EC Dental Science

Perspective Volume 19 Issue 10 - 2020

Regenerative Endodontic Treatment in Clinical Practice: A Systematic Review

Hatem Faisal Bajnaid1*, Hussain Zaki Alabdulwahhab2, Abdulhadi Mohammed Albandar3, Khulud Nasser Alhmamey4, Rahaf Abdullah Manzalawi4, Nada Mohammed Fallatah5, Renad Khalid Alamoudi6, Reem Mohammed Alharbi6, Asuf Naif Alabdali7, Abdulmalik Ahmed Alburayk8 and Maryam Nabeel Nasser6

1Department of Endodontics, King Fahad Hospital, Jeddah, Saudi Arabia
2Primary Health Care, Ministry of Health, Ras Tanura, Saudi Arabia
3Primary Health Care, Ministry of Health, Hail, Saudi Arabia
4College of Dentistry, Batterjee Medical College, Jeddah, Saudi Arabia
5College of Dentistry, Alfarabi Colleges, Jeddah, Saudi Arabia
6College of Dentistry, Ibn Sina National College, Jeddah, Saudi Arabia
7General Dentist, FMC, Jeddah, Saudi Arabia
8College of Dentistry, Alfarabi Colleges, Riyadh, Saudi Arabia

*Corresponding Author: Hatem Faisal Bajnaid, Department of Endodontics, King Fahad Hospital, Jeddah, Saudi Arabia.
Received: August 12, 2020; Published: September 24, 2020

Recently, regenerative endodontic treatment (RET) has been recognized as a ‘paradigm shift’ regarding the management of immature teeth associated with pulp necrosis. Various reports have suggested the use of RET as a first-line therapeutic option when dealing with immature teeth, particularly when the roots are not yet fully developed. For that, a systematic electronic database search was conducted for relevant studies published from inception and till 24th June 2020 in seven databases. Several position statements and clinical recommendations regarding the use of RET in clinical practice have been released by the European Society of Endodontology (ESE) and the American Association of Endodontists (AAS). Such treatment modalities depend upon the tissue engineering concept components, including stem cells, scaffolds, and signaling molecules. In clinical practice, this treatment approach involves the process of disinfection and commonly the introduction of a blood clot into the root canal space. There are three main therapeutic goals of RET. The first goal is the resolution of associated clinical signs and symptoms. The second goal is to establish further root maturation. The final goal is the restoration of neurogenesis. Up till this point, RET has been unable to reach a proven result regarding the real regeneration of pulp tissue and dentine space. From a histological aspect, healing is achieved with repair from tissues that are originated mainly from the periodontal and osseous tissues, including bone-like tissues and cementum, rather than odontoblasts and pulp tissues. We have conducted the current literature review to provide an overview of the clinical and biological aspects of regenerative endodontic treatment.

Keywords: Regenerative; Endodontic; Treatment; Pulp: RET

  1. Rafter M. “Apexification: A Review”. Dental Traumatology 21.1 (2005): 1-8.
  2. Huang GT. “Apexification: The Beginning of Its End”. International Endodontic Journal 42.10 (2009): 855-866.
  3. Banchs F and M Trope. “Revascularization of Immature Permanent Teeth with Apical Periodontitis: New Treatment Protocol?” Journal of Endodontics 30.4 (2004): 196-200.
  4. Huang GT., et al. “The Hidden Treasure in Apical Papilla: The Potential Role in Pulp/Dentin Regeneration and Bioroot Engineering”. Journal of Endodontics 34.6 (2008): 645-651.
  5. Shah N., et al. “Efficacy of Revascularization to Induce Apexification/Apexogensis in Infected, Nonvital, Immature Teeth: A Pilot Clinical Study”. Journal of Endodontics 34.8 (2008): 919-925.
  6. Hoshino E., et al. “In-Vitro Antibacterial Susceptibility of Bacteria Taken from Infected Root Dentine to a Mixture of Ciprofloxacin, Metronidazole and Minocycline”. International Endodontic Journal 29.2 (1996): 125-130.
  7. Sato I., et al. “Sterilization of Infected Root-Canal Dentine by Topical Application of a Mixture of Ciprofloxacin, Metronidazole and Minocycline in Situ”. International Endodontic Journal 29.2 (1996): 118-124.
  8. Liberati Alessandro., et al. “The Prisma Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration”. PLoS Medicine 6.7 (2009): e1000100.
  9. Vassar Matt., et al. “Manual Search Approaches Used by Systematic Reviewers in Dermatology”. Journal of the Medical Library Association: JMLA 104.4 (2016): 302.
  10. Health, National Institutes of. “Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies”. National Heart, Lung, and Blood Institute (2014).
  11. Lin LM., et al. “Regeneration of the Dentine-Pulp Complex with Revitalization/Revascularization Therapy: Challenges and Hopes”. International Endodontic Journal 47.8 (2014): 713-724.
  12. Gronthos S., et al. “Stem Cell Properties of Human Dental Pulp Stem Cells”. Journal of Dental Research 81.8 (2002): 531-535.
  13. Chmilewsky F., et al. “Sources of Dentin-Pulp Regeneration Signals and Their Modulation by the Local Microenvironment”. Journal of Endodontics 40.4 (2014): S19-S25.
  14. Galler KM., et al. “Scaffolds for Dental Pulp Tissue Engineering”. Advances in Dental Research 23.3 (2011): 333-339.
  15. Ulusoy AT., et al. “Evaluation of Blood Clot, Platelet-Rich Plasma, Platelet-Rich Fibrin, and Platelet Pellet as Scaffolds in Regenerative Endodontic Treatment: A Prospective Randomized Trial”. Journal of Endodontics 45.5 (2019): 560-566.
  16. Jung C., et al. “Pulp-Dentin Regeneration: Current Approaches and Challenges”. Journal of Tissue Engineering 10 (2019): 2041731418819263.
  17. Hargreaves Kenneth M. “Pathways of the Pulp”. Mosby (2006).
  18. Bose R., et al. “A Retrospective Evaluation of Radiographic Outcomes in Immature Teeth with Necrotic Root Canal Systems Treated with Regenerative Endodontic Procedures”. Journal of Endodontics 35.10 (2009): 1343-1349.
  19. Lee BN., et al. “A Review of the Regenerative Endodontic Treatment Procedure”. Restorative Dentistry and Endodontics 40.3 (2015): 179-187.
  20. Cvek M. “Prognosis of Luxated Non-Vital Maxillary Incisors Treated with Calcium Hydroxide and Filled with Gutta-Percha. A Retrospective Clinical Study”. Endodontics and Dental Traumatology 8.2 (1992): 45-55.
  21. Kim SG., et al. “Regenerative Endodontics: A Comprehensive Review”. International Endodontic Journal 51.12 (2018): 1367-1388.
  22. Paryani K and SG Kim. “Regenerative Endodontic Treatment of Permanent Teeth after Completion of Root Development: A Report of 2 Cases”. Journal of Endodontics 39.7 (2013): 929-934.
  23. Endodontics, American Association of. “Aae Clinical Considerations for a Regenerative Procedure”. (2018).
  24. Myers WC and SB Fountain. “Dental Pulp Regeneration Aided by Blood and Blood Substitutes after Experimentally Induced Periapical Infection”. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology 37.3 (1974): 441-450.
  25. Fouad AF. “Microbial Factors and Antimicrobial Strategies in Dental Pulp Regeneration”. Journal of Endodontics 43.9s (2017): S46-s50.
  26. Zehnder M. “Root Canal Irrigants”. Journal of Endodontics 32.5 (2006): 389-398.
  27. Kontakiotis EG., et al. “Regenerative Endodontic Therapy: A Data Analysis of Clinical Protocols”. Journal of Endodontics 41.2 (2015): 146-154.
  28. Galler KM., et al. “Influence of Root Canal Disinfectants on Growth Factor Release from Dentin”. Journal of Endodontics 41.3 (2015): 363-368.
  29. Martin DE., et al. “Concentration-Dependent Effect of Sodium Hypochlorite on Stem Cells of Apical Papilla Survival and Differentiation”. Journal of Endodontics 40.1 (2014): 51-55.
  30. Yamauchi N., et al. “Immunohistological Characterization of Newly Formed Tissues after Regenerative Procedure in Immature Dog Teeth”. Journal of Endodontics 37.12 (2011): 1636-1641.
  31. Galler KM., et al. “EDTA Conditioning of Dentine Promotes Adhesion, Migration and Differentiation of Dental Pulp Stem Cells”. International Endodontic Journal 49.6 (2016): 581-590.
  32. Trevino EG., et al. “Effect of Irrigants on the Survival of Human Stem Cells of the Apical Papilla in a Platelet-Rich Plasma Scaffold in Human Root Tips”. Journal of Endodontics 37.8 (2011): 1109-1115.
  33. Sjögren U., et al. “The Antimicrobial Effect of Calcium Hydroxide as a Short-Term Intracanal Dressing”. International Endodontic Journal 24.3 (1991): 119-125.
  34. Kitikuson P and T Srisuwan. “Attachment Ability of Human Apical Papilla Cells to Root Dentin Surfaces Treated with Either 3mix or Calcium Hydroxide”. Journal of Endodontics 42.1 (2016): 89-94.
  35. Andreasen JO., et al. “Long-Term Calcium Hydroxide as a Root Canal Dressing May Increase Risk of Root Fracture”. Dental Traumatology 18.3 (2002): 134-137.
  36. Kahler SL., et al. “The Effect of Long-Term Dressing with Calcium Hydroxide on the Fracture Susceptibility of Teeth”. Journal of Endodontics 44.3 (2018): 464-469.
  37. Althumairy RI., et al. “Effect of Dentin Conditioning with Intracanal Medicaments on Survival of Stem Cells of Apical Papilla”. Journal of Endodontics 40.4 (2014): 521-525.
  38. Cehreli ZC., et al. “Regenerative Endodontic Treatment (Revascularization) of Immature Necrotic Molars Medicated with Calcium Hydroxide: A Case Series”. Journal of Endodontics 37.9 (2011): 1327-1330.
  39. Lovelace TW., et al. “Evaluation of the Delivery of Mesenchymal Stem Cells into the Root Canal Space of Necrotic Immature Teeth after Clinical Regenerative Endodontic Procedure”. Journal of Endodontics 37.2 (2011): 133-138.
  40. Kahler B., et al. “Revascularization Outcomes: A Prospective Analysis of 16 Consecutive Cases”. Journal of Endodontics 40.3 (2014): 333-338.
  41. Chen MY., et al. “Responses of Immature Permanent Teeth with Infected Necrotic Pulp Tissue and Apical Periodontitis/Abscess to Revascularization Procedures”. International Endodontic Journal 45.3 (2012): 294-305.
  42. Song M., et al. “Revascularization-Associated Intracanal Calcification: Assessment of Prevalence and Contributing Factors”. Journal of Endodontics 43.12 (2017): 2025-2033.
  43. Majno Guido and Isabelle Joris. “Cells, Tissues, and Disease: Principles of General Pathology. Oxford University Press (2004).
  44. Lin LM and PA Rosenberg. “Repair and Regeneration in Endodontics”. International Endodontic Journal 44.10 (2011): 889-906.
  45. Da Silva LA., et al. “Revascularization and Periapical Repair after Endodontic Treatment Using Apical Negative Pressure Irrigation Versus Conventional Irrigation Plus Triantibiotic Intracanal Dressing in Dogs’ Teeth with Apical Periodontitis”. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology 109.5 (2010): 779-787.
  46. Wang X., et al. “Histologic Characterization of Regenerated Tissues in Canal Space after the Revitalization/Revascularization Procedure of Immature Dog Teeth with Apical Periodontitis”. Journal of Endodontics 36.1 (2010): 56-63.
  47. Yamauchi N., et al. “Tissue Engineering Strategies for Immature Teeth with Apical Periodontitis”. Journal of Endodontics 37.3 (2011): 390-397.
  48. Becerra P., et al. “Histologic Study of a Human Immature Permanent Premolar with Chronic Apical Abscess after Revascularization/ Revitalization”. Journal of Endodontics 40.1 (2014): 133-139.
  49. Lin LM., et al. “Histologic and Histobacteriologic Observations of Failed Revascularization/Revitalization Therapy: A Case Report”. Journal of Endodontics 40.2 (2014): 291-295.
  50. Lin LM., et al. “Continued Root Maturation Despite Persistent Apical Periodontitis of Immature Permanent Teeth after Failed Regenerative Endodontic Therapy”. Australian Endodontic Journal 44.3 (2018): 292-299.
  51. Linsuwanont P., et al. “Evaluation of Root Maturation after Revitalization in Immature Permanent Teeth with Nonvital Pulps by Cone Beam Computed Tomography and Conventional Radiographs”. International Endodontic Journal 50.9 (2017): 836-846.
  52. Žižka R., et al. “Root Maturation in Teeth Treated by Unsuccessful Revitalization: 2 Case Reports”. Journal of Endodontics 42.5 (2016): 724-729.
  53. Shimizu Emi., et al. “Clinical, Radiographic, and Histological Observation of a Human Immature Permanent Tooth with Chronic Apical Abscess after Revitalization Treatment”. Journal of endodontics 39.8 (2013): 1078-1083.
  54. Kahler B., et al. “An Evidence-Based Review of the Efficacy of Treatment Approaches for Immature Permanent Teeth with Pulp Necrosis”. Journal of Endodontics 43.7 (2017): 1052-1057.
  55. Lin J., et al. “Regenerative Endodontics Versus Apexification in Immature Permanent Teeth with Apical Periodontitis: A Prospective Randomized Controlled Study”. Journal of Endodontics 43.11 (2017): 1821-1827.
  56. Silujjai J and P Linsuwanont. “Treatment Outcomes of Apexification or Revascularization in Nonvital Immature Permanent Teeth: A Retrospective Study”. Journal of Endodontics 43.2 (2017): 238-245.

Hatem Faisal Bajnaid., et al. “Regenerative Endodontic Treatment in Clinical Practice: A Systematic Review”.”. EC Dental Science 19.10 (2020): 95-106.

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