Regenerative Endodontic Procedures Using Contemporary Endodontic Materials

Abstract

Calcium hydroxide apexification and Mineral Trioxide Aggregate (MTA) apexification are classical treatments for necrotic immature permanent teeth. The first tend to fail for lack of compliance given the high number of sessions needed; the second has technical difficulties such as material manipulation and overfilling. With both techniques, the root development is interrupted leaving the tooth with a fragile root structure, a poor crown-to-root ratio, periodontal breakdown, and high risk of fracture, compromising long-term prognosis of the tooth. New scientific literature has described a procedure that allows complete root development of these specific teeth. This regenerative endodontic procedure (REP) proposes the use of a combination of antimicrobials and irrigants, no canal walls instrumentation, induced apical bleeding to form a blood clot and a tight seal into the root canal to promote healing. MTA is the most used material to perform this seal, but updated guidelines advise the use of other bioactive endodontic cements that incorporate calcium and silicate in their compositions. They share most of their characteristics with MTA but claim to have fewer drawbacks with regards to manipulation and aesthetics. The purpose of the present article is to review pertinent literature and to describe the clinical procedures protocol with its variations, and their clinical application.

Viability and Stimulation of Human Stem Cells from the Apical Papilla (hSCAPs) Induced by Silicate-Based Materials for Their Potential Use in Regenerative Endodontics: A Systematic Review

“…Silicate-based hydraulic biomaterials, categorized as bioactive endodontic cements (BECs), emerged as bright candidates for the coronal sealing of the previously established blood clot scaffold [22]. These non-resorbable biocompatible materials have shown bioactive properties in direct contact with dental pulp stem cells (DPSCs) using in vitro assays [23].…”

Treatment outcomes of pulp revascularization in traumatized immature teeth using calcium hydroxide and 2% chlorhexidine gel as intracanal medication

“… 29 MTA is the most material used for coronal barrier 10 due to its beneficial properties, as good sealing ability, low cytotoxicity, antimicrobial effect, biocompatibility and ability to induce proliferation of stem cells from apical papilla. 30 …”

“… 4 , 15 For some time, the use of calcium hydroxide in pulp revascularization was not indicated due to its high pH and the possible tissue necrosis, preventing the differentiation of mesenchymal cells into new vital tissue. 30 However, more recent studies showed that calcium hydroxide can be recommended in pulp revascularization. 5 , 37 , 38 In addition to its property of microbial reduction and to the fact that it does not have the potential for crown discoloration, it also does not exhibit cytotoxicity to stem cells of the apical papilla, increases the release of dentin growth factors by EDTA, provides a better environment for attachment of viable apical papilla cells on dentin and does not cause bacterial resistance, as it can happen if there is a random use of antibiotics.…”

Management of an Unsuccessful Regenerative Endodontic Procedure after Tooth Fracture: A Case Report

“…Despite not knowing the real reason for the failure, there are some hypotheses like the presence of bacteria in the apical part of the root. Another possibility is the disruption of the blood clot, leaving an empty space inside the canal and no proper coronal seal [2,10,12,[14][15][16][17]. When a REP is confirmed as unsuccessful, alternative treatments must be considered such as apexification with MTA.…”