Use of scaffolds and regenerative materials for the treatment of immature necrotic permanent teeth with periapical lesion: Umbrella review

Abstract

Background: Current treatment of immature necrotic permanent teeth with a periapical lesion is regenerative endodontics, which is based on tissue engineering under the triade of stem cells, scaffolds and bioactive molecules.Objectives: This Umbrella Review was aimed to evaluate the success of scaffold and regenerative materials used for the treatment of these teeth, in terms of apical closure, tooth length increase, widening of root canal walls, tissue vitality and periapical lesion repair.Methods: An extensive literature research was carried out in the Medline, ISI Web of Science, and Scopus databases for relevant systematic reviews matching the keyword search strategy. Based on inclusion and exclusion criteria, reviewers independently rated the quality of each study to determine their level of evidence. Methodological quality assessment of each article was obtained using A Measurement Tool to Assess Systematic Reviews (AMSTAR)-2 tool, and risk of bias was assessed with the Risk of Bias in Systematic Reviews (ROBIS) tool.Results: After removing duplicates, 155 articles were found; from which 133 were excluded for being non-relevant and 15 other due to exclusion criteria. One more was discarded after methodological quality evaluation, for a total of six articles remaining. The most common scaffold used was the blood clot, others used were poly lactic-co-glycolic acid and platelet-rich fibrin matrix. The most common regeneration material used was Mineral Trioxide Aggregate (MTA), followed by Biodentine.An increase in tooth length and widening of root canal walls were reported in all selected studies with different proportions, as well as periapical lesion repair. ROBIS analysis showed that only one article had low bias, two were classified as unclear bias, while the remaining three had high risk of bias.Discussion: An exhaustive literature search was carried out applying language filters, high-quality indexed journals, year of publication, which ensures the best quality articles were included. Blood clot was the most used scaffold as is the most easy to place inside the canal and does not require to extract blood from the patient. The use of MTA General characteristics of the articles selectedThe selected systematic reviews and meta-analysis were found in different indexed journals, ranked as Q1-Q4 by Scimago Journal Rank (SJR), published between 2016 and 2020 in the Journal of Endodontics (2), Acta Odontologica Scandinavica (1), Pediatric Dentistry (1), Platelets (1) and Scientific Reports (1). The number of articles included in these systematic reviews ranged between 6 and 26; and the search motors used were PubMed, Scopus, Google Scholar, Medline, ISI Web of Science, Cochrane Library, BVS, Lilacs, BBO, Embase, Central and grey literature. Other general characteristics are listed on Table 5. Materials and methods main findingsScaffolds used were the blood clot, collagen, PLGA, PRFM, whilst the sealing materials used were MTA, Biodentine, Gutta-percha and Portland Cement. The most common scaffold/sealing material...

Clinical applications of calcium silicate‐based materials: a narrative review

“…The basic principles of GER include removal of necrotic tissues, minimal or no root canal instrumentation, copious irrigation with NaOCl and control of infection with or without intracanal medication similar to apexification treatment 83 . GER is generally performed by inducing apical bleeding to form a blood clot in the root canal and placing a CSC on the clot as a coronal barrier 84 . CSCs are preferred in this treatment as they provide a good coronal seal, have antibacterial effects due to high pH and Ca(OH) 2 release, and allow hydroxyapatite formation in contact with tissue fluids 84 .…”

“…GER is generally performed by inducing apical bleeding to form a blood clot in the root canal and placing a CSC on the clot as a coronal barrier 84 . CSCs are preferred in this treatment as they provide a good coronal seal, have antibacterial effects due to high pH and Ca(OH) 2 release, and allow hydroxyapatite formation in contact with tissue fluids 84 . During primary dentinogenesis, growth factors and bioactive molecules are secreted by odontoblasts and are incorporated within the dentine extracellular matrix 85 .…”

“…There are numerous case reports demonstrating the successful outcome of GER treatment with the placement of various CSCs including MTA, Biodentine and CEM on the blood clot 90–92 . Instead of inducing a blood clot, other scaffolds such as platelet‐rich plasma (PRP) and platelet‐rich fibrin (PRF) can be placed in the root canal to support cell growth and differentiation 84 . There are also case reports supporting the use of CSCs with PRP or PRF in GER treatment 93,94 .…”

“…According to a recent systematic review, the use of MTA and Biodentine as coronal barriers has been associated with root maturation and reduced signs and symptoms of apical periodontitis after GER treatment of immature teeth 84 . A retrospective study reported healing of apical periodontitis and root maturation in most of the cases treated after GER with the placement of MTA or EndoSequence Bioceramic Putty on the blood clot 96 .…”

Comparative outcomes of platelet concentrates and blood clot scaffolds for regenerative endodontic procedures: A systematic review of randomized controlled clinical trials

“…Conventional BC maturogenesis approaches remain poorly studied. In addition, previous studies addressing this topic have shown inconsistent results and methodological flaws ( 9 ). Consequently, this study aims to perform a systematic literature review to evaluate the effectiveness of platelet concentrates (PRP and PRF) compared with BC as scaffolds for maturogenesis in patients with immature permanent teeth with or without AP.…”