Root Canal Treatment (RCT): From Traditional Endodontic Therapies to Innovating Pulp Regeneration

Abstract

Traditional protocols involve the cleaning of the pulp chamber and root canals, the removal of bacteria and of the smear layer, and ultimately to the sealing of endodontic materials filling the pulp, and root lumen. Disinfection combined with mechanical enlargement allows occluding the lumen of the dental pulp with a central master cone, and lateral condensation using a series of small accessory cones. Innovative approaches propose bioengineered scaffolds, growth and transcription factors. Removal of the smear layer reveals different types of globular and non-globular dentins (osteodentin, osteodentin, fibrodentin), cleaning the dentinal walls before chemical or mechanical enlargement of the lumen. Three distinct options open gates for classical endodontic therapies before conventional filling. New pulp therapies derived from apexogenesis and apexification contributes to the formation of a renewed dental pulp, involving totipotent, multipotent and unipotent stem cell. Proliferation of structural cells, signaling factors, transcription factors, metalloproteinases, and cytokines are involved in pulp renewal. Coronal and root microvascularization participate to pulp regeneration and ultimately to pulp mineralization. BMP-2, TGF-β1, MTA and Portland cement may also contribute to the requirements for pulp bioengineering, leading to the future of innovating biological pulp therapies. Dental caries are mostly due to bacteria and subsequently to pulp infection [3]. Associated to the dental plaque; microorganisms alter enamel surface, either beneath the proximal contacts areas, or in the face-to-face enamelling occlusal fissures. The initial carious lesions is formed at this precocious stage. The carious lesion crosses the whole enamel thickness and spread laterally along the enlarged dentino-enamel junction. The lesion degrades firstly the mantle dentin. Caries penetrate the subjacent circumpulpal dentin through dentinal tubules

Tissue Engineering with Stem Cell from Human Exfoliated Deciduous Teeth (SHED) and Collagen Matrix, Regulated by Growth Factor in Regenerating the Dental Pulp

“…Endodontic treatment involves partial or complete pulp removal (pulp extirpation) and filling the empty root canal with artificial material. Even so, the endodontic treatment causes the tooth to become more fragile, susceptible to caries and periapical infection and more likely to fracture as the tooth losses its vitality due to the absence of blood supply and innervation [5][6][7][8][9][10][11].…”

Post-Operative Pain Intensity After Using Different Instrumentation Techniques for Canal Preparation

“…Root canal treatment (RCT) is a method which involves the cleaning of pulp canals using different instrumentation techniques and filling the prepared canals with an obturating material. 1,2 There are various methods for root canal preparation, but engine-driven instrumentation has been considered the mainstay for the last many years. 3,4 However, the reciprocating file system was proposed a few years ago as a new technique for root canal preparation.…”