China
Africa
Explore chapters and articles related to this topic
An Introduction to Bioactivity via Restorative Dental Materials
Published in Mary Anne S. Melo, Designing Bioactive Polymeric Materials for Restorative Dentistry, 2020
Mary Anne S. Melo, Ashley Reid, Abdulrahman A. Balhaddad
Another field of intense investigations on bioactive materials for endodontics is the treatment of immature tooth apex subjected to reversible pulpitis or pulpal necrosis. Traditionally, immature permanent teeth can be treated with apexification using calcium hydroxide or MTA. Unfortunately, apexification treatment cannot restore the vitality of the root canal complex in order to induce the apex formation. Therefore, the use of bioactive materials that trigger the revascularization inside the root canal system is essential to promote the apex formation and restore the vitality (Kim et al. 2018). In addition to bioactive materials, revascularization of the root canal system may include the use of stem cell therapy, pulp implantation, regenerative scaffolds, cell printing, and gene therapy (Murray et al. 2007). The stem cells could be injected into the root canal system to regenerate new pulpal tissues. The success of this technique could be improved by the presence of specific scaffolds and growth factors. In pulpal implantation, the pulpal tissue could be isolated and grown in a laboratory setting before being transferred to the pulp canal system. Also, three-dimensional cell printing has been suggested to increase the success of endodontic regeneration. The purpose of this technique is to control the position of the cells before they are transferred to the root canal system. It is suggested when performing the cell printing to keep the odontoblast cells around the peripheries and the fibroblast in the core around the nerves and blood vessels (Murray et al. 2007).
Dentin-Pulp Complex Regeneration
Published in Vincenzo Guarino, Marco Antonio Alvarez-Pérez, Current Advances in Oral and Craniofacial Tissue Engineering, 2020
Amaury Pozos-Guillén, Héctor Flores
The clinical procedures and results of regenerative endodontics are very different from conventional endodontic therapy; that has created an interest in the field of endodontics in recent years. Immature permanent teeth with necrotic pulp/apical periodontitis are traditionally treated with apexification treatment using calcium hydroxide or apical MTA plugs to induce formation of an apical hard tissue barrier before root canal filling. The calcium hydroxide apexification procedure usually takes multiple visits over an extended period, which could increase the risk of root fracture. However, an apexification procedure has no potential to restore the vitality of damaged tissue in the canal space and promote root maturation of immature permanent teeth with necrotic pulp. In the year 2001, Iwaya et al. reported a clinical case in a necrotic immature mandibular second premolar with periapical involvement in a 13-year-old patient; as an alternative to conventional root canal treatment protocol and apexification, antimicrobial agents were used in the root canal Radiographic examination showed the start of apical closure 5 months after treatment and a thickening of the canal wall and complete apical closure was confirmed 30 months after the procedure, suggesting a possible revascularization potential into the root canal space (Iwaya et al. 2001). Other reports on this new technique showed induced root maturation in infected immature teeth and described the use of a blood clot into the root canal as ‘revascularization’ (Branchs and Trope 2004). On the other hand, the term ‘revitalization’ has been suggested as it describes non-specific vital tissue rather than just blood vessels as implied by the term ‘revascularization’ (Lenzi and Trope 2012).
Dental stem cells for tooth regeneration: how far have we come and where next?
Published in Expert Opinion on Biological Therapy, 2023
As mentioned above, DPSCs, which could be obtained from permanent teeth, were the first isolated human dental mesodermal stem cells more than 20 years ago [13]. In 2017, the clinical study on regeneration of the dentin-pulp complex with DPSCs was a major advance for dental stem cell research [20]. In another clinical trial SHED were utilized for functional dental pulp regeneration [46]. In this study, children with traumatic teeth received autologous stem cells to regenerate complete dental pulp with neurovascular tissue. Xuan et al. showed that stem cell transplantation regenerated not only the entire pulp tissue with blood vessels and nerves, but also lengthened the root and reduced the width of the apical foramen compared to a control group with conventional apexification treatment [46]. The pulp regenerated from stem cells has the normal function of maintaining the continuous development of the root [20,46]. A recent study with minipigs showed that DPSCs promote not only angiogenesis during dental pulp regeneration but also the vasculature in the regenerated tissues derived from these stem cells [47].
Orthodontic management of a non-vital immature tooth treated with regenerative endodontics: a case report
Published in Journal of Orthodontics, 2018
Zynab Jawad, Claire Bates, Mandeep Duggal, Hani Nazzal
Traditionally, calcium hydroxide apexification has been used in managing these teeth, however, the long-term use of calcium hydroxide has been shown to result in denaturation of dentinal portions and reduction in dentine modulus of elasticity leading to cervical root fractures (Cvek 1992; Al-Jundi 2004; Twati et al. 2009). The use of Mineral Trioxide Aggregate (MTA) in creating a physical barrier against which root canals can be obturated is currently considered the gold standard in managing these teeth (Chala et al. 2011), however, despite the good success in the short to medium terms, currently there are no long-term data on the success of this technique (Chala et al. 2011; Nazzal and Duggal 2017; Tong et al. 2017). Both these techniques have a fundamental problem in that although they allow root canal obturation, they do not contribute to any quantitative or qualitative increase in root dimensions, therefore, they are mainly useful in those teeth with a minimum of half root length formation (Nazzal and Duggal 2017). Non-vital immature teeth with less than half root length formation pose a huge challenge with very poor short and long-term prognosis (Nazzal and Duggal 2017).