ABSTRACT
@#The plasma matrix is a kind of autologous blood conduct. It has been widely used in maxillofacial tissue regeneration, skin cosmetology and some other fields. Recently, to preserve the dental pulp as well as the teeth, pulp regeneration therapy and apical surgery have become increasingly important as well as the applications of bioactive materials. As a kind of autologous bioactive material, the plasma matrix has some natural advantages as it is easy to obtain and malleable. The plasma matrix can be used in the following cases: ①pulp revascularization of young permanent teeth with open apical foramina that cannot stimulate apical bleeding; ② apical barrier surgery with bone defects and large area perforation repair with bone defects or root sidewall repair surgery; ③ apical surgeries of teeth with large area of apical lesions, with or without periodontal diseases. The plasma matrix is a product derived from our blood, and there are no obvious contraindications for its use. Several systematic reviews have shown that the plasma matrix can effectively promote the regenerative repair of dental pulp in patients with periapical diseases. However, the applications of plasma matrix are different because its characteristics are affected by different preparation methods. In addition, there is still a lack of long-term clinical researches on the plasma matrix, and the histological evidences are difficult to obtain, so a large number of in vitro and in vivo experimental studies are still needed. This article will describe the applications of different kinds of plasma matrix for dental pulp regeneration and bone tissue regeneration in apical surgeries to provide references for clinicians in indication selection and prognosis evaluation.
ABSTRACT
El Biodentine es un material biocerámico y bioacti-vo que puede emplearse como sustituto activo de la dentina. Entre sus numerosos usos se incorpora su utilización como sellador del coágulo en los procedi-mientos endodónticos regenerativos, logrando me-jores propiedades con respecto al Gold standard. Se presenta la resolución clínica y radiográfica de tres situaciones clínicas, mediante la aplicación del proto-colo de los procedimientos endodónticos regenerati-vos, en los que se utilizó Biodentine como alternativa para el sellado del coágulo a nivel cérvico-radicular, en la obturación a nivel del límite amelocementario (AU)
Biodentine is a bio-ceramic and bioactive material that can be used as an active substitute for dentin. Its many uses include its use as a clot sealer in regenerative endodontic procedures, achieving better properties compared to the Gold standard. The clinical and radiographic resolution of three clinical situations is presented, by applying the protocol of regenerative endodontic procedures, where Biodentine was used as an alternative for sealing the clot at the cervical-radicular level in the obturation at the level of the cementoenamel limit (AU)
Subject(s)
Humans , Male , Female , Child , Biocompatible Materials/therapeutic use , Dentin , Regenerative Endodontics , Argentina , Schools, Dental , Ceramics , Dental Care for Children/methods , Dental Pulp Necrosis/therapyABSTRACT
Objective@#To compare the color stability of Biodentine and mineral trioxide aggregate (MTA) within the blood environment in vitro and to further investigate the underlying reasons for such color instability. @*Methods @#We first generated Biodentine and MTA discs with a diameter of 5 mm and a height of 3 mm. 24 discs of each material were randomly divided into two groups: the deionized water group and the defibrinated sheep blood group. Discs of each group were immersed for 1 day or 7 days before assessments. First, all discs were photographed to directly compare the discoloration of Biodentine and MTA. The color degree of the two materials was tested by a spectrophotometer. Then, the high-resolution morphological characteristics were observed by scanning electron microscopy. Finally, the chemical contents of each element in the material were measured by energy-dispersive spectroscopy.@*Results @#Compared to immediately after stripping, a change in the brightness of discs after immersion in defibrinated sheep blood for 1 day was observed only in MTA. On the 7th day after being immersed in blood, the colors of both the Biodentine and MTA discs darkened and turned deep red, but the darkness of the MTA discs increased significantly. The color change of MTA immersed in blood was measured on a spectrophotometer with a greater 7-day ∆E (21.257 ± 0.955) than the Biodentine 7-day ∆E (5.833 ± 0.501) (t=24.781, P < 0.001). MTA exhibits more discoloration as the immersion time goes on. A significant difference was noted between the 1-day ∆E(6.233 ± 0.888) and the 7-day ∆E(t=19.956, P < 0.001) of MTA immersed in blood. However, there was no statistically significant difference between the 1-day ∆E (6.790 ± 0.831) and the 7-day ∆E(t=1.707, P=0.163) of Biodentine immersed in blood. It was observed by scanning electron microscopy that after 7 days of immersion in the defibrinated sheep ablood, the surface porosity of MTA was larger than that of Biodentine, and the crystal edge of MTA became rounded and blunt. The analysis by energy-dispersive X-ray spectroscopy showed that the oxygen content decreased and the bismuth content increased in MTA after immersion in defibrinated sheep blood for 7 days. Zirconium was not detected in Biodentine due to its low radiodensity, but the contents of other elements were stable in Biodentine after immersion in defibrinated sheep blood for 7 days. @* Conclusion@#The color stability of Biodentine within the blood environment is better than that of MTA in vitro, which is mainly related to the low surface porosity and stable composition of the anti-radiation agent of Biodentine.
ABSTRACT
Regenerative endodontic therapy aiming at restoring dentin-pulp complex has been a hot research topic in recent years. Currently, only pulp revascularization has been applied clinically, while stem cell transplantation and cell homing have not been applied in clinical practice. After many years of basic research and clinical practice, regenerative endodontic therapy has made progress. However, it also exposed some problems including confusion of concepts, improper selection of indications, incomplete evaluation criteria. This article summarizes and discusses the current situation, problems and future clinical practice of regenerative endodontic therapy.
ABSTRACT
Objective: To investigate the expression of vascular endothelial cell growth factor (VEGF) in the immediate replantation of pulp healing in the rats, and to clarify the effect and its mechanism of erythropoietin (EPO) on immediate pulp reconstruction in the rats. Methods: Eighty 4-week-old healthy male Wistar rats were randomly divided into non-tooth extraction group, negative control (normal saline) group, positive control (gentamicin) group and EPO group; there were twenty rats in each group. The teeth in each group were immersed in its corresponding solution for 4 min before replantation. Four rats were killed on the days 3, 7, 14, 21 and 28, respectively, and the specimens were made in the operation area. HE staining was used to observe the pulp revascularization in different time periods. Immunohistochemical staining was used to observe the protein expression levels of VEGF in odontal tissue of the rats in each group in different time periods. Results: The HE staining results showed that compared with non-tooth extraction group, the pulp tissue of replanted teeth of the rats in normal saline group had more inflammation, less root development, less restorative dentin and cementum deposition, and wider apical pores; the inflammation of pulp tissue of replanted teeth of the rats in gentamicin group and EPO group was mild, and the root development was relatively good; there were more deposits of restorative dentin and cementum, and the apical pores were narrowed. The immunohistochemical results showed that compared with non-tooth extraction group, the positive expressions of VEGF in odontal tissue of the rats at the days 3, 7 and 14 in the other groups were strong. Afterwards, the positive expression levels of VEGF were decreased gradually with the prolongation of time. The average optical density (AOD) of VEGF positive area indicated that EPO group > gentamycin group > normal saline group > non-tooth extraction group. Compared with non-tooth extraction group, the protein expression levels of VEGF in odontal tissue of the rats in normal saline group, gentamicin group and EPO group at 3, 7, 14 and 21 d after operation were significanty increased (P0.05). Compared with normal saline group, the protein expression levels of VEGF in odontal tissue of the rats in gentamicin group and EPO group at 3, 7, 14 and 21 d after operation were significantly increased (P0.05). Compared with gentamicin group, the protein expression levels of VEGF in odontal tissue of the rats in EPO group at every time points had no significant differences (P>0.05). Conclusion: EPO can increase the expression of VEGF, induce angiogenesis in pulp tissue, and provide the rich vascular bed for replantated teeth, so as to exert the potential of dental pulp defense and repair, and promote the healing of replanted teeth.
ABSTRACT
Pulpal and periapical diseases are the common diseases in human diseases. The traditional treatment method for these diseases is root canal treatment, which is to completely remove and control infection, repair or prevent periapical lesions by root canal mechanical preparation, chemical disinfection and filling. At present, although root canal treatments have a high success rate, there are still a series of problems. Dental pulp regeneration has attracted more and more attention from researchers in promoting the formation of pulp-like tissue in root canals. The ultimate goal of regenerative endodontics is to form a functional endodontic-dentin complex with inner blood vessels and nerves, outer layers of dentin cells arranged along the root canal wall, and new dentin formed by secreting matrix, so as to restore pulp vitality. Stem cells, scaffolds, biosignal molecules, and regenerative microenvironment are key tissue engineering factors that affect pulp regeneration. In this paper, the strategies and applications of pulp regeneration were reviewed around the above factors and clinical procedures.
ABSTRACT
Recently, various levels of success have been achieved in dental pulp and dentin regeneration using latest techniques such as pulp revascularization, stem cell transplantation and cell homing. These cutting-edge technologies utilize stem cell mobilization, homing and directional differentiation, stem cell sub-population isolation, expansion and transplantation, modification and optimization of biomaterials and/or synergetic effects of biological cues. The objective of this review is to identify approaches for clinical translation and improve the success rates of pulp regeneration. We will focus on either basic and clinical research progress of dental pulp revascularization, or translational challenges and strategies of stem cell transplantation and cell homing in dental pulp regeneration.
ABSTRACT
Introduction: The study aimed to explore the profile of articles published on pulp revascularization by a bibliometric analysis. Material and methods: A search was conducted on the PubMed database and studies were independently categorized according to: (i) year of publication; (ii) country where the study was conducted; (iii) study design; (iv) main topic addressed; (v) main conclusion of the article; and (vi) clinical application/other results. Findings were reported descriptively. There was not restriction regarding to initial date and the established final date was December 2014. Results: 133 studies were found; but only 86 articles were included. The most of them was published recently (23.2% in 2014) and were conducted in 24 different countries. The most frequent study design was case report (37.2%), followed by narrative reviews (16.2%). The main topic addressed was the radiographic outcomes (38.3%) and tissue engineering (19.7%). Some of the articles point the clinical application of their results. Conclusion: Most of the publications highlight that the disinfection of the root canal (and the stimulation of residual stem cells) would induce formation of new hard tissue on the dentin wall and continue root development in length, improving the tooth survival. The number of publications on pulp revascularization has increased recently, but the majority of articles published are studies with low levels of evidence.
ABSTRACT
Tissue engineering is mainly used to replace the impaired or damaged tissues with new tissues. The key cells involved for tissue engineering are stem cells, the morphogens or growth factors. They will rapidly multiply and differentiates and forms tissues. This new technique is now most commonly used in endodontics. The aim of this study was to review about the dental pulp stem cells, which are most common growth factors, and the scaffolds used to control their differentiation. To study the clinical technique for the management of immature non-vital teeth based on this novel concept.
ABSTRACT
O tratamento endodôntico de dentes portadores de necrose pulpar e rizogênese incompleta têm sido tratados, recentemente, por meio da revascularização pulpar. Essa promissora alternativa de tratamento promove tanto o fechamento apical quanto o término do desenvolvimento radicular. Atualmente vários protocolos têm sido propostos, entretanto pouco se sabe sobre o sucesso por meio da instrumentação mecânica e do uso de medicações a base de hidróxido de cálcio ou pasta tri-antibiótica nos casos com indicação de revascularização pulpar. Objetivo : O objetivo deste estudo foi realizar uma revisão da literatura abordando os protocolos de revascularização e suas implicações clínicas para o tratamento de dentes portadores de necrose pulpar e ápices incompletos. Resultados e discussão: As causas que normalmente interrompem a formação radicular são os traumatismos dentários e cáries dentárias, que podem causar a necrose pulpar. Sendo assim, os dentes que apresentam rizogênese incompleta e necrose pulpar geralmente eram tratados pelo método de apicificação ou mesmo a confecção de um plug apical de MTA, a fim de conseguir a formação de uma barreira apical. Porém, através desse método, as raízes continuam com as paredes dentinárias finas e fragilizadas. Conclusão: Com base nessa revisão, pode-se concluir que a revascularização pulpar é uma alternativa como tratamento para dentes com rizogênese incompleta portadores de necrose pulpar, porém, não há um protocolo estabelecido e considerado ideal...
Endodontic treatment of immature teeth with necrotic pulp and incomplete root formation has been recently treated with pulp revascularization. It is a promising alternative treatment to promote apical closure and root development. To date, a variety of revascularization protocols have been described, however little is known about the success of combining mechanical instrumentation and intracanal medication such as calcium hydroxide or triantibiotic paste. Thus, the aim of this study is to present a review of literature of pulp revascularization protocols and its clinical implications for treatment of teeth with pulp necrosis and incomplete apex. The causes that usually interrupt the root formation are dental traumatisms and caries, which can lead to pulp necrosis. Therefore, the immature permanent teeth and pulp necrosis were usually treated by apexification or the confection of an apical MTA plug, in order to accomplish the formation of an apical barrier. However, by this method, the roots canal walls remain thin and fragile. It may be concluded that the pulp revascularization treatment is an alternative approach for immature permanent teeth with pulp necrosis. However, there is not a standardized protocol that is considered ideal in these cases...
Subject(s)
Humans , Dental Pulp Necrosis/etiology , Dental Pulp Necrosis/therapy , Tooth Apex/pathologyABSTRACT
Traumatic injuries to an immature permanent tooth may result in cessation of dentin deposition and root maturation. Endodontic treatment is often complicated in premature tooth with an uncertain prognosis. This article describes successful treatment of two traumatized maxillary central incisors with complicated crown fracture three months after trauma. The radiographic examination showed immature roots in maxillary central incisors of a 9-year-old boy with a radiolucent lesion adjacent to the right central incisor. Apexogenesis was performed for the left central incisor and revascularization treatment was considered for the right one. In 18-month clinical and radiographic follow-up both teeth were asymptomatic, roots continued to develop, and periapical radiolucency of the right central incisor healed. Considering the root development of these contralateral teeth it can be concluded that revascularization is an appropriate treatment method in immature necrotic teeth.
Subject(s)
Apexification , Crowns , Dentin , Follow-Up Studies , Incisor , Prognosis , Pulpotomy , ToothABSTRACT
Pulpal regeneration after tooth injury is not easy to accomplish, because of the infected pulp requires tooth extraction or root canal therapy. Current treatment modalities offer high levels of success for many conditions; an ideal form of therapy might consist of regenerative approaches in which diseased or necrotic pulp tissues are removed and replaced with healthy pulp tissue to revitalize teeth. This review describes the possible techniques that will allow regenerative endodontics to become a reality. These potential approaches include root canal revascularization, postnatal stem cell therapy, pulp implant, scaffolding implant, three dimensional cell printing, injectable scaffolds and gene therapy
ABSTRACT
Se presenta el reporte de un caso de un incisivo central superior inmaduro con necrosis pulpar y periodontitis apical crónica, al cual se le instauró la técnica de revascularización descrita por Trope, mediante la estimulación de un coágulo a partir de los tejidos periapicales, previa desinfección del conducto con una mezcla de tres antibióticos, y finalmente la colocación de MTA coronal a este; para obtener así una matriz estéril, que permitiera el crecimiento de nuevo tejido. Esta alternativa de tratamiento se presenta con gran auge en los últimos días pues puede ayudar a mejorar el pronóstico de dientes inmaduros necróticos mediante el reforzamiento de sus paredes dentinales. Después de 7 meses se observó radiográficamente una barrera calcificada bajo el MTA y un engrosamiento delas paredes laterales del conducto, lo que sugiere la obtención de un proceso biológico de desarrolloactivo con un resultado favorable, lo cual puede ayudar a disminuir por ahora la posibilidad de fractura radicular.
The article presents the report of a case of an immature maxillary central incisor with pulp necrosis and chronic apical periodontitis, which was established revascularization technique described by Trope, stimulated by a blood clot from the periapical tissues after disinfecting the canal with a mixture of three antibiotics, and finally the placement of MTA coronal this; order to obtain a sterile matrix, which allowed the growth of new tissue. This treatment option is presented with great success in recent days as it can help improve the prognosis of necrotic immature teeth by strengthening dentinal walls. After seven months was observed radiographically calcified barrier under the MTA and a thickening of the side walls of the duct, suggesting the collection of a biological process of active development with a favorable outcome, which can help reduce the possibility for now of root fracture.