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.
Highlights
Conventional endodontic treatment of permanent teeth with incomplete root development is impossible, due to the significant risk of complications, including root fracture or the accidental injection of fluids or filling materials beyond the wide root apex
When calcium hydroxide is applied, repeated placement of intracanal medicaments is necessary, which carries the risk of reinfection, and thorough instrumentation inside the root canal may cause weakening of the canal walls [3,4]
The application of new materials that are an alternative to calcium hydroxide, e.g., mineral trioxide aggregate (MTA) or Biodentine, eliminates the problem of intracanal medicament replacement
Summary
Conventional endodontic treatment of permanent teeth with incomplete root development is impossible, due to the significant risk of complications, including root fracture (the walls are thin and the roots are short) or the accidental injection of fluids or filling materials beyond the wide root apex. In the endodontic management of immature teeth, two methods are generally accepted: keeping all or part of the pulp alive, allowing the root to develop naturally (apexogenesis), or—if the pulp is non-vital—stimulating the formation of a hard barrier in its apical part, using appropriate substances inserted into the canal (apexification) [1,2]. The application of new materials that are an alternative to calcium hydroxide, e.g., MTA or Biodentine, eliminates the problem of intracanal medicament replacement. None of these substances stimulates further root development. Treatment is a filled root canal with wall thickness and length developed naturally before pulp necrosis. According to Danwittayakorn et al [7], this complication occurs with equal frequency in restorations reinforced with a root-canal post as well as with composite material alone
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