Different Approaches to the Regeneration of Dental Tissues in Regenerative Endodontics

Abstract

(1) Background: The regenerative procedure has established a new approach to root canal therapy, to preserve the vital pulp of the tooth. This present review aimed to describe and sum up the different approaches to regenerative endodontic treatment conducted in the last 10 years; (2) Methods: A literature search was performed in the PubMed and Cochrane Library electronic databases, supplemented by a manual search. The search strategy included the following terms: “regenerative endodontic protocol”, “regenerative endodontic treatment”, and “regenerative endodontics” combined with “pulp revascularization”. Only studies on humans, published in the last 10 years and written in English were included; (3) Results: Three hundred and eighty-six potentially significant articles were identified. After exclusion of duplicates, and meticulous analysis, 36 case reports were selected; (4) Conclusions: The pulp revascularization procedure may bring a favorable outcome, however, the prognosis of regenerative endodontics (RET) is unpredictable. Permanent immature teeth showed greater potential for positive outcomes after the regenerative procedure. Further controlled clinical studies are required to fully understand the process of the dentin–pulp complex regeneration, and the predictability of the procedure.

Histological Aspects Regarding Dental Pulp of Diabetic Patients

“…The condition called "Diabetic odontalgia" was described in relation with longstanding hyperglycemia. It manifests as dental pain, which is easily confused with pulpitis, so uncontrolled diabetes might affect even the success of endodontic treatment [21], despite the fact that regenerative endodontics research has increased in popularity lately [22,23].…”

Survival and Adherence of Apical Stem Cells to Root Canal Dentin after Conditioning with Apple Vinegar

“…Based on tissue engineering principles, a tetrad of elements forms the essential components in regenerative endodontics. These elements include, stem cells, scaffolds, growth factors and the microenvironment that allow the required outcome to occur (2)(3)(4) .…”

“…For regenerative endodontic procedures to be successful, it should follow the principles of the tissue engineering including, various stem cells, growth factors, scaffolds and a suitable microenvironment that induce regeneration of dental pulp and continuation of root development (4) .…”

“…Many studies evaluated the effect of irrigating solution on the viability and attachment of stem cells (2,4,11) . Sodium Hypochlorite (NaOCL) is used as main irrigant due to its antimicrobial ability and unique organic tissue dissolving action.…”

“…However, it has been found that it decreases the viability of the stem cells in concentration and time dependent manner (13) . NaOCl to be effective, its application time should be about 5 minutes (4) .…”