Year : 2017 | Volume
: 5 | Issue : 1 | Page : 1--2
Department of Paediatric Dentistry, University of the Western Cape, Bellville, Cape Town, South Africa
University of the Western Cape, Bellville, Cape Town
|How to cite this article:|
Mohamed N. Regenerative endodontics.Dent Med Res 2017;5:1-2
|How to cite this URL:|
Mohamed N. Regenerative endodontics. Dent Med Res [serial online] 2017 [cited 2021 Jul 24 ];5:1-2
Available from: https://www.dmrjournal.org/text.asp?2017/5/1/1/198781
In recent years, regenerative endodontics has emerged as an exciting new field in dentistry where the regeneration of natural tissues is attempted through utilizing the reparative capacity of the dentino-pulpal complex.
Dentists and especially pediatric dentists are often faced with having to treat traumatic injuries of anterior maxillary incisors. The management of nonvital, immature permanent teeth with thin walls and wide open apices has always been a challenge, especially in younger children who might not necessarily display adequate cooperation. Traditional treatment options for treating immature teeth with open apices and necrotic pulps include apexification with calcium hydroxide, followed by conventional root canal treatment once the apices have closed. This procedure poses a few challenges in that it is a time-consuming process where barrier formation can take up to 24 months or longer, and re-treatment is required till apex closure has been established. Patient compliance with recall visits could, therefore, be problematic. The barrier which is induced is porous in nature and is induced without further development of the root. Long-term intracanal treatment with calcium hydroxide also results in brittleness of the tooth with possible subsequent fracture during lateral condensation of the gutta-percha.
Regenerative endodontics or revascularization has challenged this traditional treatment protocol. The rationale behind this procedure is that it has now been shown that tissue in the periapical region of a nonvital tooth has the potential to regenerate and that the host's own pulpal cells can be utilized to achieve apex closure. In this way, fracture of traumatized teeth associated with long-term calcium hydroxide use during the apexification procedure can be prevented. Revascularization allows thickening of the root walls to take place and encourages increased root length. In other words, it allows normal root maturation to take place as opposed to just the formation of a calcific barrier induced by apexification with calcium hydroxide. Case selection is, however, difficult. Immature teeth should be clinically nonvital but should still have vital apical cells to perform this procedure successfully.
Various versions of the revascularization procedure have been reported on in the literature, but at present, no standardized treatment protocols exist. Literature regarding the success rates is also scant, and studies are difficult to compare due to the lack of standardization. The basic procedure involves an initial visit where the canal space is disinfected with antibiotics or calcium hydroxide. At the following visit, bleeding is induced within the pulp chamber or by going past the apex to allow the stem cells of the apical region to flood the pulp canal space. Platelet-rich plasma has also been used in some case studies. After recall periods of up to 24 months, positive responses to pulp vitality tests have been reported in the literature. As the pulp is now vital, the need for conventional root canal treatment is no longer necessary.
At first glance, it might seem impossible that something which is “dead” can be brought back to life again. It is an idea that challenges rational thought and requires an open mind visualize the possibilities of this concept. Does this mean that conventional root canal therapy as we know it could be a thing of the past? Not only would this save time but also costs involved would be considerably reduced.
Regenerative endodontics is continually evolving as new knowledge is added to the existing body of information. The possibilities seem endless, but research still has to provide clarity on the gray areas as there are a lot of questions that still need to be answered. As a pediatric dentist who often treats trauma cases in children who are less than cooperative, I look forward to the day when current research proves beyond a shadow of a doubt that conventional root canal treatment is not needed after performing a regenerative procedure that induces apex closure in a nonvital, immature permanent tooth. This concept challenges everything I have been taught at dental school, and as with all new advances, it requires a paradigm shift in the thinking of all dental professionals.