Regenerative Endodontics: A Systematic Analysis of the Failed Cases

Almutairi, Waleed; Yassen, Ghaeth H.; Aminoshariae, Anita; Williams, Kristin A.; Mickel, Andre

doi:10.1016/j.joen.2019.02.004

Cited by 79 publications

(58 citation statements)

References 51 publications

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“…The formation of a blood clot in the canal is not always predictable, and/or the blood may contaminate the crown of the tooth and cause discoloration [ 42 ]. Additionally, limitations in the disinfecting agents and the nature of dentin cause bacteria to remain present in the dentin after debridement [ 43 ]. Consequently, most failed cases after revitalization are due to remnant infection [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Autologous Platelet Concentrates in Management of Young Immature Necrotic Permanent Teeth—A Systematic Review and Meta-Analysis

Panda

Mishra

Arbildo-Vega

et al. 2020

Cells

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The use of autologous platelet concentrates (APCs) in regenerative endodontic procedures is inconsistent and unclear. The aim of this meta-analysis was to evaluate the effectiveness of autologous platelet concentrates compared to traditional blood-clot regeneration for the management of young, immature, necrotic, permanent teeth. The digital databases MEDLINE, SCOPUS, CENTRAL, Web of Science, and EMBASE were searched to identify ten randomized clinical trials. The outcomes at postoperative follow-up, such as dentinal wall thickness (DWT), increase in root length (RL), calcific barrier formation (CB), apical closure (AC), vitality response (VR), and success rate (SR), were subjected to both qualitative synthesis and quantitative meta-analysis. The meta-analysis showed that APCs significantly improved apical closure (risk ratio (RR) = 1.17; 95% CI: 1.01, 1.37; p = 0.04) and response to vitality pulp tests (RR = 1.61; 95% CI: 1.03, 2.52; p = 0.04), whereas no significant effect was observed on root lengthening, dentin wall thickness, or success rate of immature, necrotic teeth treated with regenerative endodontics. APCs could be beneficial when treating young, immature, necrotic, permanent teeth regarding better apical closure and improved response to vitality tests.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of Autologous Platelet Concentrates in Management of Young Immature Necrotic Permanent Teeth—A Systematic Review and Meta-Analysis

Panda

Mishra

Arbildo-Vega

et al. 2020

Cells

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“…In mature teeth, disinfection is carried out with a combination of mechanical instrumentation, irrigation, and the placement of an intracanal medicament. 22 Regenerative endodontic therapy in mature teeth likely encounter more challenges than in immature teeth; less stem/progenitor cells in mature teeth, less probability of blood clot formation and narrower apical pathways for stem/progenitor cell migration will be major limitations 23 .…”

Section: Discussionmentioning

confidence: 99%

“…The results cannot be compared as the selected cases were immature and blood column was selected as scaffold, this might be the reason for such low percentage of success. In referral to the systematic review analyzing the reasons of failure of regenerative endodontic cases by Almutairi et al 22 who attributed 91% of failed reported regenerative cases to the use of blood column as scaffold and recommended the use of platelet concentrates.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the Survival and Sensibility of Mature Anterior Teeth with Periapical Lesion after One Step Regenerative Approach Using Different Disinfection Maneuvers : A Randomized Clinical Trial

Mohamed Mohsen Abielhassan,

Nihal Ezzat Sabet,

Alaa Abdelsalam El Baz

2021

IJPHRD

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Aim: evaluate outcomes of single visit regenerative endodontic procedures using conventional irrigation protocol in comparison to LASER disinfection in comparison to 0.2% Nano Chitosan irrigating solution for treatment of necrotic mature anterior teeth with periapical lesions.Methodology: 45 patients were recruited in this trial. Preoperative standardized cone beam computed tomography (CBCT) was performed for the patients after fulfillment of inclusion criteria.After complete diagnostic steps and signing of consent forms and performance of access cavity preparation,patients were randomly distributed into three groups with three disinfection maneuvers:1. Group A (Intervention 1)final disinfection using Low Power Diode LASER disinfection. Group B (Intervention 2 ) final rinseusing 0.2% Nano Chitosan irrigation disinfection in a side perforated needle.3. Group C (Control) conventional irrigation protocol using 1.25% sodium hypochlorite irrigating solution and 17% EDTA only.Platelet rich fibrin was packed inside the root canals followed by collagen plug and Biodentin. Teeth were restored using resin modified glass ionomer.Patients were recalled for regular follow ups at 6 and 12 months. Patients were examined for survival of treated teeth and any inflammatory signs or symptoms. All samples were tested for sensibility. All data were statistically analyzed.Results: Single visit regenerative endodontics possessed an overall percentage of success 95.5% in all groups in terms of survival of treated teeth. Regarding sensibility nano chitosan also possessed the highest percentage of cases regaining sensitivity by 73.3% followed by laser group 67.7% followed by the control group with 46.7% also with no statistical significant difference between all groups. Conclusion:Within limitations of this study single visit regenerative endodontics can be applied to cases with necrotic pulps and periapical lesions where thorough disinfection is recommended in cases of single visit approach to ensure maximum elimination of bacterial cells from root canal hindering successful

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“…La infección residual juega un rol fundamental en el fracaso de la terapia, ya que se ha comprobado que cerca del 80 % de los casos de endodoncia regenerativa muestran signos de infección persistente (Almutairi et al, 2019). Estudios in vivo han demostrado que la presencia de bacterias está estadísticamente relacionada con la falta de desarrollo radicular después de la terapia (Verma et al, 2017) y estudios in vitro han demostrado que la presencia de lipopolisacáridos (un componente de la membrana de las bacterias) interfiere con la diferenciación odontogénica de las células madre (Widbiller et al, 2018).…”

Section: Endodoncia Regenerativa Para Dientes Inmaduros Necróticosunclassified

“…En cuanto a la causa de la necrosis pulpar, algunos estudios señalan que los dientes necrosados debido a traumatismo tienen peores resultados en cuanto a desarrollo radicular que aquellos necrosados por caries o dens evaginatus (Nazzal et al, 2018;Almutairi et al). La hipótesis que actualmente se expone como causa de esta diferencia es que cuando ocurre un trauma hay un daño de la vaina epitelial de Herwith, estructura que en una situación fisiológica dirige el desarrollo radicular.…”

Section: Endodoncia Regenerativa Para Dientes Inmaduros Necróticosunclassified

Tratamiento del Diente Permanente Necrótico. Un Cambio de Paradigma en el Campo de la Endodoncia

Bucchi¹

2020

Int. J. Odontostomat.

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RESUMEN: El tratamiento de dientes inmaduros necróticos es hoy un gran desafío clínico. La ausencia de cierre del ápice y el reducido grosor de las paredes de la dentina hacen que el tratamiento endodóntico del diente sea difícil e impredecible. Tradicionalmente, estos dientes han sido tratados con apexificación y obturación del canal radicular, sin embargo, con este tratamiento el diente permanece desvitalizado y con paredes de dentina frágiles y cortas, lo que compromete su pronóstico. La endodoncia regenerativa, por el contrario, busca revitalizar el diente e inducir una maduración de la raíz, y se basa en la utilización de las células madre mesenquimales presentes en la región periapical, los factores de crecimiento presentes en la dentina y un andamio que permite el crecimiento de tejido nuevo al interior del canal. Los resultados clínicos son alentadores, ya que en general existe maduración de la raíz y revascularización del diente, sin embargo, el tejido neoformado es tejido de tipo reparativo y, a excepción de estudios ocasionales, no se ha observado regeneración de dentina y pulpa. La endodoncia regenerativa se originó para tratar dientes inmaduros necróticos. Sin embargo, recientemente, estudios preliminares han expandido la aplicación de la endodoncia regenerativa a dientes maduros necróticos, es decir, en pacientes adultos. Los resultados clínicos son positivos y similares a los del diente inmaduro, sin embargo, la investigación referente a la revitalización de dientes maduros se encuentra en etapas tempranas y requiere de un mayor nivel de evidencia antes de ser ofrecida sistemáticamente como terapia a pacientes adultos. Los beneficios potenciales justifican mayor investigación al respecto. Este artículo resume la evidencia científica disponible con respecto a la revitalización de dientes inmaduros y maduros necróticos, sus fundamentos biológicos, los resultados esperados y limitaciones, así como el protocolo clínico.

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Regenerative Endodontics: A Systematic Analysis of the Failed Cases

Cited by 79 publications

References 51 publications

Effectiveness of Autologous Platelet Concentrates in Management of Young Immature Necrotic Permanent Teeth—A Systematic Review and Meta-Analysis

Effectiveness of Autologous Platelet Concentrates in Management of Young Immature Necrotic Permanent Teeth—A Systematic Review and Meta-Analysis

Assessment of the Survival and Sensibility of Mature Anterior Teeth with Periapical Lesion after One Step Regenerative Approach Using Different Disinfection Maneuvers : A Randomized Clinical Trial

Tratamiento del Diente Permanente Necrótico. Un Cambio de Paradigma en el Campo de la Endodoncia

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