Regenerative Endodontic Treatment Research Articles

Time-Dependent Morphological Changes in Traumatic Immature Teeth With Necrotic Pulps Following Regenerative Endodontic Treatment: A Retrospective Study.

Regenerative endodontic treatment is a promising approach for healing periapical lesions and continuous root maturation. Although previous studies have reported its outcomes, the dynamics of morphological changes over time remain unclear. Therefore, this study aimed to evaluate changes in the periapical status and root dimensions over a 60-month follow-up period. The follow-up duration, periapical status changes, calcific barrier formation, degree of apical closure and radiographic root area changes were compared with those of the last follow-up in this retrospective study. Radiographic root area changes were calculated as the difference between the total root and total canal areas. Fifty-eight patients (81 teeth) underwent regenerative endodontic treatment during the study period, of whom 32 patients (36 teeth, 62%) were included. The survival and success rates of the treated teeth were 100% and 94.4%, respectively. All teeth developed a calcific bridge in the cervical third of the root canal, indicating the presence of vital tissue. Apical narrowing (partial or total) was observed in 75% of the cases. The root maturation stage affected the percentage increase in the radiographic root area. Teeth in Cvek stages II-III showed a higher radiographic root area increase than more mature teeth. All tooth radiographic root areas increased significantly in the initial 20 months of the treatment and moderately thereafter. Regenerative endodontic treatment is a safe approach for traumatised immature teeth. The presence of a radiographic calcified bridge may be an early indication of treatment success. The main complete tooth morphological changes occur after approximately 20 months posttreatment. These findings may help clinicians better understand the time-dependent changes in the root morphology after treatment, improve the follow-up schedule and predict the progress of healing during follow-up visits.

Regenerative endodontic treatment with T-PRF after delayed trauma

Regenerative endodontic treatment with T-PRF after delayed trauma

Regenerative endodontic treatment with autologous platelet-rich plasma

Regenerative endodontic treatment with autologous platelet-rich plasma

Regenerative Endodontic Treatment in Immature Permanent Teeth: Case Series

Regenerative Endodontic Treatment in Immature Permanent Teeth: Case Series

Regenerative endodontic treatment of immature tooth with chronic lesion

Regenerative endodontic treatment of immature tooth with chronic lesion

Regenerative endodontic treatment of ımmature permanent tooth: Case report

Regenerative endodontic treatment of ımmature permanent tooth: Case report

Case Series of Regenerative Endodontic Treatment

Case Series of Regenerative Endodontic Treatment

Comparative Evaluation of Platelet-rich Fibrin and Treated Dentin Matrix in Regenerative Endodontic Treatment of Nonvital Immature Permanent Teeth: A Randomized Clinical Trial.

Clinical and radiographic evaluation of the efficacy of platelet-rich fibrin (PRF) and treated dentin matrix (TDM) in regenerative endodontic treatment and periapical healing of nonvital immature permanent teeth with chronic apical periodontitis. Twenty-four children aged between 7 and 11 years, each presenting with a nonvital immature permanent upper central incisor, were selected. They were randomly allocated into two groups (n = 12), group I (PRF) and group II (TDM). Baseline clinical findings were recorded, and preoperative cone-beam computed tomography (CBCT) was taken. Follow-up was done clinically for 15 months at 3-month intervals (3, 6, 9, 12, and 15 months), and CBCT was taken at the end of the 15-month follow-up. Root length, apical diameter, radiographic root area (RRA), and size of the periapical lesion were quantitively assessed at the end of follow-up period and compared to the preoperative CBCT. Clinical success was 100% in both groups by the end of the follow-up period. Radiographically, after a 15-month follow-up, there was a significant increase in root length and RRA, and there was also a significant reduction in apical diameter and lesion size within each group (p < 0.05). However, there was no statistically significant difference between both groups regarding the mean percentage of increase in root length and mean percentage of reduction of apical diameter (p > 0.05). On the other hand, PRF showed more increase in RRA and more reduction in lesion size, with a statistically significant difference between both groups (p < 0.05). Both PRF and TDM were clinically successful. Platelet-rich fibrin showed better radiographic outcomes and periapical healing. Platelet-rich fibrin is a viable scaffold to aid further root development and resolution of periapical lesions of nonvital immature permanent teeth. Further studies with different forms of TDM are needed to assess the efficacy of TDM in regenerative endodontic treatment of nonvital immature permanent teeth. How to cite this article: Asal MA, Elkalla IH, Awad SM, et al. Comparative Evaluation of Platelet-rich Fibrin and Treated Dentin Matrix in Regenerative Endodontic Treatment of Nonvital Immature Permanent Teeth: A Randomized Clinical Trial. J Contemp Dent Pract 2024;25(6):563-574.

The Impact of Silver Nanoparticles’ Size on Biofilm Eradication

IntroductionEfficient intracanal disinfection is required for a successful regenerative endodontic treatment. Thus, this study aimed to identify the silver nanoparticles’ (NPs) size (AgNPs) with the highest antibiofilm efficacy when mixed with calcium hydroxide [Ca(OH)2] to eradicate an in vitro endodontic biofilm. MethodsThe various sizes of AgNPs and mixtures were characterized by scanning electron microscopy, transmission electron microscopy, and ultraviolet-visible spectroscopy. A total of 168 dentin root segments were prepared, sterilized, and inoculated for 3 weeks with Actinomyces naeslundii and Fusobacterium nucleatum. Samples were randomly allocated to 4 experimental groups (n = 28/group): 2 nm AgNPs + 35% Ca(OH)2, 5 nm AgNPs + 35% Ca(OH)2, 10 nm AgNPs + 35% Ca(OH)2, and 35% Ca(OH)2 alone. Samples exposed to saline and triple antibiotic paste (TAP) acted as negative and positive control groups, respectively. After 1 and 2 weeks, samples were stained with LIVE/DEAD BacLight dye and examined under a confocal laser scanning microscope to determine the proportion of dead bacteria. ResultsThe characterization procedure revealed a spherical NP's structure with minor aggregations. Except for Ca(OH)2 group, all groups had significantly higher antibiofilm efficacy at 2 weeks. Both the 10 nm mixture (99.5%) and TAP (99.2%) exhibited the highest antibiofilm efficacy at 2 weeks and were not significantly different from one another (P > .05). No significant difference was noted between the 2 and 5 nm mixtures at 1 week (81% and 84%) and 2 weeks (89% and 91%). ConclusionThe 10 nm AgNPs (0.02%) + 35% Ca(OH)2 mixture exhibited the highest antibiofilm efficacy at 2 weeks compared to all other mixtures at both observation periods. Interestingly, the 10 nm mixture performed similarly to TAP at 2 weeks. Excluding Ca(OH)2 group, longer application significantly improved the antibiofilm efficacy of all tested medicaments. Clinical RelevanceThe 10 nm AgNPs + 35% Ca(OH)2 mixture revealed promising results as an intracanal medicament in the regenerative endodontic treatment protocol.

Arrest and Repair of Inflammatory Root Resorption After an Endodontic Regeneration Procedure – A Hypothesis and Case Report

IntroductionExternal inflammatory root resorption (EIRR) is a significant complication that can occur following traumatic dental injuries, with a prevalence of approximately 18%. Most cases occur during the early stage of the mixed dentition. Specifically, EIRR occurs in approximately 5%–8% of luxation injuries, 30% of replanted teeth following avulsion, and 38% of intruded teeth. Conventional methods for addressing EIRR in immature teeth pose several challenges. This often requires numerous dental visits where Ledermix and calcium hydroxide are used, which may significantly prolong the treatment. Additionally, the effect of prolonged use of calcium hydroxide medication in the root canal is debatable. Recent publications have highlighted the ability of regenerative endodontic treatment (RET) to effectively stop and repair EIRR in a relatively brief time, yielding impressive results. Nevertheless, the underlying mechanism responsible for this effect remains unclear. MethodsA hypothesis is proposed and drawn from existing data, explaining the mechanism by which RET triggers alterations in the root dimensions of necrotic immature teeth, facilitating continuous root maturation. The hypothesis suggests that bioactive molecules, including growth factors, might be able to penetrate the denuded dentin, reach the resorbed area, and attract stem cells from the surrounding periodontal ligament and adjacent bone, leading to the arrest of the resorption process. ResultsThis recruitment may trigger repair mechanisms, ultimately resulting in the coverage of the denuded dentin with a new layer of periodontal ligament, cementoid, and cementum. ConclusionsA hypothesis of the potential mechanism in which RET may arrest EIRR is presented along with a case report.

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.

Assessing Cell Viability: Comparative Analysis of Calcium Hydroxide, Triple Antibiotic Paste, and Their Synergistic Impact on human Dental Pulp Stem Cells

Abstract Objective The American Association of Endodontists recommends the use of calcium hydroxide (Ca(OH)2) or triple antibiotic paste (TAP) as preferred medicaments in regenerative endodontic treatment. Although both medicaments showed an excellent antibacterial property, their impact on the viability of human dental pulp stem cells (hDPSCs) when used in combination remains uncertain. Previous studies have indicated that at certain concentrations, both Ca(OH)2 and TAP can be harmful to cells. Therefore, it is aimed to assess the effects of Ca(OH)2, TAP, and their combined application on the viability of hDPSCs in this study. Materials and Methods Primary cultured hDPSCs, reaching 80% confluency and at passages 3rd to 4th, were subjected to 24-hour starvation. Subsequently, they were cultured in media supplemented with Ca(OH)2, TAP at 0.1 and 1 mg/mL concentrations, and a combination of Ca(OH)2 and TAP at equivalent concentrations, with Dulbecco's modified eagle medium serving as the control group. The viability and morphology of hDPSCs were assessed using both the quantitative 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and qualitative 4',6-diamidino-2-phenylindole staining. Statistical Analysis First, the data were analyzed by one-way analysis of variance, followed by Bonferroni post hoc to compare between groups. All the tests were conducted at a significance level of 95% (p &lt; 0.05). Results In this study, a notable variation in hDPSCs viability was observed among all groups, with the lowest viability recorded in the combination of Ca(OH)2 + TAP at 1 mg/mL (p &lt; 0.05). Conclusion Ca(OH)2, TAP, and their combination are not toxic to hDPSCs and the use of their combination was superior in hDPSCs viability on Ca(OH)2 + TAP in the 0.1 mg/mL group.

Regenerative potential of mesoporous silica nanoparticles scaffold on dental pulp and root maturation in immature dog’s teeth: a histologic and radiographic study

ObjectiveTo evaluate histologically and radiographically the potential of dog’s immature roots with apical periodontitis to regenerate after regenerative endodontic treatment using mesoporous silica nanoparticles (MSNs) with/without bone morphogenic protein (BMP-2) as scaffolds.MethodsIn 4 mongrel dogs, 56 immature teeth with 96 roots were infected, resulting in necrotic pulps and periapical pathosis. According to the evaluation time (Group I = 30 days and Group II = 90 days), 90 roots were divided into two equal groups (45 roots each) and 6 roots used to replace any lost root during the procedure. The two main groups were further divided according to treatment protocol into 5 subgroups (9 roots each): blood clot (BC subgroup), mesoporous silica nanoparticles scaffold only (MSNs subgroup), mesoporous silica nanoparticles impregnated with BMP2 (MSNs + BMP2 subgroup), infected teeth without treatment (+ ve control subgroup) and normal untouched teeth (-ve control subgroup). All teeth surfaces were coated with Tincture iodine and calcium hydroxide was applied prior to treatment protocols. Then, teeth were restored with glass ionomer filling to seal the remaining part of the access cavity. Radiography evaluation of the increase in root length, root thickness and occurrence of apical closure were performed. Following the sacrifice of the two dogs at each time of evaluation, histopathological analysis was performed and included the inflammatory cells count, bone resorption, tissue ingrowth, deposition of hard tissue, and closure of the apical part. All data were statistically analyzed.ResultsCompared to BC subgroup, MSNs and MSNs + BMP-2 subgroups exhibited significant higher increase in root length and thickness as well as higher vital tissue in-growth and new hard tissue formation in group II (P < 0.05). MSNs + BMP-2 subgroup had significant higher increase in root length and thickness as well as significant lower inflammatory cell count than MSNs subgroup in both groups (P < 0.05). There were no significant differences between MSNs and MSNs + BMP-2 subgroups regarding new hard tissue formation in both groups and apical closure in group I (P > 0.05).ConclusionMSNs with/without BMP-2 scaffolds enabled the continuing growth of roots in immature teeth with necrotic pulps and periapical pathosis. Addition of BMP-2 to MSNs scaffold improved its outcome in regenerative endodontics.Clinical relevanceMSNs with/without BMP-2 scaffolds may alternate blood clot for regenerative endodontic treatment of immature teeth with necrotic pulps.

Dens invaginatus Type II in an Immature Lateral Incisor With Apical Periodontitis Treated With Regenerative and Strategic Antimicrobial Procedures: A Case Report

Dens invaginatus is a developmental dental anomaly that can predispose the tooth to pulp and periradicular disease. Management of this condition can be challenging because of anatomic and microbiologic issues. This case report describes the regenerative endodontic treatment using a strategic antimicrobial protocol for management of an immature maxillary lateral incisor with type-II dens invaginatus associated with apical periodontitis in a 13-year-old patient. The tooth presented with a complex anatomy and was associated with an active sinus tract. Because the true root canal was not negotiable in its coronal part due to the presence of the dens invaginatus, the closed end of the invagination (pseudocanal) was perforated to permit access to the apical segment of the true root canal for cleaning and disinfection. Both the invagination and the true canal were treated using an antimicrobial regimen based on chemomechanical preparation with sodium hypochlorite irrigation, supplementary disinfection with passive ultrasonic irrigation and interappointment calcium hydroxide medication. After 2 exchanges of calcium hydroxide medication, the sinus tract did not disappear, then the antimicrobial protocol was changed to include an antibiotic solution for irrigation and antibiotic paste for intracanal medication. After signs and symptoms disappeared, regenerative endodontic treatment was performed by inducing blood clot formation within the root canal. The coronal canal segment including the invagination was filled with Biodentine. Follow-up including cone-beam computed tomography examination showed complete healing of the apical periodontitis lesion and mineralized tissue formation at the apical portion of the true root canal.

Regenerative endodontic treatment and traumatic dental injuries.

Pulp necrosis is the most common complication following dental trauma and is often associated with apical periodontitis. The management of these teeth is challenging in terms of large root canals, open apices, thin dentinal walls, and short roots. Over decades the conventional treatment for these teeth was calcium hydroxide apexification, a time-consuming procedure despite high success rates. Subsequently after the introduction of mineral trioxide aggregate and hydraulic calcium silicate materials single visit apical plug procedures became increasingly practiced with comparable success rates to the conventional apexification. The search continued afterward for a clinical procedure that may stimulate further root development and apical closure to avoid the long-term complication of root fracture after apexification. Regenerative procedures using stem cells derived from the apical papilla and blood clots as scaffolds were then introduced for the management of immature teeth, with variable protocols and success rates. This review will cover the evidence available and current position of regenerative endodontic procedures in traumatized immature teeth with apical periodontitis, in terms of clinical protocols, outcome, and potential prognostic factors.

Histological evaluation of different concentrations of hyaluronic-acid-added zinc oxide eugenol on rat molar pulp.

Hyaluronic acid (HA), known for diverse properties, was investigated for its potential in dental pulp therapy. This study investigated the potential of HA in dental pulp therapy by examining the physical properties and effects of zinc oxide eugenol (ZOE) pulpotomy materials containing varying HA concentrations on rat molar teeth. In vitro tests assessed compressive strength and hardness of ZOE materials blended with HA (0.5%, 1%, 3%) and HA gels (0.54%, 0.8%). 120 samples, encompassing the control group, underwent compressive strength testing, while 60 samples were designated for hardness assessment. In vivo experiments on rat molars studied histological effects of HA-containing ZOE on dental pulp over 1week and 1month. Gels with HA concentrations of 0.5%, 1%, and 0.54% were used in pulpotomy on 22 rats. Each rat underwent the procedure on four teeth, with one tooth serving as a control, totaling 88 teeth subjected to the intervention. In the analyses, SPSS 22.0 was used and the significance level was set at P = 0.05. Findings showed that HA at 0.5% maintained compressive strength, but higher concentrations decreased mechanical properties significantly (P = 0.001). Histological assessments indicated better outcomes with lower HA concentrations in terms of odontoblast layer continuity (P = 0.005 at 1month) and pulp vitality (P = 0.001 at 1week and P = 0.018 at 1month). The study suggests HA holds promise for pulpotomy and regenerative endodontic treatments, but further research is needed to understand long-term clinical implications.

Effects of Final Root Canal Irrigants in Conventional and Regenerative Endodontic Treatments: A Systematic Review

Background: The effectiveness of final root canal irrigants is crucial for successful conventional and regenerative endodontic treatments. This study aimed to systematically review the impact of final irrigants on dentin, disinfection, and regenerative potential in endodontic therapies. Methods: MEDLINE, Cochrane Library, and Web of Science databases were electronically searched for articles on final irrigants in conventional and regenerative endodontics, evaluating effects on dentin, smear layer, fracture resistance, stem cells, growth factors, and antimicrobial properties. The risk of bias was assessed using the Systematic Review Centre for Laboratory Animal Experimentation risk of bias tool. Results: Overall, 25 eligible studies were included in this review after screening 2842 articles. Commonly assessed irrigants included ethylenediaminetetraacetic acid (EDTA) (21 studies), sodium hypochlorite (NaOCl; 12 studies), and citric acid (6 studies). EDTA could enhance growth factors but could weaken dentin. NaOCl affected dentin despite its antimicrobial benefits. Nanoparticles, chitosan, peracetic acid (PAA), and citric acid showed potential benefits. A meta-analysis was not performed due to methodological heterogeneity. Conclusion: In general, optimized irrigation strategies balancing disinfection, biocompatibility, and regenerative potential are necessary. More research is required to develop improved irrigation protocols. Registration: PROSPERO CRD42023420406.

Improving Antimicrobial Properties of GelMA Biocomposite Hydrogels for Regenerative Endodontic Treatment.

Regenerative endodontics is a developing field involving the restoration of tooth structure and re-vitality of necrotic pulp. One of the most critical clinical considerations for regenerative endodontic procedures is the disinfection of the root canal system, since infection interferes with regeneration, repair, and stem cell activity. In this study, we aimed to provide the synthesis of injectable biopolymeric tissue scaffolds that can be used in routine clinical and regenerative endodontic treatment procedures using Gelatin methacryloyl (GelMA), and to test the antimicrobial efficacy of Gelatin methacryloyl/Silver nanoparticles (GelMA/AgNP), Gelatin methacryloyl/Hyaluronic acid (GelMA/HYA), and Gelatin methacryloyl/hydroxyapatite (GelMA/HA) composite hydrogels against microorganisms that are often encountered in stubborn infections in endodontic microbiology. Injectable biocomposite hydrogels exhibiting effective antimicrobial activity and non-cytotoxic behavior were successfully synthesized. This is also promising for clinical applications of regenerative endodontic procedures with hydrogels, which are proposed based on the collected data. The GelMA hydrogel loaded with hyaluronic acid showed the highest efficacy against Enterococcus faecalis, one of the stubborn bacteria in the root canal. The GelMA hydrogel loaded with hydroxyapatite also showed a significant effect against Candida albicans, which is another bacteria responsible for stubborn infections in the root canal.

Effects of Platelet-Rich Plasma and Platelet-Rich Fibrin Usage in Regenerative Endodontic Treatments: An Analysis of Root Length and Dentin Thickness

Effects of Platelet-Rich Plasma and Platelet-Rich Fibrin Usage in Regenerative Endodontic Treatments: An Analysis of Root Length and Dentin Thickness

Regenerative endodontic treatment of necrotic permanent teeth with pre-eruptive intracoronal radiolucency: a case report.

Pre-eruptive intracoronal radiolucency is a rare dental anomaly with unclear aetiology, generally asymptomatic and diagnosed through routine radiographs. Failure to diagnose and treat it early can lead to rapid pulp damage, potentially compromising root development. The presented clinical report describes a mandibular second premolar with pre-eruptive intracoronal radiolucency that caused early pulp necrosis with arrest of root formation and emphasises the endodontic management using regenerative endodontic therapy.