Regenerative Endodontics and Minimally Invasive Dentistry: Intertwining Paths Crossing Over Into Clinical Translation

Abstract

Regenerative endodontic procedures have been described for over a decade as a paradigm shift in the treatment of immature necrotic permanent teeth, owing to their ability to allow root maturation with subsequent enhancement of the tooth’s fracture resistance in addition to the potential for regeneration of vital intracanal tissues. Concomitantly, minimally invasive endodontics is another rising concept with the main concern of preservation of tooth structure. Stemming from their potential to preserve the original tooth structure, both regenerative and minimally invasive endodontics could be considered as two revolutionary sciences with one common goal. Achieving this goal would entail not only employing the appropriate strategies to recreate the ideal regenerative niche but modifying existing concepts and protocols currently being implemented in regenerative endodontics to address two important challenges affecting the outcome of these procedures; conservation of tooth structure and achieving effective disinfection. Therefore, the search for new biomimetic cell-friendly disinfecting agents and strategies is crucial if such a novel integratory concept is to be foreseen in the future. This could be attainable by advocating a new merged concept of “minimally invasive regenerative endodontic procedures (MIREPs),” through modifying the clinical protocol of REPs by incorporating a minimally invasive access cavity design/preparation and biomimetic disinfection protocol, which could enhance clinical treatment outcomes and in the future; allow for personalized disinfection/regeneration protocols to further optimize the outcomes of MIREPs. In this review, we aim to introduce this new concept, its realization and challenges along with future perspectives for clinical implementation.

Calcium Phosphate Delivery Systems for Regeneration and Biomineralization of Mineralized Tissues of the Craniofacial Complex

“…These insults to the dentin–pulp complex can increase patient pain and, if left untreated, tooth loss and serious damage to surrounding tissues. Currently, there are only two strategies available to treat deep cavitated lesions . First, vital pulp therapy harnesses the healthy stem cell population within the dental pulp to induce odontoblast-like cells to differentiate, replace the damaged population, and form a dentinal bridge with scar tissue.…”

“…Currently, there are only two strategies available to treat deep cavitated lesions. 97 First, vital pulp therapy harnesses the healthy stem cell population within the dental pulp to induce odontoblast-like cells to differentiate, replace the damaged population, and form a dentinal bridge with scar tissue. Second, if the dentin–pulp damage is irreversible, then a root canal is performed that causes the loss of the vasculature, innervation, and stem cell population which drastically reduces the longevity of the tooth.…”

Minimal Invasive Endodontics: A Comprehensive Narrative Review

“…The occlusal and cervical portions of the tooth are less stressed according to the Consortium for Educational Communication (CEC) design, which preserves more of the coronal tooth structure (Yuan et al, 2016). As a result, the tooth's ability to withstand masticatory stresses may be enhanced by a minimal canal preparation with a reduced taper [ 20 ].…”

“…At this point, it is necessary to clean off any remaining dirt and smear layer. There is a strong correlation between root canal infection and treatment failure, as shown by the large majority of patients who do not respond well to regenerative endodontic [ 20 ]. Research by Plotino and colleagues found that an instrument with a 25-size bore provided a better canal surface in the root canal's apical third [ 35 ].…”

Autologous Platelet Rich Plasma (PRGF) Preserves Genomic Stability of Gingival Fibroblasts and Alveolar Osteoblasts after Long-Term Cell Culture

“…Regenerative medicine has multiple potential applications and is geared towards the healing or substitution of damaged tissues to restore the previous function. The application of regenerative medicine in dentistry is motivated by the need of more personalized therapies and minimally invasive treatments [ 1 , 2 , 3 ]. Morbidity reduction and enhancing tissue healing (time and quality) would allow the clinicians to offer a better treatment to their patients.…”