Treatment Of Immature Permanent Teeth Research Articles

Functional extracellular vesicles from SHEDs combined with gelatin methacryloyl promote the odontogenic differentiation of DPSCs for pulp regeneration

BackgroundPulp regeneration is a novel approach for the treatment of immature permanent teeth with pulp necrosis. This technique includes the combination of stem cells, scaffolds, and growth factors. Recently, stem cell-derived extracellular vesicles (EVs) have emerged as a new methodology for pulp regeneration. Emerging evidence has proven that preconditioning is an effective scheme to modify EVs for better therapeutic potency. Meanwhile, proper scaffolding is of great significance to protect EVs from rapid clearance and destruction. This investigation aims to fabricate an injectable hydrogel loaded with EVs from pre-differentiated stem cells from human exfoliated deciduous teeth (SHEDs) and examine their effects on pulp regeneration.ResultsWe successfully employed the odontogenic induction medium (OM) of SHEDs to generate functional EV (OM-EV). The OM-EV at a concentration of 20 µg/mL was demonstrated to promote the proliferation and migration of dental pulp stem cells (DPSCs). The results revealed that OM-EV has a better potential to promote odontogenic differentiation of DPSCs than common EVs (CM-EV) in vitro through Alizarin red phalloidin, alkaline phosphatase staining, and assessment of the expression of odontogenic-related markers. High-throughput sequencing suggests that the superior effects of OM-EV may be attributed to activation of the AMPK/mTOR pathway. Simultaneously, we prepared a photocrosslinkable gelatin methacryloyl (GelMA) to construct an OM-EV-encapsulated hydrogel. The hydrogel exhibited sustained release of OM-EV and good biocompatibility for DPSCs. The released OM-EV from the hydrogel could be internalized by DPSCs, thereby enhancing their survival and migration. In tooth root slices that were subcutaneously transplanted in nude mice, the OM-EV-encapsulated hydrogel was found to facilitate dentinogenesis. After 8 weeks, there was more formation of mineralized tissue, as well as higher levels of dentin sialophosphoprotein (DSPP) and dentin matrix protein-1 (DMP-1).ConclusionsThe effects of EV can be substantially enhanced by preconditioning of SHEDs. The functional EVs from SHEDs combined with GelMA are capable of effectively promoting dentinogenesis through upregulating the odontogenic differentiation of DPSCs, which provides a promising therapeutic approach for pulp regeneration.

Access to Care Considerations for the Endodontic Treatment of Immature Permanent Teeth: A National Survey of Pediatric Dentists and Endodontists

IntroductionThis study aimed to investigate access to care and financial considerations associated with the endodontic treatment of immature permanent teeth. MethodsSurveys were distributed to endodontists (n = 2,457) and pediatric dentists (n = 3,974) in the United States. Data were analyzed using X2 analysis and logistic regression. The level of significance was set to 0.05. ResultsThe response rate was 13% (n = 840). Respondent specialist groups were similar by age and years since specialty residency completion, but significantly different with regard to primary practice setting (eg private practice, Federally Qualified Health Center, hospital), (P = .001). The majority (91%) of respondents reported participation with dental insurance. Pediatric dentists (69%) were significantly more likely than endodontists (17%) to participate with public-payer dental insurance (P < .001). The majority of respondents (82%) indicated that patients reported economic factors (time or money) as a barrier to accessing endodontic treatment. Pediatric dentists were significantly more likely to consider economic factors when planning for treatment (P < .001). Pediatric dentists were more likely than endodontists to have the opinion that endodontic procedures for treatment of necrotic immature permanent teeth should cost less than root canal therapy (apexification, P < .001; regenerative endodontic procedures, P = .002). Pediatric dentists (33%) reported encountering barriers when attempting to refer their patients to an endodontist. Inability to find an endodontist that participates with dental insurance was the most frequently cited barrier. ConclusionsLimited clinician participation with dental insurance and gaps in insurance coverage for endodontic procedures appear to contribute to access to care barriers for pediatric patients.

Long-term Success of Regenerative Endodontic Procedures

ABSTRACT Background: Regenerative endodontic procedures (REPs) have emerged as a transformative approach to treating immature permanent teeth with necrotic pulp tissue Materials and Methods: A prospective study was conducted, enrolling 100 patients with immature permanent teeth requiring REPs. All procedures were performed by a single experienced endodontist following established protocols. Patients were followed up for a minimum of 5 years’ post-treatment. Clinical examinations, radiographic assessments, and patient-reported outcomes were recorded at regular intervals. Data were analyzed using statistical methods to determine the success rates, complications, and factors influencing long-term outcomes. Results: The results of this original research reveal a significant and sustained success rate for REPs. After a minimum follow-up period of 5 years, an arbitrary value of 92% for tooth survival was achieved. Radiographic assessments demonstrated consistent healing of apical lesions, and continued root development was observed in the majority of cases. Patient-reported outcomes indicated a high level of satisfaction with the procedure. Complications such as crown discoloration and tooth fracture occurred in a minority of cases but were effectively managed without compromising the overall success of REPs Conclusion: This original research provides strong evidence for the long-term success of REPs in the treatment of immature permanent teeth with necrotic pulp tissue. The high tooth survival rate, continued root development, and patient satisfaction support the efficacy of REPs as a reliable treatment option.

Micro-computed tomography (micro-CT) evaluation of root canal morphology in immature maxillary third molars.

The endodontic treatment of immature permanent teeth with necrotic pulp is a significant clinical challenge. The success of regenerative endodontic procedure is highly dependent on disinfection of the root canal and an accurate anatomical knowledge of the root canal. The aim of this study was to use micro-computed tomography (micro-CT) analysis to investigate the configuration of root canals in the upper permanent third maxillary molars with incomplete root development in their coronal, apical and middle third portions. Thirty immature third permanent maxillary molars were scanned using a micro-CT system. Then, we measured the diameters and areas of the root canal in the coronal, middle and apical third of the roots. The ratio between the long and short diameter of each root canal was then calculated and the canals were divided into several groups: round, oval, long oval, flat and irregular. The round configuration was not observed in the distobuccal and mesiobuccal roots in any of their anatomical regions. Oval and long oval canals predominated in the distobuccal root. The greatest variations were observed in the mesiobuccal root, with the ribbon-shaped canal predominating in the middle region and an irregular shape in the apical region. In the coronal region of the palatal canal, the round configuration predominated; in the middle third, we observed an almost equivalent distribution between round and oval configurations; apically, the oval shape predominated. In conclusion, we observed significant complexity and variation in the morphology and configuration of root canals in immature permanent molars, thus generating additional obstacles for the success of regenerative endodontics.

Regenerative endodontic treatment of immature permanent teeth after mechanical instrumentation with XP-Endo Finisher.

The traditional treatment of immature permanent teeth with necrotic pulp involves creating an apical barrier by using calcium hydroxide or an MTA plug for an extended period of time. A novel therapeutic approach called regenerative endodontic procedures (REP) is used to allow root development to continue.

Comparison of pulpal vitalization and root canal therapy in symptomatic immature permanent molars.

Endodontic treatment of immature permanent teeth has various problems. Today, the primary goal in the treatment of such teeth is to preserve the life of the pulp so that roots can develop entirely and naturally. If vital pulp therapy can treat these teeth, the treatment will be simpler and less expensive. Therefore, this study compared vital pulp therapy (including calcium-enriched mixture (CEM) cement and MTA methods) and root canal therapy (RCT) in symptomatic immature permanent molars. Also, the expression of TLR-2 and TLR-4 was evaluated in the gingival tissue of patients for further evaluation. In this clinical trial study, 615 patients randomly received three treatments: pulpotomy with CEM (205 cases), pulpotomy with MTA (207 cases), and root canal therapy (203 cases). The presence of periapical lesion was evaluated radiographically at three-time points: start, six months, and 12 months after treatment. The expression of TLR-2 and TLR-4 was also evaluated in the gingival tissue of patients by the Real-time PCR technique. The one-year follow-up of the periapical index shows that the presence of periapical lesion at six-month follow-up in the three groups of MTA, CEM, and RCT equals 14 cases (8%), 7 cases (4%), and 40 cases (22%). The one-year follow-up equals 12 cases (7%), 9 cases (5%), and 33 cases (18%), respectively. The TLR-2 and TLR-4 gene expression results showed no statistical difference between the three groups (CEM, MTA, and RCT). Still, one year after treatment, there was a statistically different between vital pulp therapy (CEM and MTA) and root canal therapy (P<0.05). Also, the results showed no statistical difference between CEM and MTA treatment in terms of TLR-2 and TLR-4 gene expression before and one year after treatment. In general, the results showed that pulpotomy treatment using two biomaterials, CEM and MTA, is more successful than RCT treatment.

Clinical and radiographic outcomes of regenerative endodontic treatment performed by endodontic postgraduate students: a retrospective study

ObjectivesRegenerative endodontic treatment is a clinical procedure aimed at biologically regenerating damaged root canal tissue of immature permanent teeth. This study aimed to report the outcomes of regenerative endodontic treatment performed by endodontic postgraduate students.Materials and MethodsClinical and radiographic data of 27 patients, aged 10–22 years, who underwent regenerative treatment of immature permanent teeth from 2015 to 2019 were followed up, wherein clinical and radiographic examinations were performed for each patient. Postoperative success rate and tooth survival were analyzed, and the postoperative radiographic root area changes were quantified.ResultsA total of 23 patients attended the dental appointments, showing that all teeth survived and were asymptomatic. Specifically, 7 periapical pathosis cases were completely healed, 12 were incompletely healed, and 4 cases failed. Moreover, significant differences were found between discolored and non-discolored teeth, and between the presence or absence of periapical radiolucency. Additionally, 3 anterior teeth showed complete closure of the apical foramen, while the apical foramen width was reduced in 17 teeth and failed in 3 teeth. Root length was also found to have been increased in 7 anterior and 4 posterior teeth, and the average length ranged from 4.00–0.63 mm in the anterior teeth, 2.85–1.48 mm of the mesial root, and 2.73–2.16 mm of the molar teeth distal root. Furthermore, calcified tissue deposition was observed in 7 teeth.ConclusionsA favorable outcome of regenerative endodontic treatment of immature permanent teeth with necrotic pulp was achieved with a high survival rate.

Treatment of Immature Permanent Teeth With Platelet-Rich Fibrin: A Series of Three Cases

Treatment of Immature Permanent Teeth With Platelet-Rich Fibrin: A Series of Three Cases

A contemporary approach to treat necrotic immature teeth using different bioceramic materials

Aim: The present report describes the endodontic treatment of an immature maxillary central incisor with an open apex and extensive periapical lesion. Summary: Cone-beam computed tomographic images demonstrated the unusual root canal anatomy and a contemporary approach using bioceramic intracanal dressing, root repair materials and root canal sealers were used. One year after the end of treatment, the patient was asymptomatic and a new cone-beam computed tomographic exam showed complete apical repair, with new bone formation and closure of the root apex. The combination of modern imaging and the use of contemporary materials contributed to adequate diagnosis, planning and treatment of this case. Key-learning points: Immature permanent teeth with apical periodontitis represent a clinical challenge. Calcium silicate-based materials are widely used in endodontics, mainly due to their excellent biological and physical properties. The association of different type of calcium silicate-based materials could be a good option of the treatment of immature permanent teeth with apical periodontitis.

Second-Generation Bioceramics in the Treatment of Immature Permanent Teeth: Systematic Review of the Literature

Second-Generation Bioceramics in the Treatment of Immature Permanent Teeth: Systematic Review of the Literature

Regenerative Endodontics as the Future Treatment of Immature Permanent Teeth

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.

The endodontic treatment for immature permanent teeth with pulp necrosis

Root canal treatment of immature permanent teeth with pulp necrosis presents clinical difficulties due to wideroot canals and apical foramen. In addition, there is a high risk associated with a potential cervical fracture due to the thin dentinal walls even after successful root canal treatment. Thus, a notion of continued root development of the immature tooth has continuously explored. Regenerative endodontic treatment (RET) provides a biological treatment approach based on regeneration and revascularization principles. Unlike conventionalapexification, RET promotes the growth and development of immature roots and the healing of the periapical lesion via disinfection of the infected root canal system. Therefore, RET may provide a positive effect on thelong-term prognosis of immature permanent teeth with pulp necrosis.

Nekrotik Pulpalı İmmatür Daimî Dişlerin Rejeneratif Endodontik Tedavisi: İki Olgu Sunumu

Nekrotik Pulpalı İmmatür Daimî Dişlerin Rejeneratif Endodontik Tedavisi: İki Olgu Sunumu

MTA apexification as a savior of questionable tooth: A Case report

Treatment of traumatized immature teeth poses a challenge for clinician. Apexification is considered to be the treatment of choice for non-vital young permanent teeth. The present report, highlight the case of traumatized young permanent tooth where apexificationwas achieved in a previously endodontically treated tooth. Endodontic treatment of immature permanent teeth without apical barrier leads to failure of treatment due to incomplete sealing of the canal. Also, the success of endodontic treatment is determined by the quality of obturation. In wide canals, traditional obturating technique may result in spaces being left in the canal space. Obturation using rolled cone technique to achieve a good seal is used in the present case. Keywords: MTA Apexification, Rolled cone technique, Traumatic injury.

Evaluation of the regenerative potential of dentin conditioning and naturally derived scaffold for necrotic immature permanent teeth in a dog model.

This study evaluated the outcome of partial exposure of dentin matrix to ethylenediaminetetraacetic acid (EDTA) and application of platelet-rich fibrin (PRF) scaffold on regeneration of necrotic immature permanent teeth in a dog model. The present study was carried out on 216 permanent immature roots in nine mongrel dogs aged 6-9months. Pulp necrosis and periapical pathosis were induced in 180 roots. These roots were divided into five equal groups (36 roots each) according to the treatment protocol: group I: blood clot; group II: 17% EDTA solution and blood clot; group III: PRF; group IV: 17% EDTA solution and PRF; and group V: without treatment (positive control). The negative control group (group VI) represented 36 untouched normal roots for normal maturation. The groups were followed up for 1, 2 and 3months (subgroups). Maturation of the roots was monitored by radiography and histopathology. All data were statistically analysed. Group IV exhibited the highest increase in root length and thickness, decrease in apical diameter, the highest score of vital tissue infiltration and least inflammatory scores. There was a significant difference regarding the increase in root length and thickness and decrease in apical diameter in all subgroups of the experimental and negative control groups (P≤.05). PRF has a better regenerative potential than the blood clot during treatment of immature permanent teeth with necrotic pulp. Inclusion of 17% EDTA solution as a final irrigation enhances the regenerative potential of both PRF and blood clot.

What is the most effective endodontic medicament for pulpotomies in immature permanent teeth?

Data sources MEDLINE (via PubMed), EMBASE, the Cochrane library (CENTRAL) and the clinicaltrials.gov database were used as the data sources for the systematic review. Date restrictions were from database inception to October 2018 and only articles published in English were included. Hand searching of reference lists was carried out. Missing data was sought from authors if required for analysis.Study selection Two independent researchers identified randomised controlled trials assessing the outcomes of pulpotomy procedures on vital permanent teeth with immature apices. Studies were only included if they reported clinical and radiographic success rates. After full text assessment, any disagreement between reviewers was resolved via discussion.Data extraction and synthesis Data extraction was carried out using a table which was custom designed for this study. Accuracy of data was checked by a third reviewer. Strict criteria for healing were used for clinical and radiographic outcomes. Success rates were calculated for each intervention. Statistical testing on the data was completed using a fixed- or random-effect model depending on heterogeneity identified, using the i2 test. Results were presented as relative risks with 95% confidence intervals. Two independent reviewers assessed the quality of studies using the Cochrane risk of bias assessment tool.Results Following screening of 1364 articles, five studies were included for qualitative analysis and two for quantitative analysis. All included studies were assessed as having a high risk of bias, which was attributed to the nature of the intervention and challenges in blinding the researcher. Four out of the five included studies were assessed as having a low risk of bias for detection, because of blinding of the investigator assessing the outcome. The remaining study had an unclear risk of bias for this parameter. No significant difference was detected between mineral trioxide aggregate (MTA) and calcium hydroxide (CH) at 6 months or 12 months post-treatment. MTA was also compared to platelet-rich fibrin (PRF), calcium-enriched mixture (CEM) and triple antibiotic paste (TAP) in individual studies with no statistically significant differences identified between groups. Significant clinical and radiographic differences were observed in favour of MTA and TAP compared to abscess remedy (AR), although this was noted as weak evidence.Conclusions Based on the present evidence, there were similar success rates when using MTA, CH, CEM, RPF and TAP as medicaments for pulpotomies in the treatment of immature permanent teeth. More high-quality RCTs are needed in this field in future studies.

Status and Survey of Pulp Treatment by Korean Pediatric Dentists

The pulp treatment of primary and immature teeth in the children and adolescents is affected by the environment of the patients, clinical careers and dentists performing the techniques, as well as clinical modalities and pulpal diagnosis. The purpose of this study was to investigate the current status of pulp treatment performed in real clinical practice, as well as the reasons behind the choice of treatment methods.The study was conducted on a total of 153 members of the Korean Academy of Pediatric Dentistry, and statistical data from the Health Insurance Review and Assessment Service (HIRA) from 2010 to 2018 were analyzed together. Both the survey results and the statistics from the HIRA showed that 1-visit pulpectomies of primary teeth were most common, and the frequency of the use of the Ni-Ti file was increased in children with primary or mixed-dentition. In the treatment of immature permanent teeth, regenerative endodontic treatment by individual dentists was found to be less frequent than in university hospitals.

Clinical efficacy of treatment of immature permanent teeth in children with different risk of caries

Relevance. Nowadays the choice of restorative material and treatment plan for caries of immature permanent teeth in children remains of current interest. Purpose. To evaluate the clinical efficacy of modified glass-ionomer cement for restoration of permanent immature teeth in children with different risk of dental caries. Materials and methods. The results of the treatment of immature permanent teeth in children with different risk of caries are proposed in this article. 100 permanent immature teeth in children with a low, moderate and high risk of dental caries with acute and chronic process were treated using modified glass ionomer cement. Remineralizing therapy was carried out in children with acute caries for 2 weeks before restoration. The duration of remineralizing therapy in children with a high risk and chronic caries was 2 weeks, in the acute caries – 4 weeks. Remineralizing therapy included application of calcium and phosphate containing agents. Assessment of the fillings was conducted in 12 and 24 months in accordance with Ryge criteria which take into account the anatomical shape, marginal adaptation, marginal pigmentation, color stability, and surface roughness. Results. It has been found the high effectiveness of the proposed method of treatment after two years. 100% retention of restorations were revealed. 80-95% fillings were of satisfactory quality, 5-20% of fillings were of acceptable quality and do not require correction or re-treatment.Conclusions. The modified glass-ionomer cement restorations with previous remineralizing therapy provide the high clinical efficacy for the treatment of caries in permanent immature teeth in children with different risk caries in 85-90% of clinical cases.

Effectiveness of different root canal irrigation protocols in treatment of immature permanent teeth

Effectiveness of different root canal irrigation protocols in treatment of immature permanent teeth

Materials for pulpotomy in immature permanent teeth: a systematic review and meta-analysis

BackgroundPulpotomy is one of the most widely used methods in preserving vital pulp in teeth, which is of great significance in achieving continue root formation in immature permanent teeth suffering from dental caries or trauma. The aim of this meta-analysis and systemic review is to synthesize the available evidences to compare different pulpotomy dressing agents for pulpotomy treatment in immature permanent teeth.MethodsElectronic databases including MEDLINE (via Pubmed), EMBASE, the Cochrane library (CENTRAL) and the clinicaltrials.gov database were searched. The references of all included articles or relevant reviews were cross-checked. Only randomized controlled trials (RCTs) comparing two or more pulp dressing agent in permanent teeth with open apex would be included. Also, the studies should have at least 6 months of follow-up, report clinical and radiographic success in detail and publish in English.ResultsFive RCTs were included for a systematic review, and all of them had a high risk of bias. There is little difference in success rate between mineral trioxide aggregate (MTA) and calcium hydroxide (CH) at 6-month follow-up (risk ratio (RR) 1; 95% confidence interval (CI) 0.94 to 1.06) and 12-month follow-up (RR 1.04; 95% CI 0.96 to 1.13). There is no difference between MTA versus platelet-rich fibrin and MTA versus calcium-enriched mixture (CEM). There is only weak evidence of increased success rate in using MTA and triple antibiotic paste (TAP) rather than abscess remedy.ConclusionsBased on the present evidence, similar success rates with MTA were found between the dressing agents CH, CEM, RPF and TAP as pulpotomy-dressing agents in the treatment of immature permanent teeth. More high-quality RCTs are needed in this field in future studies.