Apical Closure Research Articles

Outcome of Partial Pulpotomy in Immature Permanent Teeth with Symptomatic Irreversible Pulpitis: A Prospective Case Series Assessment

IntroductionThe aim of this prospective case series was to assess the clinical and radiographic outcome of partial pulpotomy in caries-exposed symptomatic, vital, immature, permanent molars. MethodsThirty-four immature molars with deep caries and symptoms of irreversible pulpitis were treated by partial pulpotomy and ProRoot MTA as a capping material. After complete caries removal, the inflamed part of the pulp was removed. Complete hemostasis was achieved using a sterile cotton pellet moist initially with sodium hypochlorite 1.5% and then with sterile saline. ProRoot MTA (Dentsply Sirona, Charlotte, NC) was placed as a capping material onto the remaining pulp tissue. The cavity was sealed using a light-curing resin-modified Ca(OH)2 cavity liner, and patients were referred to a pediatric dentist for permanent restoration. Descriptive statistics and cross tabulations were performed including variables examined before, during, and after the procedure. ResultsAll examined teeth presented a favorable clinical and radiographic outcome with normal periapical tissues, complete apical closure, and formation of a dentinal bridge beneath the capping material. Signs of partial pulp chamber calcification were only detected in 2 cases. Postoperatively, most patients did not report any pain (23/34, 67.7%), whereas the rest reported minor intensity pain (11/34, 32.3) and the use of analgesic or anti-inflammatory drugs only for 1 day (10/34, 29.4%). ConclusionsPartial pulpotomy seems to provide a universally successful outcome when managing symptomatic vital immature teeth with no signs of complications and completion of apical closure. It could be a viable treatment of choice in cases of caries-exposed vital immature teeth with symptoms of irreversible pulpitis.

Regenerative Therapy for the Permanent Immature Teeth: A Long Term Study. An Original Research.

Endodontics faces several clinical difficulties while treating young necrotic permanent teeth. The use of regenerative endodontic procedures (REPs) enables apical closure, improved canal wall thickness, and root growth. The objective of this study was to assess the effects of these regenerative procedures on immature necrotic permanent teeth. This prospective clinical study was conducted at the tertiary care hospital for the study period of 2 years. This study includes 30 necrotic permanent immature teeth that were studied in 30 subjects of both genders. A standard REP protocol was used to treat every tooth. A follow-up visit was scheduled for each patient at timely intervals. Various study parameters as well as the demographics were assessed at each visit. To examine various parameters, a calibrated endodontist also performed a radiographic evaluation. Our findings point to excellent rates of survival, clinical success, and apical pathological resolution for 29 teeth. After 2 years, there were significant variations in the root thickness area and the average root length. The apical diameter significantly decreased during the research period, with 30.8% of the instances exhibiting full apical closure. Apical diameter, root length, and thickness changed more frequently in teeth with the level of the immaturity of the root, although the variations were not significant. REP treatment for teeth preceded symptom relief. Increased root thickness, root length, and apical closure were seen at 30 months, even if the clinically meaningful change was not attained in all patients.

The Differences of the Calcium Hydroxide and the Mineral Trioxide Aggregate in the Apical Closure of Immature, Non-Vital Permanent Teeth

When an immature tooth comes into contact with trauma, the dental pulp in the developing tooth can die, which can cause the absence of root and apical closure. Apexification is a technique used to repair these abnormalities. This method allows us to promote the growth of a hardened root end block. MTA and Ca (OH)2 are two materials that can be used in this process. Either MTA or calcium hydroxide have a good chance of producing positive clinical results. MTA is favored over calcium hydroxide for its significantly shorter time for apical barrier formation, low solubility, easy approach, and ability to prevent root fracture, while calcium hydroxide is preferred over MTA for root length elongation in open apex teeth. The limitations of calcium hydroxide include the fact that it takes more time and multiple visits to form the root-end barrier, is more prone to fracture, and has the potential for reinfection. The goal of this review is to collect revisions on inducing root formation and synthetic barrier approaches and consider the advantages and disadvantages of calcium hydroxide versus MTA.

The Differences of the Calcium Hydroxide and the Mineral Trioxide Aggregate in the Apical Closure of Immature, Non-Vital Permanent Teeth

The Differences of the Calcium Hydroxide and the Mineral Trioxide Aggregate in the Apical Closure of Immature, Non-Vital Permanent Teeth

Biodentine™ Pulpotomy in Stage I primary Molars: A 12-month Follow-up.

This study aims to evaluate, over 12 months of clinical and radiographic follow-ups, the performance and outcomes of Biodentine™ pulpotomy in stage I primary molars. A total number of 20 stage I primary molars requiring pulpotomy were selected from eight healthy patients aged between 34 and 45 months. Patients presenting a negative attitude toward dental treatment on the dental chair were scheduled for dental treatments under general anesthesia.Pulpotomy with Biodentine™ as a pulp-dressing material was performed on all selected molars. The patients were called back at 1 and 3 months for clinical follow-ups, then at 6 and 12 months for clinical and radiographic follow-ups. Data were tabulated according to follow-up intervals and occurrence of any changes in root maturation, pulp canal obliteration (PCO), periodontal ligament space (PLS), and bone or root lesion. No statistically significant differences were recorded at 1, 3, 6, and 12 months. There was a statistically significant increase in number of roots with closed apices from six roots at 6 months to 50 roots at 12 months (p < 0.0005) and the PCO was present in all 50 roots at 12 months, after it was present in 36 roots only at 6 months (p = 0.0001). This is the first randomized clinical trial that evaluates the performance of Biodentine™ as a pulp-dressing agent in stage I primary molar pulpotomy over 12 months of follow-up. Contrary to previous studies, the present work highlights the continued root formation and apical closure (AC) in pulpotomized immature primary molars. Nasrallah H, Noueiri BE. Biodentine™ Pulpotomy in Stage I primary Molars: A 12-month Follow-up. Int J Clin Pediatr Dent 2022;15(6):660-666.

Evolution of regenerative endodontic in young permanent teeth: a literature review

Objective: to compare different protocols available for regenerative endodontic. Methodology: articles published between 2001 and 2021 were searched on the database PubMed using the following keywords: “pulp revascularization” or “pulp revitalization” or “apexification”. Inclusion criteria were studies on humans, patients with immature permanent teeth with necrosis or irreversible pulpitis, a follow-up of at least 12 months, clearly described protocols and in English language. Results: The search produced 944 results. After applying the inclusion and exclusion criteria, only 35 were selected. 11 articles were added following a bibliographic review of the selected articles and a total of 46 cases were included. The success rate outcome for regenerative endodontic was of 80% observed in a total of 278 teeth. During irrigation, NaOCL was used in most of the cases with concentration varying from 0.5% to 6% and TAP has been the most used intracanal medication (32.7%). Periapical healing and resolution of the symptoms were observed in 95.7%, while apexogenesis was observed in 80.2%. Increase in root length reach 60%, root thickness 64.8% and apical closure 61,9%. Pulp vitality was found in 7.2% of the cases and discoloration in 29.5%. Conclusion: Regenerative endodontic showed signs of apexogenesis in most cases, and a pronounced increase in root thickness, root length and closure of the apex. Due to a high number of protocols and their heterogenicity, the superiority of one over the others cannot be established. More randomized clinical trials are needed to determine the most effective protocol.

Regeneration of immature incisor using platelet rich fibrin: report of a novel clinical application

BackgroundEndodontic treatment of young permanent teeth with necrotic pulp presents a clinical challenge for the dentist, and conventional endodontic treatment will result in tooth fracture along with a poor prognosis. Regenerative endodontics is a new protocol that has been advanced in the last decades for managing immature permanent teeth. Rare successful management of immature permanent incisors using platelet-rich fibrin is a technique-sensitive procedure.Case presentationA 08 years 04 months old female reported the chief complaint of pain in the upper front tooth region for one week. A blunderbuss canal was identified on radiographic examination, and revascularization using platelet-rich fibrin was planned and adopted. After the treatment, apical closure and root lengthening were noted without complications during subsequent follow-ups. Complete periapical healing with greater than 1.5 cm of dentinal thickness was noted.ConclusionRevascularization can be considered a viable treatment option for immature nonvital permanent teeth; with advancements in regenerative medicine and clinical practices, revascularization therapies could be developed as a novel mode of treatment in non-vital and dental traumatic cases.

Regenerative therapy in young permanent tooth: Case report

Pulp necrosis in immature permanent teeth represents a challenge for clinical management. The dentin wall in immature teeth is thin and the root is short, leading to an unfavorable long-term prognosis due to the risk of root fracture. Regenerative endodontic procedures have been shown to be effective and improve the prognosis of the compromised immature tooth by re-establishing functional pulp tissue that promotes continued root development and immune competence. The objective of the study was to report a case of a young permanent molar, diagnosed with necrosis and incomplete rhizogenesis. A female patient, 08 years old, attended the clinic of the specialization course in Endodontics, Faculty of Dentistry São Leopoldo Mandic, Belo Horizonte Unit. Regenerative therapy was proposed, which involved the following steps: anesthesia, opening, odontometry, minimal instrumentation, disinfection with 2% chlorhexidine gel, irrigation with saline solution, intracanal medication with calcium hydroxide paste, induction of bleeding to form a blood clot, cervical sealing with mineral trioxide aggregate and composite resin. The patient remained symptom-free up to 5 months after treatment. However, radiographically, an increase in the periapical radiolucent area was noted, so it was decided to carry out the conventional endodontic treatment. Regenerative therapy can be an alternative to apexification in immature teeth in cases of irreversible pulpitis and pulp necrosis associated or not with a periapicalesionson. It is a simple treatment with advantageous results as it promotes an increase in the length and thickness of the dentin wall and apical closure as seen in the case described in this work.

Apexification of the mineral trioxide aggregate in nonvital immature anterior teeth with and without platelet-rich plasma: A preliminary clinical study

ABSTRACT Introduction: Treatment of permanent teeth with weak root dentin, exposed apex, necrotic pulp, periapical disease, and stunted root growth present a significant challenge to the practicing conservative dentistry. Necrotic immature permanent teeth with open apices are arduous to seal by thermo-plasticized or lateral condensation methods. Apexification methods have traditionally used a variety of materials including calcium hydroxide, biodentine, and mineral trioxide aggregate (MTA). Calcium hydroxide apexification takes a long time to develop an apical barrier and contains large pores, resulting in inadequate sealing ability and a bad outcome. MTA is a biomimetic and bio-inductive substance that has been employed to construct a single-step apical barrier in immature open apices with and without periapical pathology. Endodontic in this 21st century uses regenerative procedures in a nonvital, immature tooth with wide-open apices but it is also a very lengthy procedure and poor patient compliance due to slow biologic healing and long-term follow-up of the patients. Platelet-rich plasma (PRP) contains various growth factors such as platelet-derived growth factors and transforming growth factors and has been proposed as a potentially ideal scaffold for accelerated wound healing. Aims and Objectives: To evaluate and compare the clinical and radiographic outcome of MTA apexification with and without PRP in periapical healing kinetics in nonvital, immature teeth. Materials and Methods: An analysis was performed on patient with immature teeth, open-apex, maxillary front nonvital that were randomly divided into two groups of eighteen patients (eighteen roots permanent upper anterior) each: Group I in which MTA apexification was performed without PRP and Group II consisting of 18 roots where MTA apexification were carried out on a collagen sponge supplemented with PRP. Results: The cases were followed up at 6 months and 12 months after treatment, both clinically and radiographically, by two independent assessors. Periapical healing (PAH) was good in 6–18 roots, and in Group I-11 roots showed excellent healing. In Group II-17 roots showed excellent results. Case number 18 and case number 9 were lost to follow-up due to migration to groups I and II, respectively. Apical closure was 100% in Group II and 77% in Group I. Conclusions: Single-step MTA apexification with PRP is a conservative and effective method for inducing PAH and is time-saving in managing nonvital, immature teeth with an open apex.

NON-SURGICAL TREATMENT OF A TRAUMATIZED TOOTH WITH PERIAPICAL INJURY AND IMMATURE APICE USING MTA AS AN APICAL BARRIER: A CASE REPORT

A clinical case is described of a 17-year-old patient who suffered a trauma at the age of 8, compromising the upper right incisor, which prevented complete apical closure and the presence of a periapical lesion. The patient reports having interrupted the root canal treatment one year ago, in the diagnostic periapical radiograph the endodontic treatment already started is confirmed and temporary crown filling material is observed, the presence perhaps of calcium hydroxide inside the root canal, incomplete apical formation and a periapical radiolucent lesion. Root canal treatment was resumed using K-type manual files until reaching a #140 apical caliber, 5.25% sodium hypochlorite was used as irrigant, Ultrapex (Ca(OH)2 + Iodoform) was placed as intracanal medication for several months. Two years after resuming treatment, the patient was asymptomatic, and in the control periapical radiograph it was possible to observe the considerable decrease in the periapical lesion, therefore it was decided to obturate using the classic lateral condensation technique, AH Plus sealant and previous at this stage, 4mm of MTA was placed as an apical barrier. Conclusions The importance of using intracanal medication in situations of dental necrosis with a periapical lesion of considerable size is shown through this clinical case. This case was caused due to dental trauma which, as we know, can evolve in very different ways and in many situations the dental prognosis ends up being very unfavorable. In addition, because it is an immature apex, the use of an MTA apical barrier was essential for containing the filling materials to avoid their extrusion into the periapical tissues and ensuring a better sealing in the apical third.

Concentration of sodium hypochlorite disinfection in regenerative endodontic procedure: A systematic review

Objectives: To evaluate whether low concentration sodium hypochlorite (NaOCl) disinfectant protocol can achieve a sufficient amount of disinfection to provide a conducive environment for clinical and radiographic success of regenerative endodontic procedure. Materials and methods: This systematic review includes necrotic immature permanent anterior teeth below 20 years of age using triple antibiotic paste as an intra-canal medicament and autologous platelet concentrates as scaffold. The interventional group was low concentration (≤2%) NaOCl and comparator group included high concentration (&gt;2%) NaOCl as disinfectant. Cochrane risk of bias assessment 2 (RoB 2) tool was used for assessment of risk of bias. Included studies were evaluated for the absence of clinical signs and symptoms, increase in root length and apical closure on radiograph, and positive response to vitality testing. Results: After evaluation, seven studies were included. Clinical success rate was seen in 98.33% cases in low concentration (≤2%) and 95% cases in high concentration (&gt;2%) NaOCl. The radiographic success rate was 86.66% in low concentration (≤2%) and 80% in high concentration (&gt;2%) NaOCl disinfection. Positive response for vitality testing was seen in 46.66% cases in low concentration (≤2%) and 38.70% in high concentration NaOCl (&gt;2%). Conclusion: Low concentration (≤2%) NaOCl is as effective as high concentration (&gt;2%) to achieve disinfection of the root canal. However, an increased success rate is associated with the use of low concentration (≤2%) NaOCl. Response to pulp vitality is observed to be superior with low concentration (≤ 2%) NaOCl although it might be attributed to a longer follow-up period.

Evaluating the radiographic results of apexification treatment in children

Aim: This retrospective study aimed to evaluate the radiographic success of apexification treatments applied with different materials and techniques. Methodology: Periapical radiographs of 224 maxillary incisors in patients between 6 and 12 years of age who had undergone apexification treatment at the Dicle University, Faculty of Dentistry, Department of Pediatric Dentistry were retrospectively examined. Each apex was scored using the periapical index (PAI) on X-rays obtained at 12 months of follow-up after treatment, and the presence or absence of the apical barrier was evaluated. The Kruskal–Wallis H, Mann–Whitney U, and chi-square tests were used for the statistical analysis (p &lt; 0.05). Results: In the maxillary incisors, apexification was most commonly performed on the maxillary right central teeth (74.11%). The cause for this treatment was trauma in 97.77% of the patients. Enlargement in the periodontal space (95.98%), the presence of lesions (60.71%), loss of lamina dura (54.46%), and external resorption (43.75%) were observed. At 12 months of follow-up after treatment, apical closure (87.95%) was observed in all teeth with open apexes, and the ratio of patients with a PAI of &lt; 2 was 89.35% for calcium hydroxide (CH) apexification and 92.73% for mineral trioxide aggregate (MTA) apexification. Conclusion: The radiographic success of apexification treatments with CH and MTA was found to be high in 224 immature upper incisors. How to cite this article: Akleyin E, Polat Y, Harman EB, Çelenk S. Evaluating the radiographic results of apexification treatment in children. Int Dent Res 2022;12(3):158-64. https://doi.org/10.5577/intdentres.2022.vol12.no3.8 Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Pulp Revascularization of Immature permanent teeth: A Systematic Review

Dental pulp has capacity to regenerate under certain conditions. Due to recent advances in dental materials and techniques newer methods of regeneration of the pulp tissue are replacing traditional method of pulp therapy. Pulp revascularization play a vital role in apical closure of the root. This article is an attempt to review the procedure of revascularization in tooth as well as materials used.

Are platelet concentrate scaffolds superior to traditional blood clot scaffolds in regeneration therapy of necrotic immature permanent teeth? A systematic review and meta-analysis.

The effectiveness of platelet concentrates in promoting root development of necrotic immature permanent teeth is unclear. The present study evaluated whether the platelet concentrate protocol was superior to the traditional blood clot protocol in regeneration therapy. We searched Electronic databases, such as PubMed, Cochrane Library, ClinicalTrials and EMBASE. Randomized controlled trial studies, cohort studies, case-control studies and cross-sectional studies were included, in which platelet-rich concentrates were tested for periapical healing and root development, with the blood clot treatment protocol as the control group. Clinical and radiographic outcomes were considered. Selected articles were assessed for risk of bias. Pooled risk ratios (risk ratio, RR) were calculated for clinical success, responses to cold and electric pulp tests, periapical lesions, apex closure, root lengthening, and thickening of the dentin walls. Subgroup meta-analysis were conducted according to the type of platelet concentrate used. Of the 1272 screenedstudies, 13 randomized controlled studies, 2 case-control studies and 1 cohort study were selected, in which 465 immature necrotic permanent teeth, particularly incisors and premolars, were treated. Of these 465 teeth, 457 (98.2%) in both the control and experimental groups remained clinically asymptomatic for the entire study duration, whereas eight (1.8%) showed signs and symptoms of failure, including spontaneous pain, sensitivity to percussion or reinfection. Compared with control teeth, teeth treated with PRP achieved better apical healing than BC group (RR 1.13, 95% CI 1.01-1.26, P = 0.03), and teeth treated with platelet concentrates showed improved apical closure (RR 1.04, 95% CI 0.86-1.25, P = 0.69), root lengthening (RR 1.01, 95% CI 0.74-1.39, P = 0.93), and thickening of the dentin walls (RR 1.35, 95% CI 0.95-1.93, P = 0.09), although these differences were not statistically significant. Platelet concentrates can be used as successful scaffolds for regenerative endodontic treatment of necrotic immature permanent teeth, and PRP as a scaffold may achieve better periapical healing of teeth with periapical inflammation, although they did not differ significantly from conventional blood clot scaffolds in development of the root.

Management of Displaced Maxillary Canines by Extraction of the Primary Canine: Factors Affecting Treatment Outcome

The purpose of this study was to evaluate the effect of interceptive primary canine extraction in palatally and buccally displaced maxillary permanent canines, and to analyze the clinical and radiographic factors affecting the treatment outcome. 97 maxillary permanent canines from 86 patients whose maxillary permanent canine were in the mesio-occlusal directions and overlapped with the roots of the adjacent teeth were analyzed. In 64 of 97 (66.0%) maxillary permanent canines, the displaced crown was completely deviated from the adjacent lateral incisor root only by extraction of the primary canine. Not only the characteristics of maxillary permanent canines such as bucco-palatal displacement direction, horizontal and vertical position of the crown tip, and presence of apical closure, but also periapical rarefaction on the primary canine and peg-shaped adjacent lateral incisor significantly affected the treatment outcome.

Influence of ethylenediaminetetraacetic acid irrigation on the regenerative endodontic procedure in an immature rat molar model.

To analyse the influence of ethylenediaminetetraacetic acid (EDTA) on the repair process in immature rat molars after a regenerative endodontic procedure (REP). The lower first molars of 12 4-week-old Wistar rats underwent pulpectomy in the mesial root and were divided into the following groups: sodium hypochlorite (NaOCl; n=6) - the mesial canals were irrigated with 2.5% NaOCl for 5min, and NaOCl-EDTA (n=6) - the canals were irrigated with 2.5% NaOCl, followed by 17% EDTA for 5min each. After evoking bleeding using a size 10K-file, the cavities were sealed. Three molars on the untreated side were randomly used as control (control-15 d; n=3), and three molars from the other three rats untreated were used as immediate control (n=3). After 15 days (NaOCl, NaOCl-EDTA and control-15 d groups) or immediately (control-immediate), the animals were euthanized, and the teeth were subjected to histologic evaluation of tissue regeneration and presence of collagen fibres. Mann-Whitney U-test was used (p < .05). The experimental groups had newly formed cementum-like tissue and increased root length and thickness. Half of the specimens in NaOCl-EDTA group showed apical foramen closure, whilst the NaOCl group had partial apical closure. The experimental groups showed inflammatory infiltrate extending mainly to the medium third of the root canal. These parameters were similar between experimental groups (p > .05). Newly formed connective tissue in the pulp space was significantly higher in the NaOCl-EDTA group than in NaOCl group (p < .05). Regarding the collagen fibres, the NaOCl-EDTA group had more collagen fibres in the root tip, but there was no significant difference compared to NaOCl group, and both groups showed greater amount of immature fibres in this area; in the centre of the apical third of root canal, there was equivalence between mature and immature fibres from both groups (p > .05). Ethylenediaminetetraacetic acid irrigation improved newly formed intracanal connective tissue after REP in immature molars of rats; however, EDTA did not influence cementum-like tissue formation, apical closure, inflammatory infiltrate and maturation of collagen fibres.

COMPARATIVE EVALUATION OF TIMING AND CLOSURE OF IMMATURE ANTERIOR TEETH WITH OPEN APEX USING TWO DIFFERENT REGENERATIVE MATERIAL: A CASE REPORT-12 MONTHS FOLLOW-UP

Regenerative endodontic Procedures provide an unconventional approach which relies on the principle of tissue engineering. Pulp necrosis of immature permanent teeth may impair root development and apical closure of root canals. Completion of root development takes around 3 years after eruption of permanent teeth. Management of immature non vital teeth is very challenging for a clinician because teeth may have wide open apex and thin root canal walls that may diverge towards the apex. Conventional cleaning and shaping of the canals and obturation may not be possible because of the lack of apical stop. Since debridement of pulp canal space is difficult, there is an increased possibility of root perforation and cervical root fracture, besides the presence of an open immature root apex jeopardize the apical seal of a root canal treatment resulting in subsequent failure. The purpose of this report is to present the case of a patient wherein apexification of an immature permanent maxillary left central incisor tooth was induced by the Biodentine (Calcium trisilicate cement) and Metapex paste (Calcium hydroxide and Iodoform).

Non-surgical Treatment of a Non-vital, Immature Permanent Tooth with a Large Periapical Abscess: A Case Report with 8-month Follow-up

Aim: The purpose of this case report is to present a non-surgical treatment of a non-vital immature upper central incisor with a large periapical abscess within 8 months of follow-up.&#x0D; Methods and Materials: A traumatic case was presented in which a paste of calcium hydroxide and iodoform (Metapex®) was placed in the root canal of an immature permanent tooth with a large periapical abscess. Affected teeth were radiographically evaluated periodically over 8 months after paste insertion. At the end of 8 months, this case showed persistent root growth and apexification with no evidence of periapical radiolucency. After that, a normal root canal treatment was performed.&#x0D; Conclusion: In this clinical case, calcium hydroxide and iodoform paste (Metapex®) was found to induce apical closure radiographically and clinically. At 8 months, the periapical abscess was shown to have healed with continued root growth.

Biological characteristics and pulp regeneration potential of stem cells from canine deciduous teeth compared with those of permanent teeth

BackgroundClinical studies have demonstrated that dental pulp stem cells isolated from permanent teeth (PT-DPSCs) are safe and efficacious for complete pulp regeneration in mature pulpectomized permanent teeth with complete apical closure. Moreover, dental pulp stem cells from deciduous teeth (DT-DPSCs) have also been shown to be useful for pulp regenerative cell therapy of injured immature permanent teeth. However, direct comparisons of the pulp regenerative potential of DT-DPSCs and PT-DPSCs from the same individual have not been performed. This study aimed to compare the differences in stem cell properties and pulp regenerative potential of DT-DPSCs and PT-DPSCs of identical origin.MethodsDT-DPSCs and PT-DPSCs were isolated from the same individual dogs at 4 months and 9 months of age, respectively. The expression of cell surface antigen markers, proliferation and migration activities, and gene expression of stem cell markers, angiogenic/neurotrophic factors and senescence markers were compared. The effects of conditioned medium (CM) derived from these cells on cellular proliferation, migration, angiogenesis, neurite outgrowth and immunosuppression were also compared. Autologous transplantation of DT-DPSCs or PT-DPSCs together with G-CSF was performed to treat pulpectomized teeth in individual dogs. The vascularization and reinnervation of the regenerated pulp tissues were qualitatively and quantitatively compared between groups by histomorphometric analyses.ResultsThe rates of positive CXCR4 and G-CSFR expression in DT-DPSCs were significantly higher than those in PT-DPSCs. DT-DPSCs migrated at a higher rate with/without G-CSF and exhibited increased expression of the stem cell markers Oct3/4 and CXCR4 and the angiogenic factor VEGF and decreased expression of the senescence marker p16 than PT-DPSCs. DT-DPSC-derived CM promoted increased cell proliferation, migration with G-CSF, and angiogenesis compared with PT-DPSC-derived CM; however, no difference was observed in neurite outgrowth or immunosuppression. The regenerated pulp tissues in the pulpectomized teeth were quantitatively and qualitatively similar between the DT-DPSCs and PT-DPSCs transplant groups.ConclusionsThese results demonstrated that DT-DPSCs could be a potential clinical alternative to PT-DPSCs for pulp regenerative therapy. DT-DPSCs can be preserved in an individual cell bank and used for potential future pulp regenerative therapy before the supply of an individual’s own sound discarded teeth has been exhausted.

Use of scaffolds and regenerative materials for the treatment of immature necrotic permanent teeth with periapical lesion: Umbrella review.

Current treatment of immature necrotic permanent teeth with a periapical lesion is regenerative endodontics, which is based on tissue engineering under the triade of stem cells, scaffolds and bioactive molecules. This Umbrella Review was aimed to evaluate the success of scaffold and regenerative materials used for the treatment of these teeth, in terms of apical closure, tooth length increase, widening of root canal walls, tissue vitality and periapical lesion repair. An extensive literature research was carried out in the Medline, ISI Web of Science, and Scopus databases for relevant systematic reviews matching the keyword search strategy. Based on inclusion and exclusion criteria, reviewers independently rated the quality of each study to determine their level of evidence. Methodological quality assessment of each article was obtained using A Measurement Tool to Assess Systematic Reviews (AMSTAR)-2 tool, and risk of bias was assessed with the Risk of Bias in Systematic Reviews (ROBIS) tool. After removing duplicates, 155 articles were found; from which 133 were excluded for being non-relevant and 15 other due to exclusion criteria. One more was discarded after methodological quality evaluation, for a total of six articles remaining. The most common scaffold used was the blood clot, others used were poly lactic-co-glycolic acid and platelet-rich fibrin matrix. The most common regeneration material used was Mineral Trioxide Aggregate (MTA), followed by Biodentine. An increase in tooth length and widening of root canal walls were reported in all selected studies with different proportions, as well as periapical lesion repair. ROBIS analysis showed that only one article had low bias, two were classified as unclear bias, while the remaining three had high risk of bias. An exhaustive literature search was carried out applying language filters, high-quality indexed journals, year of publication, which ensures the best quality articles were included. Blood clot was the most used scaffold as is the most easy to place inside the canal and does not require to extract blood from the patient. The use of MTA and Biodentine as sealing materials has been associated with thickening of canal walls, apical closure and reduced signs and symptoms of apical periodontitis. However, most of the included reviews assessed were case reports and only in a few of them were clinical trials included. There is also a lack of risk of bias analysis in most reviews. The blood clot is the most common scaffold used for inducing regeneration during the treatment of immature necrotic teeth. Tooth length increase and widening of root canal walls are the most common criteria used in the studies as success indicators. MTA and Biodentine did not show differences in the results analysed. Quality assessment and bias risk evaluation showed that it is necessary to design better studies with rigorous methodology to recommend a trustable and predictable protocol for the treatment of immature necrotic permanent teeth with periapical lesions. International Prospective Register of Systematic Reviews (PROSPERO) CRD42021248404.