Regenerative endodontics: vary of scaffolds and its benefits for pediatric dentistry

Authors

DOI:

https://doi.org/10.56569/UDJ.2.2.2023.107-113

Keywords:

pulp scaffold, regenerative endodontics, dental pulp regeneration, pulp revascularization, immature permanent teeth, pediatric dentistry, literature review

Abstract

Background. Regenerative Endodontic Procedures deliver a suitable environment to promote natural regeneration/repair with a functional pulp–dentin wall and apical closure. However, REPs have a number of features that can complicate their implementation, especially for children. One of them is scaffold formation.

Objective. To describe alternative scaffold formation options for pulp revitalization and compare their effectiveness and describe possible causes of periapical tissues not bleeding during endodontic regenerative procedures.

Materials and methods. A comprehensive search strategy was done through PubMed and Cochrane Library databases by using MESH terms equivalent to the keywords.  Review articles for the last 5 years were selected according to the keywords with exclusion criteria. 

Results. According to the search criteria and keywords, 801 articles were obtained, after applying the exclusion criteria, 11 ones that met the selection requirements were left.

Conclusions. The main method of scaffold obtaining is the blood clot formation. However, if it is not possible to make the periapical tissues bleed for clot formation, then the use of platelet-enriched autologous plasma or platelet-rich fibrin is recommended. This technique has proven to be as effective as the main one. It can prevent painfulness caused by bleeding provoking for blood clot formation. 

References

Cervino G, Laino L, D’Amico C, Russo D, Nucci L, Amoroso G, Gorassini F, Tepedino M, Terranova A, Gambino D, Mastroieni R. Mineral trioxide aggregate applications in endodontics: A review. Eur J Dent. 2020;14(04):683-91. doi: https://doi.org/10.1055/s-0040-1713073

Duggal M, Tong HJ, Al-Ansary M, Twati W, Day PF, Nazzal H. Interventions for the endodontic management of non-vital traumatized immature permanent anterior teeth in children and adolescents: a systematic review of the evidence and guidelines of the European Academy of Paediatric Dentistry. Eur Arch Paediatr Dent. 2017;18(3):139-151. doi: https://doi.org/10.1007/s40368-017-0289-5

Chisini LA, Grazioli G, Francia A, San Martin AS, Demarco FF, Conde MC. Revascularization versus apical barrier technique with mineral trioxide aggregate plug: A systematic review. G Ital Endod. 2018;32(1):9-16. doi: https://doi.org/10.1016/j.gien.2018.03.006

Murray PE. Review of guidance for the selection of regenerative endodontics, apexogenesis, apexification, pulpotomy, and other endodontic treatments for immature permanent teeth. Int Endod J. 2023;56:188-199. doi: https://doi.org/10.1111/iej.13809

Murray PE, Garcia-Godoy F, Hargreaves KM. Regenerative Endodontics: A Review of Current Status and a Call for Action. J Endod. 2007;33:377-390. doi: https://doi.org/10.1016/j.joen.2006.09.013

Kaushik SN, Kim B, Cruz Walma AM, Choi SC, Wu H, Mao JJ, Jun HW, Cheon K. Biomimetic microenvironments for regenerative endodontics. Biomater Res. 2016;20:1-12. doi: https://doi.org/10.1186/s40824-016-0061-7

Antunes LS, Salles AG, Gomes CC, Andrade TB, Delmindo MP, Antunes LAA. The effectiveness of pulp revascularization in root formation of necrotic immature permanent teeth: A systematic review. Acta Odontol Scand. 2016;74:161-169. doi: https://doi.org/10.3109/00016357.2015.1069394

Metlerska J, Fagogeni I, Nowicka A. Efficacy of Autologous Platelet Concentrates in Regenerative Endodontic Treatment: A Systematic Review of Human Studies. J Endod. 2019:45:20-30.e1. doi: https://doi.org/10.1016/j.joen.2018.09.003

Nicoloso GF, Goldenfum GM, Dal Pizzol TDS, Scarparo RK, Montagner F, De Almeida Rodrigues J, Casagrande L. Pulp revascularization or apexification for the treatment of immature necrotic permanent teeth: Systematic review and meta-analysis. J Clin Pediatr Dent. 2019;43:305-313. doi: https://doi.org/10.17796/1053-4625-43.5.1

AAE. AAE Clinical Considerations for a Regenerative Procedure Revised 2018. Available online. Accessed on 7th of January 2021.

Kontakiotis EG, Filippatos CG, Agrafioti A. Levels of evidence for the outcome of regenerative endodontic therapy. J Endod. 2014;40:1045-1053. doi: https://doi.org/10.1016/j.joen.2014.03.013

He L, Zhong J, Gong Q, Kim SG, Zeichner SJ, Xiang L, Ye L, Zhou X, Zheng J, Liu Y, Guan C. Treatment of necrotic teeth by apical revascularization: meta-analysis. Sci Rep. 2017;7(1):13941. doi: https://doi.org/10.1038/s41598-017-14412-x

Koç S, Del Fabbro M. Does the Etiology of Pulp Necrosis Affect Regenerative Endodontic Treatment Outcomes? A Systematic Review and Meta-analyses. J Evid Based Dent Pract. 2020;20:101400. doi: https://doi.org/10.1016/j.jebdp.2020.101400

Cui D, Yu S, Zhou X, Liu Y, Gan L, Pan Y, Zheng L, Wan M. Roles of Dental Mesenchymal Stem Cells in the Management of Immature Necrotic Permanent Teeth. Front Cell Dev Biol. 2021;9:666186. doi: https://doi.org/10.3389/fcell.2021.666186.6/j.jebdp.2020.101400

Nakashima M, Iohara K, Murakami M, Nakamura H, Sato Y, Ariji Y, Matsushita K. Pulp regeneration by transplantation of dental pulp stem cells in pulpitis: a pilot clinical study. Stem Cell Res Ther. 2017;8:1-3. doi: https://doi.org/10.1186/s13287-017-0506-5

Xuan K, Li B, Guo H, Sun W, Kou X, He X, Zhang Y, Sun J, Liu A, Liao L, Liu S. Deciduous autologous tooth stem cells regenerate dental pulp after implantation into injured teeth. Sci Transl Med. 2018;10(455):eaaf3227. doi: https://doi.org/10.1126/scitranslmed.aaf3227.

Galler KM, Krastl G, Simon S, Van Gorp G, Meschi N, Vahedi B, Lambrechts P. European Society of Endodontology position statement: Revitalization procedures. Int Endod J. 2016;49(8):717-23. doi: https://doi.org/10.1111/iej.12629

Huang GT, Al‐Habib M, Gauthier P. Challenges of stem cell‐based pulp and dentin regeneration: A clinical perspective. Endod Topics. 2013;28(1):51-60. doi: https://doi.org/10.1111/etp.12035

Kharchi AS, Tagiyeva-Milne N, Kanagasingam S. Regenerative endodontic procedures, disinfectants and outcomes: A systematic review. Prim Dent J. 2020;9(4):65-84. doi: https://doi.org/10.1177/2050168420963302

Torabinejad M, Nosrat A, Verma P, Udochukwu O. Regenerative endodontic treatment or mineral trioxide aggregate apical plug in teeth with necrotic pulps and open apices: a systematic review and meta-analysis. J Endod. 2017;43(11):1806-20. doi: https://doi.org/10.1016/j.joen.2017.06.029

Lolato A, Bucchi C, Taschieri S, Kabbaney AE, Del Fabbro M. Platelet concentrates for revitalization of immature necrotic teeth: A systematic review of the clinical studies. Platelets. 2016;27:383-392. doi: https://doi.org/10.3109/09537104.2015.1131255

Ong TK, Lim GS, Singh M, Fial AV. Quantitative Assessment of Root Development after Regenerative Endodontic Therapy: A Systematic Review and Meta-Analysis. J Endod. 2020;46:1856-1866.e2. doi: https://doi.org/10.1016/j.joen.2020.08.016

Panda S, Mishra L, Arbildo-Vega HI, Lapinska B, Lukomska-Szymanska M, Khijmatgar S, Parolia A, Bucchi C, Del Fabbro M. Effectiveness of Autologous Platelet Concentrates in Management of Young Immature Necrotic Permanent Teeth-A Systematic Review and Meta-Analysis. Cells. 2020;9:2241. doi: https://doi.org/10.3390/cells9102241

Alghamdi FT, Alqurashi AE. Regenerative Endodontic Therapy in the Management of Immature Necrotic Permanent Dentition: A Systematic Review. Sci World J. 2020;2020:7954357. doi: https://doi.org/10.1155/2020/7954357

Lopes LB, Neves JA, Botelho J, Machado V, Mendes J.J. Regenerative Endodontic Procedures: An Umbrella Review. Int J Environ Res Public Health. 2021;18:754. doi: https://doi.org/10.3390/ijerph18020754

Sharma S, Srivastava D, Grover S, Sharma V. Biomaterials in tooth tissue engineering: A review. J Clin Diagn Res. 2014;8:309-315. doi: https://doi.org/10.7860/JCDR/2014/7609.3937

Suamte L, Tirkey A, Babu PJ. Design of 3D smart scaffolds using natural, synthetic and hybrid derived polymers for skin regenerative applications. Smart Mater Med. 2023:4:243-256. doi: https://doi.org/10.1016/j.smaim.2022.09.005

Tran TT, Hamid ZA, Cheong KY. A Review of Mechanical Properties of Scaffold in Tissue Engineering: Aloe Vera Composites. J Phys Conf Ser. 2018;1082:012080. doi: https://doi.org/10.1088/1742-6596/1082/1/012080

Srivastava S. Current and future perspectives for dentin-pulp tissue engineering – An update. S Afr Dent J. 2019;74:110–114. https://doi.org/10.17159/2519-0105/2019/v74no3a1

Dang M, Saunders L, Niu X, Fan Y, Ma PX. Biomimetic delivery of signals for bone tissue engineering. Bone Res. 2018;6:25. doi: https://doi.org/10.1038/s41413-018-0025-8

Xie Z, Shen Z, Zhan P, Yang J, Huang Q, Huang S, Chen L, Lin Z. Functional dental pulp regeneration: Basic research and clinical translation. Int J Mol Sci 2021;22:8991. doi: https://doi.org/10.3390/ijms22168991

Moussa DG, Aparicio C. Present and future of tissue engineering scaffolds for dentin-pulp complex regeneration. J Tissue Eng Regen Med. 2019;13:58-75. doi: https://doi.org/10.1002/term.2769

Noohi P, Abdekhodaie MJ, Nekoofar MH, Galler KM, Dummer PMH. Advances in scaffolds used for pulp-dentine complex tissue engineering: A narrative review. Int Endod J. 2022;55(12):1277-1316. doi: https://doi.org/10.1111/iej.13826

Sugiaman VK, Jeffrey, Naliani S, Pranata N, Djuanda R, Saputri RI. Polymeric Scaffolds Used in Dental Pulp Regeneration by Tissue Engineering Approach. Polymers. 2023;15(5):1082. https://doi.org/10.3390/polym15051082

Caviedes‐Bucheli J, Muñoz‐Alvear HD, Lopez‐Moncayo LF, Narvaez‐Hidalgo A, Zambrano‐Guerrero L, Gaviño‐Orduña JF, Portigliatti R, Gomez‐Sosa JF, Munoz HR. Use of scaffolds and regenerative materials for the treatment of immature necrotic permanent teeth with periapical lesion: Umbrella review. Int Endod J. 2022;55(10):967-88. doi: https://doi.org/10.1111/iej.13799.

Wei X, Yang M, Yue L, Huang D, Zhou X, Wang X, Zhang Q, Qiu L, Huang Z, Wang H, Meng L. Expert consensus on regenerative endodontic procedures. Int J Oral Sci. 2022;14(1):55. doi: https://doi.org/10.1038/s41368-022-00206-z.

Staffoli S, Plotino G, Nunez Torrijos BG, Grande NM, Bossù M, Gambarini G, Polimeni A. Regenerative Endodontic Procedures Using Contemporary Endodontic Materials. Materials (Basel). 2019;12(6):908. doi: https://doi.org/10.3390/ma12060908

Tzanetakis GN, Giannakoulas DG, Papanakou S, Gizani S, Lygidakis N. Regenerative endodontic therapy of immature permanent molars with pulp necrosis: a cases series and a literature review. Eur Arch Paediatr Dent. 2021;22(3):515-525. doi: https://doi.org/10.1007/s40368-020-00550-w.

Kim SG, Malek M, Sigurdsson A, Lin LM, Kahler B. Regenerative endodontics: a comprehensive review. Int Endod J. 2018;51(12):1367-1388. doi: https://doi.org/10.1111/iej.12954

Tang Q, Jin H, Lin S, Ma L, Tian T, Qin X. Are platelet concentrate scaffolds superior to traditional blood clot scaffolds in regeneration therapy of necrotic immature permanent teeth? A systematic review and meta-analysis. BMC Oral Health. 2022;22(1):589. doi: https://doi.org/10.1186/s12903-022-02605-4.

Murray PE. Platelet-Rich Plasma and Platelet-Rich Fibrin Can Induce Apical Closure More Frequently Than Blood-Clot Revascularization for the Regeneration of Immature Permanent Teeth: A Meta-Analysis of Clinical Efficacy. Front Bioeng Biotechnol. 2018;6:139. doi: https://doi.org/10.3389/fbioe.2018.00139.

Pecci-Lloret MP, Nandin-Muttoni G, Pecci-Lloret MR, Guerrero-Gironés J, Rodríguez-Lozano FJ. Scaffolds for pulp revitalisation: A systematic review of randomized clinical trials. Ann Anat. 2022;243:151936. doi: https://doi.org/10.1016/j.aanat.2022.151936.

Eramo S, Natali A, Pinna R, Milia E. Dental pulp regeneration via cell homing. Int Endod J. 2018;51:405–419. doi: https://doi.org/doi.org/10.1111/iej.12868

Altaii M, Richards L, Rossi-Fedele G. Histological assessment of regenerative endodontic treatment in animal studies with different scaffolds: A systematic review. Dent Traumatol. 2017;33:235–244. doi: https://doi.org/10.1111/edt.12338

Downloads

Published

28.10.2023

How to Cite

Kovnatskyi, Oleg, and Stanislav Heranin. 2023. “Regenerative Endodontics: Vary of Scaffolds and Its Benefits for Pediatric Dentistry”. Ukrainian Dental Journal 2 (2):107-13. https://doi.org/10.56569/UDJ.2.2.2023.107-113.