Clinical Outcomes of Immature Teeth Treated with Regenerative Endodontic Procedures—A San Antonio Study

Chrepa, Vanessa; Joon, Ruchika; Austah, Obadah; Diogenes, Aníbal; Hargreaves, Kenneth M.; EzEldeen, Mostafa; Ruparel, Nikita B.

doi:10.1016/j.joen.2020.04.008

Cited by 56 publications

(57 citation statements)

References 45 publications

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“…It could depend on the severity, source and duration of apical periodontitis or the severity of damage caused by the dental trauma to HERS and the apical papilla (Chrepa et al . 2020). Clinically it is impossible to know their conditions; therefore, the outcomes of CF‐RET in immature permanent teeth with pulp necrosis/ apical periodontitis following dental trauma are unpredictable.…”

Section: Unpredictability Of Treatment Outcomesmentioning

confidence: 99%

Clinical cell‐based versus cell‐free regenerative endodontics: clarification of concept and term

et al. 2021

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There is no consensus on the true meaning of clinical regenerative endodontics, and there is confusion over the concept and the term. Commonly used terms include revitalization and revascularization. The clinical methods for endodontic revitalization procedures and the tissue engineering concept differ depending on whether there is exogenous delivery of cells – called cell therapy, or not. Here, in this review, the difference is clarified by emphasizing the correct terminology: cell‐free versus cell‐based regenerative endodontic therapy (CF‐RET versus CB‐RET). The revitalization procedures practised clinically do not fit into the modern tissue engineering concepts of pulp regeneration but can be categorized as CF‐RET. The modern tissue engineering concept in pulp regeneration is a CB‐RET, which so far is at the clinical trial stage. However, histological examination of teeth following regenerative endodontic treatments reveals healing with repair derived from stem cells that originate from the periodontal, bone and other tissues. The aim of regenerative endodontics is regeneration of the pulp–dentine complex. This review discusses why CF‐RET is unlikely to regenerate a pulp–dentine complex with current protocols. The American Association of Endodontists and the European Society of Endodontology have not yet recommended autologous stem cell transplantation (CB‐RERT) which aspires for regeneration. Therefore, an understanding of the concept, term, difficulties and differences in current protocols is important for the clinician. However, rather than being discouraged that ideal regeneration has not been achieved to date, repair can be an acceptable outcome in clinical regenerative endodontics as it has also been accepted in medicine. Repair should also be considered in the context that resolution of the clinical signs/symptoms of pulp necrosis/apical periodontitis is generally reliably obtained in clinical regenerative endodontics.

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Section: Unpredictability Of Treatment Outcomesmentioning

confidence: 99%

Clinical cell‐based versus cell‐free regenerative endodontics: clarification of concept and term

et al. 2021

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“…Triple Antibiotic Paste NR PRP was prepared according to Dohan et al [39], after which concentrated platelet-rich plasma (cPRP) was prepared and introduced inside dry root canals using a sterile 30 G syringe. The canal was then backfilled with cPRP to a level just beneath the CEJ and left to clot for 10 min.…”

Section: Characteristics Of the Studiesmentioning

confidence: 99%

“…Triple Antibiotic Paste 3 weeks PRP was prepared according to the description by Dohan et al [39]. PRP was combined with equal volumes of sterile solution containing 10% calcium chloride and sterile bovine thrombin (100 U/mL) to achieve coagulation.…”

Section: Characteristics Of the Studiesmentioning

confidence: 99%

Effectiveness of Autologous Platelet Concentrates in Management of Young Immature Necrotic Permanent Teeth—A Systematic Review and Meta-Analysis

Panda

Mishra

Arbildo-Vega

et al. 2020

Cells

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The use of autologous platelet concentrates (APCs) in regenerative endodontic procedures is inconsistent and unclear. The aim of this meta-analysis was to evaluate the effectiveness of autologous platelet concentrates compared to traditional blood-clot regeneration for the management of young, immature, necrotic, permanent teeth. The digital databases MEDLINE, SCOPUS, CENTRAL, Web of Science, and EMBASE were searched to identify ten randomized clinical trials. The outcomes at postoperative follow-up, such as dentinal wall thickness (DWT), increase in root length (RL), calcific barrier formation (CB), apical closure (AC), vitality response (VR), and success rate (SR), were subjected to both qualitative synthesis and quantitative meta-analysis. The meta-analysis showed that APCs significantly improved apical closure (risk ratio (RR) = 1.17; 95% CI: 1.01, 1.37; p = 0.04) and response to vitality pulp tests (RR = 1.61; 95% CI: 1.03, 2.52; p = 0.04), whereas no significant effect was observed on root lengthening, dentin wall thickness, or success rate of immature, necrotic teeth treated with regenerative endodontics. APCs could be beneficial when treating young, immature, necrotic, permanent teeth regarding better apical closure and improved response to vitality tests.

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“…The main limitation of this strategy is however the predictability of the number of the recruited cells. Moreover, as discussed below, the current concept does not yield predictable results and can lead to blood-and material-induced tooth discoloration (Chrepa et al, 2020;Kahler et al, 2014). The use of recombinant growth factors may induce non-desirable side effects, because of their pleiotropic effects on metabolism.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic potential of mesenchymal stem cell-derived extracellular vesicles in regenerative endodontics

Ivica

Zehnder

Weber³

2021

eCM

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Regenerative endodontic procedures are an alternative to conventional root-canal treatment and apexification. There are two different tissue engineering approaches that are currently followed, both aiming at the colonisation of the cleaned pulp space by pluripotent cells and subsequent pulp regeneration. Firstly, the transplantation of mesenchymal stem cells (MSCs), and secondly a cell-free strategy that relies on bioactive molecules to trigger the recruitment of the patient’s own cells. The first approach is hampered by costs and regulatory issues. Despite great initial enthusiasm with a clinically used cell-free approach that relies on induced bleeding into the pulp space, results have been revealed to be rather unpredictable, and mere repair rather than regeneration of the pulp-dentin complex is what is typically achieved. Moreover, the extent of further root development is variable, and the concept is limited to immature teeth. This article discusses a third possible way of regenerative endodontics that involves the application of MSC-derived exosomes. These are extracellular vesicles that contain proteins, lipids, and nucleic acids, reflecting the secretome of MSCs. Based on the first in vitro and in vivo studies, exosomes appear to be a potent tool to improve pulp regeneration. This narrative review aims to investigate the therapeutic use of human MSCs or dental pulp-derived exosomes in regenerative endodontics. Furthermore, the focus of this review is on targeting important questions that should be investigated in future in-vivo and clinical studies, such as the choice of scaffold material for exosome delivery into the pulp space.

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Clinical Outcomes of Immature Teeth Treated with Regenerative Endodontic Procedures—A San Antonio Study

Cited by 56 publications

References 45 publications

Clinical cell‐based versus cell‐free regenerative endodontics: clarification of concept and term

Clinical cell‐based versus cell‐free regenerative endodontics: clarification of concept and term

Effectiveness of Autologous Platelet Concentrates in Management of Young Immature Necrotic Permanent Teeth—A Systematic Review and Meta-Analysis

Therapeutic potential of mesenchymal stem cell-derived extracellular vesicles in regenerative endodontics

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