Regenerative Endodontics

Regenerative endodontics has encountered substantial challenges toward clinical translation. The adoption by the American Dental Association of evoked pulp bleeding in immature permanent teeth is an important step for regenerative endodontics. However, there is no regenerative therapy for most endodontic diseases. Simple recapitulation of cell therapy and tissue engineering strategies that are under development for other organ systems has not led to clinical translation in regeneration endodontics. Recent work using novel biomaterial scaffolds and growth factors that orchestrate the homing of host endogenous cells represents a departure from traditional cell transplantation approaches and may accelerate clinical translation.

  • Despite a great deal of enthusiasm and effort, regenerative endodontics has encountered substantial challenges toward clinical translation. The recent adoption by the American Dental Association of evoked pulp bleeding in immature permanent teeth is an important step for regenerative endodontics. However, there is no regenerative therapy for most endodontic diseases.

  • Simple recapitulation of cell therapy and tissue engineering strategies that are under development for other organ systems have not led to clinical translation in regenerative endodontics. Dental pulp stem cells may seem to be a priori choice for dental pulp regeneration. However, dental pulp stem cells may not be available in patients who are in need of pulp regeneration.

  • Even if dental pulp stem cells are available autologously or perhaps allogeneically, one must address a multitude of scientific, regulatory, and commercialization barriers; unless these issues are resolved, transplantation of dental pulp stem cells will remain a scientific exercise rather than a clinical reality.

  • Recent work using novel biomaterial scaffolds and growth factors that orchestrate the homing of host endogenous cells represents a departure from traditional cell transplantation approaches and may accelerate clinical translation. Given the functions and scale of dental pulp and dentin, regenerative endodontics is poised to become one of the early biologic solutions in regenerative dental medicine.

Key Points

Introduction

Endodontics is a dental specialty that treats trauma and infections involving the dental pulp, dentin, and periapical lesions. Each year, a total of approximately 16 million endodontic procedures are performed in the United States. Root canal treatment (RCT) that involves the extirpation of the injured or infected dental pulp and filling of the root canal and pulp chamber with bioinert materials is the most common endodontic treatment. Success rates for endodontic therapies vary, depending on case selection, practitioner skills, availability of instruments and materials, etc. In general, current endodontic treatments are effective to eliminate pain and control infections. Therefore, why regenerative endodontics? Endodontic therapies, like many other dental treatments, are not without failure. Reinfections and tooth fractures are among some of the undesirable and frustrating complications for patients and practitioners, leading to additional lost work hours. Table 1 demonstrates causes and incidences of failure of common endodontic treatments and how regenerative endodontics may address current endodontic failures.

Oct 29, 2016 | Posted by in General Dentistry | Comments Off on Regenerative Endodontics
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