December 21, 2015
The regenerative endodontic procedure is described as revival of dental pulp in the case of irreversible pulpitis. The main goal is to stimulate development of the roots and the surrounding tissues. Where pulp has already become necrotic in immature permanent teeth, the treatment of choice used to be apexification. However, there has been a recent shift in treatment protocols that are based on biological principles.
Stem cells that are present in the children's dental pulp can be encouraged to redevelop leading to healing of the infected or injured pulp. This leads to further development of the dentin, increases the thickness of the root walls and may even contribute to increase in the root canal length. This is important as the chances of tooth loss increase with incomplete root development. The trend in endodontics is now going towards pulp revascularization and keeping the dental pulp alive rather than conventional root canal procedure.
Regenerative endodontics utilizes the concepts of tissue engineering to maintain pulp functionality and save the original tooth. The concept of tissue engineering pertains to the use of biological material to regenerate human cells and tissues. It restores the normal dental pulp function, root formation and encourages apex closures.
The main basics for tissue engineering are stem cells, scaffolds and growth factors. Researches reveal that stem cells can proliferate and differentiate, thereby creating the possibility of pulp regeneration. Another equally important factor is the provision of tissue scaffolds that offer support for the tissue regeneration and blood supply development. These scaffolds may consist of a blood clot, platelet-rich plasma or made of other natural or biodegradable synthetic materials. Growth factors like bone morphogenetic protein and fibroblastic growth factor are utilized to induce cell proliferation and differentiation.
The initial focus is on proper disinfection of the pulp chamber and dressing it with a paste of three antibiotics. Once symptoms have cleared, the paste is removed and a scaffold is created, followed by releasing growth factors. After this the canal is sealed with the help of MTA, composite resin and glass ionomer cement. This prevents the possibility of re-infection. Complete healing is likely to take about 18 months and the pulp should become responsive to pulp vitality testing.
Why is regenerative endodontic therapy preferred over apexification?
The biggest drawback with apexification is that there is no further development of the tooth structure and the formation of the dentin and roots gets arrested at the point of injury. This makes it prone to fracture and eventual tooth loss. As regenerative therapy encourages further growth of the roots and apical closure, the tooth structure is strengthened and there is greater likelihood of saving the original tooth.