Pulp Revascularization Research Articles

Potential for pulp revascularization in mature anterior teeth with lateral luxation in relation to the patient's age at the time of injury-a retrospective cohort study.

The aim of this study was to investigate the potential for pulp revascularization in relation to patient age at the time of injury following luxation injury of mature anterior permanent teeth. A total of 93 teeth from 70 patients were included. The patients were divided into subgroups based on their age at the time of the injury. the Aalen-Johansen method was used to estimate the risks of pulp canal obliteration (PCO) and pulp necrosis (PN). The absolute 2year risks of PCO and PN were obtained with cause-specific Cox regression and reported separately for each cohort, standardised to age at injury and degree of repositioning. For the group younger than 15years of age, the risk of PN after 12months was 62.3% [95% CI 44.9; 79.7] in the cohort from 1972 to 1980 and 28.6% [95% CI 4.9; 52.2] in the cohort from 2012 to 2020. For the age group 16-20 years, the risk of PN after 12 months was 66.7 [95% CI 40.0;93.3] in the cohort from 1972 to 1980 and 25% [95% CI 0.0;55.0] in the cohort from 2012 to 2020. For the age group between 21 and 25, the risk of PN after 12months was 66.7% [95% CI 40.0; 93.3] in the cohort from 1972 to 1980 and 55.6% [95% CI 23.1; 88.0] in the cohort from 2012 to 2020. There is potential for pulp revascularization in mature anterior teeth with lateral luxation in patients up to 25 years of age. The risk of PN appears to increase with age.

Pulp revascularization in the immature tooth: 24-month follow-up

Pulp revascularization in the immature tooth: 24-month follow-up

PULP REVASCULARIZATION IN LOWER MOLARS

Objective: The aim of this study was to report a pulp revascularization case report performed on a lower molar. Methodology: The searches were carried out on Web of Science, PUBMED Central, BVS/BIREME, Scielo, Brazilian CAPES as well as Google academic portal. Twenty four articles were researched concerning the revascularization process to reach apical finalization. Knowledge from books and periodicals were also consulted, constituting the gray literature to give reliable information for this paper. In order to reinforce the basis of this study, it was decided to use the protocols of Yin (2001) and Pereira et al. (2008). Results: During the reporting process, supported by literature review, it is possible to note that for pulp revascularization to occur successfully, infection control, stimulation of local bleeding and cell activation are necessary steps. Furthermore, factors such as age, clinical cure and nutritional conditions directly influence the success rate of each case.

A review of tissue engineering in regenerative endodontic treatment

Background: Regenerative endodontic treatments are classified based on approach in the procedures and principles. One is cell-free approach that involves a revitalization procedure to achieve continued root growth while the other is cell-based approach which involves pulp/dentin regeneration through isolation and ex vivo expansion of stem cells seeded in the scaffold and then transplanted into the canal space. Technically, the cell-free approach is simpler than cell-based approach because the former does not concern about external stem cell isolation and culture. Currently, the gold standard and the one that has been clinically performed is cell-free approach. Cell-based approach is still not a standard because currently the cell-based approach is still in the clinical trial stage. Purpose: to evaluate the biological basis and clinical protocols recently used in regenerative endodontic treatment and discuss potentially future treatment approaches. Review: The literature review was searched in PUBMED with the keywords: immature permanent teeth, pulp revascularization, stem cells and regenerative endodontics. The regenerative endodontic treatments with various procedures and techniques result in a significant increase in root length and dentinal wall thickness. Stimulation of stem cells in apical root canal system is required to induce tissue formation and continued root maturation. Conclusion: The success of regenerative endodontic therapy relies on the development of a technique that enables clinicians to create functional pulp tissue within cleaned and shaped root canal systems. It is hoped that further research studies are required to define advantages and limitations of cell-free and cell-based approach.

Association between host defence peptide IDR-1002 and ciprofloxacin: Effects on human dental pulp cells.

To evaluate the effects of the association of host defence peptide IDR-1002 and ciprofloxacin on human dental pulp cells (hDPSCs). hDPSCs were stimulated with ciprofloxacin and IDR-1002. Cell viability (by MTT assay), migration capacity (by scratch assay), production of inflammatory and anti-inflammatory mediators by hDPSCs (RT-PCR) and osteogenic differentiation (alizarin red staining) were evaluated. Phenotypic profile of hDPSCs demonstrated 97% for positive marked mesenchymal stem cell. Increased pulp cell migration and proliferation were observed after 24 and 48 h of exposure to IDR-1002 with ciprofloxacin. Mineral matrix formation by hDPSCs was observed of the association while its reduction was observed in the presence of peptide. After 24 h, the association between ciprofloxacin and IDR-1002 significantly downregulated TNFRSF-1, IL-1β, IL-8, IL-6 and IL-10 gene expression (p ≤ 0.0001). The association between the IDR-1002 and ciprofloxacin showed favourable immunomodulatory potential, emerging as a promising option for pulp revascularisation processes.

Restoring Vitality: The Science and Practice of Pulp Revascularization in Endodontics.

Pulp revascularization is an emerging treatment modality in endodontics aimed at preserving the vitality and function of immature permanent teeth with necrotic pulp and apical periodontitis. This review provides a comprehensive examination of the current state of pulp revascularization, encompassing its rationale, clinical procedures, indications, contraindications, advantages, limitations, and potential future prospects. By critically analyzing the existing literature and clinical experiences, this review aims to offer insights into the efficacy, challenges, and potential advancements in the field of pulp revascularization.

WITHDRAWN: Unveiling the future of endodontics: An update on dental pulp regeneration strategies

Pulpal and periapical ailments, prevalent oral afflictions, result from irreversible perturbations to dental pulp caused by potent stimuli such as caries, trauma, or iatrogenic factors. Current treatments include root canal therapy and pulp revascularization, yet achieving complete pulp tissue regeneration remains challenging. Recent advancements in biomaterial science and tissue engineering have shifted focus towards employing diverse methodologies for restoring damaged tooth pulp. These include stem/progenitor cell populations, revascularization techniques, scaffolds, and material-based approaches. Notably, the identification of dental pulp stem cells (DPSCs) has increased interest in stem cell-mediated pulp regeneration. Current research explores cell transplantation and homing strategies. Despite progress, challenges persist in preclinical and clinical applications. This narrative review assesses the current state of regenerative endodontics, emphasizing dental pulp regeneration techniques, including their advantages, drawbacks, and biological aspects such as DPSCs, biomaterials, and growth factors. Challenges and potential solutions are discussed to guide future clinical translation, offering insights for advancing regenerative endodontics.

Regenerative Endodontic Procedures in Immature Teeth Affected by Regional Odontodysplasia

IntroductionRegional odontodysplasia (ROD) is a rare developmental disorder characterized by hypo-mineralization and hypoplasia of enamel and dentin. Symptoms include poorly developed tooth buds, delayed eruption of permanent teeth in affected quadrants, and ghost teeth. The affected teeth often become necrotic due to abnormal enamel and dentin development, making them susceptible to caries and infection. The aim of this case report is to describe the treatment of ROD through pulp revascularization. Case reportA 13-year-old girl was referred for endodontic treatment. The mandibular left incisors and first premolar, which were affected by regional odontodysplasia, lost their vitality because of the impaired structure of the enamel. Due to the teeth's early developmental stage, a regenerative endodontic treatment was attempted. All 3 teeth were treated using the same protocol following the AAE guidelines. After 4 weeks, treatment of the premolar was completed, whereas the incisor teeth remained symptomatic and were and therefore, intracanal dressing with calcium hydroxide was repeated and left in place for 5 months. Finally, the regenerative procedure was completed, and the crowns were restored. The patient was scheduled for follow-up examinations after 6 months, and then yearly for the next 3 years. After 1 year, the periapical lesion around the central incisor and premolar had resolved, the lesion around the apex of the lateral incisor was healing, and the roots had continued to develop. After 3 years, complete healing and pulp canal obliteration were observed in the central incisor and in the premolar. However, the root of the lateral incisor tooth was split, and it was recommended to extract this tooth. ConclusionThe positive outcomes of regenerative endodontics in the central incisor and premolar suggest that revascularization of the pulp may be optional for the treatment of immature necrotic teeth affected by developmental disorders, such as ROD, amelogenesis imperfecta, or dentinogenesis imperfecta.

Application of Oxygen Saturation Test after Replantation of Avulsed Immature Permanent Teeth: A Prospective Observational Study

IntroductionThe evaluation of pulp status is crucial for avulsed immature permanent teeth after replantation. In addition to commonly used clinical and radiographic examinations providing clinical evidence, the oxygen saturation test may offer valuable assistance. The aim of this study was to analyze the efficacy of a pulse oximeter in evaluating pulp status in avulsed and replanted immature permanent teeth. MethodsA prospective observational study was performed including 51 avulsed and replanted immature permanent teeth. Routine clinical and radiographic examinations were performed and used as the basis for the diagnosis of pulp status during the 1-year follow-up period. Meanwhile, the oxygen saturation values of these teeth were recorded using a modified pulse oximeter at each visit. ResultsSeven teeth completed pulp revascularization (success group), whereas 44 teeth failed to revascularize (failure group). Abnormal clinical and/or radiographic manifestations in the failure group were observed at an average period of 42.7 days, which was too late because a high incidence of inflammatory root resorption (43.18%) had occurred. For oxygen saturation tests, teeth in the success group showed an immediate postreplantation oxygen value of 70.71 ± 3.35, then an upward trend starting from the 2-week postreplantation visit, and a significantly increased final value of 81.86 ± 2.34 at the 1-year visit. In contrast, no increase trend was found for teeth in the failure group because abnormal clinical and/or radiographic manifestations emerged. ConclusionsThe oxygen saturation test is a reliable diagnostic method to evaluate pulp status of avulsed teeth as early as 2 weeks after replantation.

Pulp revascularization procedure for external inflammatory dental root resorption treatment

To assess the effectiveness of pulp revascularization procedure in children with external inflammatory root resorption (EIRR) after constant teeth injury. The study comprised 17 children aged 6-10 years diagnosed with EIRR as a long-term complication of dental trauma in 19 teeth. EIRR was diagnosed with periapical radiographs and CBCT was performed to further assess the pathology extension. Pulp revascularization was carried out in all 19 teeth. There was no resorption progression in all cases. EIRR areas were substituted by bone. In 10 from 19 teeth with early stages of root development bone or cement-like tissue ingrowth into the root canal was observed radiologically. In cases of severe EIRR this ingrowth may partially compensate for lost tissues which is confirmed by a high percentage (94.7%) of functional teeth during mean follow up time of 38±10 months. Pulp revascularization is an effective method for retaining teeth with EIRR for a relatively long period of time and allows maintaining alveolar bone volume both due to functional tooth preservation and healing of bone lesions in periapical and resorption areas.

Mechanism of Linagliptin on Stromal Cell-Derived Factor 1 and Vascular Endothelial Growth Factor Protein after Molar Pulp Revascularization in Rats

Mechanism of Linagliptin on Stromal Cell-Derived Factor 1 and Vascular Endothelial Growth Factor Protein after Molar Pulp Revascularization in Rats

Systematic review of clinical protocols for pulp revascularization in immature permanent teeth

Systematic review of clinical protocols for pulp revascularization in immature permanent teeth

Revascularization in Immature Permanent Teeth - A Case Series

Immature permanent teeth with developing, root apices with dental pulp infections resulting from caries or trauma represent a formidable clinical challenge. Biologically based principles of regenerative endodontic procedures in the treatment of immature, necrotic teeth have replaced the traditional ‘apexification’ procedures. The purpose of this case series was to investigate the outcome of the pulpal revascularization procedure on immature permanent teeth with or without apical periodontitis. The case series comprised 3 patients (8–11 years of age), consisting of 4 incisors and 1 premolar with incompletely formed apex with or without signs or symptoms of periapical pathology. Induction of blood clot was the technique selected for root closure if the tooth was asymptomatic following the placement of intracanal antibiotic paste for 3 weeks. Apexification was initiated if the tooth remains symptomatic. Out of the five teeth revascularisation was successful, and continued root-end closure was obtained in four teeth. One tooth remained symptomatic and apexification was initiated. One patient failed to follow up for the study. Revascularisation by induction of apical bleeding is a potential source of stem cells for the continued root maturation and it creates a blood clot that would act as a biologic scaffold for the recruited stem cells.

THE USE OF LASER THERAPY IN PULP REVASCULARIZATION USO DA LASERTERAPIA NA REVASCULARIZAÇÃO PULPAR

This literature review studies the use of laser therapy in pulpal revascularization, since this therapeutic method has been gaining more and more space in dentistry. This procedure consists of the use of low power laser rays that will be absorbed by the pulp tissue present in the biostimulation of these cells, thus promoting the restoration of cell function and tissue repair. When talking about laser in dentistry, its importance in regenerative endodontic procedures is indisputable, in addition to promoting bone repair, as well as reducing the microbiota of root canals. It also acts in the prevention of a painful postoperative period, when applied soon after the endodontic session. It is important to emphasize that the application of this therapy requires further studies and prior training by the dentist in order to ensure, in addition to its greater effectiveness, adequate protection for the patient.

Histologic and proteomic profile of two methods to decellularize human dental pulp tissue

ObjectiveThe present study compared the structural and proteomic architecture of extracellular matrices (ECM) of decellularized human dental pulp using two previously described protocols. DesignPulp tissue from 150 molars was extracted and three treatments took place, based on the Matoug-Elwerfelli Group (MG) and the Song Group (SG) protocols and an untreated pulp group (CG), to examine histoarchitecture and the effectiveness of the decellularization process, using histological analysis (n = 12) and scanning electron microscopy (SEM) (n = 3). Protein extraction took place using 100 mg dry weight of pulp, in triplicates for each group, and the shotgun proteome analysis was performed by nanoUPLC-MSE. Proteins were identified using the revised human UNIPROT database attached to the PLGS search engine. ResultsHistological analysis and SEM demonstrated that ECM in MG was more preserved. Proteome analysis showed that the decellularized process in MG maintained approximately 69.56% of proteins identified in untreated pulp tissue while SG maintained 28.26%. ConclusionsECM appears to be suitable as a potential biological scaffold for pulp revascularization and regeneration procedures, especially those processed according to the Matoug-Elwerfelli protocol. This finding can collaborate to enhance clinical solutions for young permanent teeth that have suffered necrosis.

Evaluation of removal efficiency of capping materials used in pulp revascularization in vitro

BackgroundThis study aimed to evaluate the removal efficiency of different capping materials used in pulp revascularization (PR) in a failure scenario.MethodsThe apices of freshly extracted 30 maxillary incisors were cut to mimic the immature teeth; then, root canals were shaped up to #6 Peeso reamers. The regeneration steps of the American Association of Endodontists (AAE) were followed to simulate PR treatment in vitro. The canals were dressed with the Ciprofloxacin and Metronidazole medicament mixture for 2 weeks. Then capping material groups were created: BioDentine (BD), ProRootMTA (PMTA), and RetroMTA (RMTA) (n = 10). The sealed specimens were stored for 2 weeks at 37 ºC in phosphate-buffered saline then the samples were examined by micro-computed tomography (µ-CT) analysis. Set capping materials were retrieved using a specific cement removal kit by a single blind operator. The residue materials were examined again by µCT. Kruskal–Wallis and Mann–Whitney U tests sought the significance for residue volumes. One-way ANOVA and Tukey post hoc tests with the Bonferroni corrections sought significance for the duration (p = 0.05).ResultsIn the first examined µCT data, the mean (SD) capping material volumes of the PMTA, BD, and RMTA were 6.447 µm3 (1.086), 8.771 µm3 (0.491), and 8.114 µm3 (2.447), respectively.In the last examined µCT data, the median (IQR) residual volumes of the PMTA, BD, and RMTA were 0.051 µm3 (0.1), 0.313 µm3 (0.5), and 0.124 µm3 (0.1), respectively. A significant difference was found between BD and PMTA in the residual volumes (p < 0.05).The mean (SD) durations of the retrieving procedures of PMTA, BD, and RMTA were 19.83 min (2.34), 19.24 (3.60), and 22.04 (1.68), respectively (p = 0.063).ConclusionsWithin the limitations of the presented study, it was concluded that the capping materials were largely removed from the root canals using a non-invasive approach. Nevertheless, this duration of the retrieving could be described as long.

Dental pulp revascularization of an open-apex maxillary central incisor in a patient in the fifth decade

ABSTRACTThis report presents a case of revascularization of an open-apex maxillary central incisor in a 46-year-old patient using concentrated growth factor (CGF). After disinfection protocol, the apical foramen was mechanically enlarged, and autologous CGF gel was prepared and placed into the root canal to a level close to the cementoenamel junction. The follow-up evaluation confirmed the clinical success of the treatment with the restoration of tooth sensation within 6 months. The previous flat-shaped apex morphology of the tooth changed into a more rounded shape but with no real change in the length of the root or the size of the canal. This case report shows the potential of using the root canal revascularization technique to treat nonvital teeth in elder patients with the advantage of restoration of tooth sensation. The promising role of the CGF in sdental pulp regeneration is also highlighted.

Current Trends in Pulp Regeneration-Review

Advances in knowledge and treatment options have made pulp regeneration a current objective in clinical dental practice. In recent years, several studies have been carried out and there have been several attempts to develop methodologies regarding pulp regeneration. For the survival as well as for the long-term preservation of the tooth, obtaining a solid and viable pulp is essential. Current endodontic treatment concepts are based on replacing the inflamed/necrotic pulp tissue with a synthetic biomaterial. Recent studies have proposed total or partial pulp regeneration as an alternative treatment method. Recent studies have highlighted that inflamed/necrotic pulp tissues can be replaced by regenerated pulp tissues. Thus, the quality of life is improved through regenerative endodontics. Teeth are revitalized. The latest researches on pulp revascularization have indicated by clinical and radiographic results a possible clinical application of pulp regeneration using the modern cellular homing strategy. Thus, pulp tissues that are functional must be clinically regenerated with the characterization of vascularization, with the characterization of reinnervation as well as with a dentin deposition having a regulated rate almost similar to the normal one. The purpose of this review is to evaluate current pulp treatment options through regenerative approaches.

COMPARISON OF APEXIFICATION BY MINERAL TRIOXIDE AGGREGATE AND PULP REVASCULARIZATION IN IMMATURE NECROTIC TEETH

Injuries to immature permanent teeth may cause pulp necrosis. Conventional treatment for such teeth is root canal treatment and apexification, but recently a new treatment option of revascularization has been introduced, also known as regenerative endodontic treatment. This study compared the treatment outcome of apexification and pulp revascularization in immature necrotic teeth. All the patients were treated, and data were acquired from the dental outpatient department of Shahida Islam Medical and Dental College, Lodhran, between November 15, 2021, to November 14, 2022, duration. To complete this research, Randomized Controlled Clinical Trial was used as a study design to collect the patients, later divided into two groups. Means age of all the patients in this study was 11.41 ± 4.20 years; the mean age of the patients in Group A=11.50 ± 4.24 years and Group B=11.32 ± 4.26 years. The success rate in Group A= 60 (87.32%) was lower than that of Group B= 67 (97.04%). The results of this study revealed that pulp revascularization has a higher success rate than apexification by mineral trioxide aggregate.

Treatment Outcome of Regenerative Endodontic Procedures for Necrotic Immature and Mature Permanent Teeth: A Systematic Review and Meta-Analysis Based on Randomised Controlled Trials.

To analyse whether the stage of apical development affects the effectiveness of regenerative endodontic treatment by comparing the outcomes for necrotic mature and immature permanent teeth treated with regenerative endodontic procedures. Multiple databases (PubMed, Cochrane Library, Web of Science, EMBASE and OpenGrey databases) were searched through February 17th, 2022. Inclusion criteria were randomised controlled trials that included treatment of necrotic immature or mature permanent teeth using any regenerative endodontic procedures (REPs) that aimed to achieve pulp revascularisation or regeneration. The Cochrane Risk of Bias 2.0 tool was used to assess risk of bias. The included indicators were asymptomatic sign, success, pulp sensitivity, and discolouration. The extracted data were expressed by percentage for statistical analysis. The random effect model was used to explain the results. Comprehensive Meta-Analysis Version 2 was used to perform the statistical analyses. Twenty-seven RCTs were eligible for inclusion in the meta-analysis. The success rates of necrotic immature and mature permanent teeth were 95.6% (95% CI, 92.4%-97.5%; I2=34.9%) and 95.5% (95%CI, 87.9%-98.4%; I2=0%), respectively. The asymptomatic rates of necrotic immature and mature permanent teeth were 96.2% (95%CI, 93.5%-97.9%; I2=30.1%) and 97.0% (95%CI, 92.6%-98.8%; I2=0%), respectively. The treatment of immature and mature necrotic permanent teeth with REPs yields high success rates and low symptomatic rates. The incidence of positive sensitivity response for electric pulp testing in necrotic immature permanent teeth (25.2% [95% CI, 18.2%-33.8%; I2=0%]) was lower than that in necrotic mature permanent teeth (45.4% [95% CI, 27.2%-64.8%; I2=75.2%]), and this difference was statistically significant. The restoration of pulp sensitivity seems to be more evident in necrotic mature permanent teeth than in necrotic immature permanent teeth. The crown discolouration rate of immature permanent teeth was 62.5% (95% CI, 49.7%-73.8%; I2=76.1%). Necrotic immature permanent teeth have a considerable crown discolouration rate. REPs for both immature and mature necrotic permanent teeth yield high success rates and promote root development. The vitality responses seem to be more evident in necrotic mature permanent teeth than in necrotic immature permanent teeth.