Regenerative Endodontics as the Future Treatment of Immature Permanent Teeth

Abstract

The regenerative endodontic procedure (REP) is an alternative solution for endodontic treatment of permanent teeth with incomplete root apex development. It results in angiogenesis, reinnervation, and further root formation. Indications for REP include immature permanent teeth with necrotic pulp and inflammatory lesions of the periapical tissues. The main contraindications comprise significant destruction of the tooth tissues and a lack of patient cooperation. We distinguish the following stages of this procedure: disinfection of the canal, delivery of the REP components, closure of the cavity, and follow-up appointments. For effective canal disinfection, the use of both rinsing agents and intracanal medicaments is suggested. Sodium hypochlorite and triple antibiotic paste are used most commonly. Light-activated disinfection is proposed as an alternative method. The prerequisite for the regeneration process of the pulp is the supply of its essential components: stem cells, growth factors, and scaffolds to the canal lumen. Blood clotting, platelet-rich plasma, and platelet-rich fibrin are used for this purpose. For a proper course of REP, it is also necessary to close the tooth canal tightly. For this purpose, mineral trioxide aggregate (MTA), tricalcium silicate (Biodentine), or types of glass ionomer cement are employed. The patient should attend regularly scheduled follow-up appointments and each time undergo a thorough interview, physical and radiological examination. The most important indicator of a successful REP is the continued growth of the root in length and thickness and the closure of the root apex visible on X-rays. Many different proposals for a management protocol have been published; the following paper proposes the authors’ original scheme. Regenerative endodontics is the future of the endodontic treatment of immature permanent teeth; however, it still requires a lot of research to refine and standardize the treatment protocol. The application of tissue engineering methods seems to be promising, also for mature teeth treatment.

Clinical and radiographic evaluation of NeoMTA versus conventional white mineral trioxide aggregate in revascularization of non-vital immature permanent anterior teeth (A randomized controlled trial)

“…The cause of post-revascularization discoloration is still debatable, but most fingers point to the presence of bismuth oxide in the conventional WMTA and its reaction with dental tissues, blood products, and irrigants used in revascularization procedures [ 16 , 17 ]. Although WMTA was developed to overcome tooth discoloration encountered with the use of the Grey mineral trioxide aggregate (GMTA), several in vitro studies had reported evidence of tooth discoloration [ 14 , 18 ].…”

Regenerative Endodontic Procedures in Teeth with Root Resorption: A Systematic Review.

“…The AAE guidelines recommends low concentrations of NaOCl[1.5–3%] ( 35 ). The higher concentrations of NaOCl[5.25–6%] used in seven teeth ( 23 – 26 ) and 2% chlorhexidine in one tooth ( 32 ) may be potential causes of stem cell damage ( 46 ). In the case of internal resorptions, the use of agitation may facilitate penetration of the irrigant into the resorptive defects, thus improving chemical disinfection and removal of granulation tissue, organic debris, and biofilms ( 22 ).…”

“…Also, the long-term prognosis of RET still needs to be fully understood. It may be associated with complications, such as ankylosis, calcification, obliteration, tooth fracture, periapical tissue inflammation, or lack of further root growth ( 46 ). In cases of severe root resorption, revascularisation-associated intracanal calcification may help compensate for lost tooth tissue.…”

Review on Preformed Crowns in Pediatric Dentistry—The Composition and Application

“…The information on composition was gathered from product safety data sheets. The selected publications contain a thorough description of each group of crowns, their properties, advantages, disadvantages, indications, contraindications, preparation protocols, and treatment results ( Figure 1 ) [ 18 ].…”