Regenerative Endodontics and Minimally Invasive Dentistry: Intertwining Paths Crossing Over Into Clinical Translation.

Hisham Elnawam,Mai Hussein,Menatallah Abdelmougod,Rania El Backly,Hamdy Aboualmakarem,Ahmed Mobarak,Michael Girgis

doi:10.3389/fbioe.2022.837639

Hisham Elnawam, Mai Hussein + Show 5 more

Open Access

https://doi.org/10.3389/fbioe.2022.837639

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Abstract

Regenerative endodontic procedures have been described for over a decade as a paradigm shift in the treatment of immature necrotic permanent teeth, owing to their ability to allow root maturation with subsequent enhancement of the tooth’s fracture resistance in addition to the potential for regeneration of vital intracanal tissues. Concomitantly, minimally invasive endodontics is another rising concept with the main concern of preservation of tooth structure. Stemming from their potential to preserve the original tooth structure, both regenerative and minimally invasive endodontics could be considered as two revolutionary sciences with one common goal. Achieving this goal would entail not only employing the appropriate strategies to recreate the ideal regenerative niche but modifying existing concepts and protocols currently being implemented in regenerative endodontics to address two important challenges affecting the outcome of these procedures; conservation of tooth structure and achieving effective disinfection. Therefore, the search for new biomimetic cell-friendly disinfecting agents and strategies is crucial if such a novel integratory concept is to be foreseen in the future. This could be attainable by advocating a new merged concept of “minimally invasive regenerative endodontic procedures (MIREPs),” through modifying the clinical protocol of REPs by incorporating a minimally invasive access cavity design/preparation and biomimetic disinfection protocol, which could enhance clinical treatment outcomes and in the future; allow for personalized disinfection/regeneration protocols to further optimize the outcomes of MIREPs. In this review, we aim to introduce this new concept, its realization and challenges along with future perspectives for clinical implementation.

Highlights

Regenerative Endodontics and Minimally Invasive Dentistry in the Wake of the COVID-19 PandemicAt the end of the year 2019, the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-COV-2) virus changed the face of humanity (Ather et al, 2020)
Disinfection is a critical factor to ensure periapical healing in regenerative endodontics where literature has shown that residual infection can lead to either failure or hinder continued root development (Verma et al, 2017)
By minimizing tooth structure removal as we elaborated in this review, fracture resistance of such teeth can be maintained (Isufi et al, 2020; Elkholy et al, 2021), at the same time, to avoid sacrificing disinfection for the sake of preserving tooth structure, we suggest an alternative enhanced disinfection protocol that would conserve sound tooth structure while at the same time maintain an appropriate level of disinfection to allow stem cell migration and success of the final regenerative treatment

Summary

INTRODUCTION

Regenerative Endodontics and Minimally Invasive Dentistry in the Wake of the COVID-19 Pandemic. A newly defined role for regenerative therapies has re-emerged with the potential of tissue engineering and regenerative medicine to play a critical role in improving clinical practices amid a global viral outbreak This can range from the development of in-vitro models for drug testing and disease modeling, designing drug delivery systems to optimizing vaccine delivery platforms (Tatara, 2020). With the advent of advanced tricalcium-silicate cements and sophisticated bonding and restorative materials, successful long-term outcomes are being increasingly documented with reproducibility and obvious advantages for both the patient and the practitioner This new direction is currently on its way to embedding firm roots in the field with a mental makeshift from a science of “maybe” to a science that has transitioned into routine clinical practice; ironically pushed forward by a global pandemic. There are controversies in literature concerning the cleaning effectiveness and difficult exploration of root canal systems through these accesses, affecting the longevity of teeth from a biological point of view (Silva et al, 2020a)

Regenerative Endodontics as a Minimally Invasive Treatment Modality

How Detrimental Really is Residual Bacterial Biofilm?

DISCUSSION

Findings

AUTHOR CONTRIBUTIONS