RESUMO
Statement of the Problem: Treatment of immature necrotic teeth is a problematic situation. Conventional root canal therapy is challenging and leaves a weak, fragile, and undeveloped tooth for lifetime. Purpose: This review was aimed to assess the outcome of available randomized clinical trials (RCTs) on the efficacy of platelet concentrates (PC) in dentine-pulp complex regeneration. Materials and Method: In this systematic review, an electronic search was conducted on MEDLINE, EMBASE, Cochrane, and Google scholar databases. A further manual search was performed on the list of related articles in order to ensure inclusion of potentially missed articles in earlier electronic search. Those proved RCTs matched with the standard criteria were included following an initial assessment of abstracts and the text independently by the reviewers. Results: From the total 602 harvested articles, only 13 met the criteria and were evaluated with 11 having parallel design and 2 split mouth. Only one study featured low risk of bias, while three had moderate risk and the rest were at high risk of bias. Six studies had used platelet rich plasma (PRP), 4 employed platelet rich fibrin (PRF), one utilized injectable platelet rich fibrin (I-PRF), and three used both PRF and PRP for their experimental groups while blood clot (BC) was used as the control group for all. The success rate was reported at 87.3% judged by the absence of pathologic signs and symptoms. Conclusion: Dentin wall thickening, root lengthening and apex closure were higher in PC groups, however, these differences were not statistically significant in reported studies. It can be concluded that PCs promote the pulp tissue revitalization and continuation of root development. However, a consensus on its potency for true pulp regeneration is yet to be reached.
RESUMO
OBJECTIVE: Recent studies suggest xenogeneic extracellular matrices as potential regenerative tools in dental pulp regeneration. This study aimed to fabricate and characterize a novel three-dimensional macroporous pulp-derived scaffold that enables the attachment, penetration, proliferation and differentiation of mesenchymal stem cells. METHOD: Bovine pulp was decellularized and characterized with histological and DNA content methods. This scaffold was prepared using finely milled lyophilized decellularized pulp extracellular matrix (ECM) digested with pepsin. Three different concentrations of ECM (1.50, 2.25 and 3.00mg/ml) were freeze-dried and were tested with/without chemical crosslinking. The specimens were subjected to physicochemical characterization, cell viability and quantitative real time polymerase chain reaction assessments with human bone marrow mesenchymal stem cells (hBMMSCs). All scaffolds were subcutaneously implanted in rats for two weeks and histological and immunostaining analyses were performed. RESULTS: Histological and DNA analysis confirmed complete decellularization. All samples demonstrated more than 97% porosity and 1.50mg/ml scaffold demonstrated highest water absorption. The highest cell viability and proliferation of hBMMSCs was observed on the 3.00mg/ml crosslinked scaffolds. The gene expression analysis showed a significant increase of dmp-1 and collagen-I on 3.00mg/ml crosslinked scaffolds compared to the other scaffolds. Histological examination of subcutaneous implanted scaffolds revealed low immunological response, and enhanced angiogenesis in cross-linked samples compared to non-crosslinked samples. SIGNIFICANCE: The three-dimensional macroporous pulp-derived injectable scaffold developed and characterized in this study displayed potential for regenerative therapy. While the scaffold biodegradability was decreased by crosslinking, the biocompatibility of post-crosslinked scaffold was significantly improved.
