Abstract
Aims: To evaluate the tissues formed by the pulp stem cell homing technique through the histopathological sections, after a three months follow-up period. Materials and Methods: The study was performed on twelve right second premolars of twelve local breed female dogs, that were randomly selected form different areas of Mosul City. The study was divided into four stages, stage I (Induce infection), stage II (Disinfection), stage III (Treatment), and stage IV (3 months follow-up). In the stage IV the tooth and the surrounding bone segment was sectioned and routinely processed to produce H&Estained tissue sections that were evaluated under the light microscope. The histological examiners were evaluated presence or absence of 1st normal pulp-like tissue, 2nd newly hard tissue (bone,cementum, dentin),3rd empty/necrosis,4th intra-canal inflammation, 5th periapical inflammation, 6th apical narrowing and wall thickening. Results: The results have shown that 85.71% of specimens had normal pulp-like tissue ,100% had newly hard tissue structure, 14.28% had an empty canal necrosis, 57.14%had intra-canal inflammation, 71.42% had periapical inflammation, and 85.71% had apical narrowing. Conclusion: The pulp stem cell homing procedure showed an effective way to treat an open apex tooth and this procedure was increased the root length and thickness and also filled the pulp space with pulp-like tissue. The procedure did not regenerate the tooth structure, but formed a tissue like dental structure (dentin, bone and cementum) and these tissues did not for regeneration, but for tissue repair.
Highlights
One of the most critical cases that will make endodontic and pediatric dentists confused about the best treatment plan are those cases with periapical periodontitis and an open apex tooth. [1,2,3] Pulp necrosis can be managed by root canal treatment in teeth with a mature apex; if the formation of root is not completed, a combination of dentin thin walls and an open apex, make the accomplishment of root canal treatment challenging.[4]
The final samples size diminished to seven since two experimental tooth were missed during the second stage due to sever mobility related to primary endodontic lesion with secondary periodontal lesions
All the specimens (100%) showed hard tissue structures deposition Table [1]. It was mostly bone–like tissue structure that was seen in the apical area of the root canals, there was newly formed cementumlike tissue that seen was attached to the internal dentine of the canal in the pulp space as in Figure (5c)
Summary
One of the most critical cases that will make endodontic and pediatric dentists confused about the best treatment plan are those cases with periapical periodontitis and an open apex tooth. [1,2,3] Pulp necrosis can be managed by root canal treatment in teeth with a mature apex; if the formation of root is not completed, a combination of dentin thin walls and an open apex, make the accomplishment of root canal treatment challenging.[4]. The other strategy for dental pulp regeneration (termed cell homing or revitalization technique) is defined as attraction and recruitment of endogenous. Techniques for revitalization in endodontics do not depend on stem cell population expansion that will transplant inside the root canal, but on the use of recruitment factors or “mobilization” factors, which include chemotactic agents, growth factors, and other signaling factors. These factors use to “home” the cells from the periapical area or “apical vasculature” to the site of injury, inside the root canal system. Stem cell (SC) homing is defined as the recruitment of endogenous SCs from bone marrow and other niches by signaling “mobilization” factors to the site of injury to induce repair [11]
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