Lyft combined with a blood clot used as a scaffold may improve the outcomes of REPs in non-infected, pulpless, immature teeth in dogs.

Histological Evaluation of Fda-Approved Hyaluronic Acid Based Scaffold in Revascularization of Necrotic Mature Permanent Teeth With Apical Periodontitis in Dogs

“…There was no difference regarding the type of formed tissues in both groups. (3) However; Revascularization using HA scaffolds with induced blood clot significantly enhanced tissue formation with better corono-apical extension than using HA scaffolds alone. (Table 1).…”

“…Previous studies have shown promising results when FDA-approved Restylane Lyft sterile injectable dermal filler was used as a scaffold for pulp regeneration in vitro and in immature teeth in vivo. (2,3) However, to date, the performance of Restylane Lyft hasn't been histologically investigated as scaffold in mature teeth.…”

Crucial Triad in Pulp-Dentin Complex Regeneration: Dental Stem Cells, Scaffolds, and Signaling Molecules

“…These biomaterials are expanded in vitro to environmentally mimic the in vivo condition. (71,72) Ideal scaffolds for regenerative endodontic therapy should resemble the extracellular matrix (ECM) of pulp-dentin complex in terms of dimensional stability, sufficient porosity with adequate particle size, similar biodegradability rate, as well as physical and mechanical strength (71,73,74), since biocompatibility is highly important to prevent adverse tissue reactions. (75) Bioscaffold for regenerative endodontic therapy includes broad ranges of applications and sources.…”

“…(96) For the regeneration of pulp and dentin-like tissue, polymers like collagen, gelatin, fibrin, chitosan, and HA have shown the ability to improve root development, including increase root length, root thickness, and enhance the mineralization of root canal. (73,89,91,93,94,(96)(97)(98) While being used as a single scaffold, those natural polymers also showed better ability in increasing intracanal connective tissue formations and narrowing apical width compared with BC, healing the periapical lesion, increasing dental wall thickness, as well as resuming the maturation process for the immature teeth. (73,(88)(89)(90)93,98) Natural polymers are often combined and crosslinked with other bioscaffold or chemical agents to improve its potential in regenerative therapy.…”

“…(73,89,91,93,94,(96)(97)(98) While being used as a single scaffold, those natural polymers also showed better ability in increasing intracanal connective tissue formations and narrowing apical width compared with BC, healing the periapical lesion, increasing dental wall thickness, as well as resuming the maturation process for the immature teeth. (73,(88)(89)(90)93,98) Natural polymers are often combined and crosslinked with other bioscaffold or chemical agents to improve its potential in regenerative therapy. (119) Dental pulp regeneration through cell homing approaches can be improved by using the combination of HA hydrogel and BC, as well as combination of chitosan hydrogel and BC scaffolds.…”