Regenerative endodontic therapy is a tissue engineering based approach of treatment for endodontic disease. Its purpose is to achieve the regeneration of the pulp-dentin complex, thus to promote root development of the immature permanent tooth with necrotic pulp. Like other treatments based on tissue engineering techniques, the success of regenerative pulp therapy depends on such three elements as seed cells, scaffold materials and growth factors. Since its inception 20 years ago, there have been various terminologies in the literature, with similarities and differences in connotation. The present article summarizes and analyzes the term evolution, biological basis, clinical considerations and future scientific research directions of regenerative endodontics, in order to find out the unsolved scientific problems and to promote the development and standardization of this technique in clinical practice.
Dental Pulp ; Dental Pulp Necrosis ; Humans ; Regeneration ; Regenerative Endodontics ; Root Canal Therapy ; Tissue Engineering

We report a clinical case of type Ⅲ dens invaginatus with endodontic-periodontal lesion in a maxillary lateral incisor. The palatal radicular anomaly predisposed the tooth to periodontal lesions. The caries along the palatal groove caused tooth pulp necrosis and periapical lesions. By means of microscopic root canal therapy, apical surgery, and guided periodontal tissue regeneration, the apical and periodontal infection were controlled, and the affected tooth was retained.
Dens in Dente ; Dental Pulp Necrosis ; Humans ; Incisor ; Root Canal Therapy

OBJECTIVEThe aim of the present study is to investigate the prognosis and influencing factors of crown-fractured young permanent teeth with pulp exposure.

METHODSCase records of crown-fractured young permanent teeth with pulp exposure in the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology during 1991 to 2008 with more than 2 years follow-up were collected. These patients were treated with pulpotomy at the first visit at our hospital no matter whether these teeth were treated or untreated with direct pulp capping. The age of patients, interval between trauma and treatment, root development, mobility and tenderness to percussion were recorded. The prognosis was analyzed and Logistic regression was used to analyze the influencing factors.

RESULTSTotally 118 cases satisfied the inclusion criteria, including 136 crown-fractured teeth with pulp exposure. The patients of (8.8 +/- 1.2) years old were periodically monitored for (46.1 +/- 22.0) months. The success rate of pulpotomy after pulp exposure was 85.3%. Pulp necrosis occurred in 20 teeth (25.0 +/- 19.0) months after trauma. The extent of tenderness to percussion showed significant correlation with pulp necrosis, while the age of the patients, interval between injury and treatment, and mobility of the teeth were not related to pulp necrosis.

CONCLUSIONThe success rate of pulpotomy after pulp exposure is good. Tenderness to percussion is an important signal of pulp necrosis. There are no evidence about the relationship between the patient's age, interval between injury and treatment, mobility of the pulp-exposed teeth and the pulp prognosis.

Age Factors ; Child ; Crowns ; Dental Pulp ; Dental Pulp Exposure ; Dental Pulp Necrosis ; Humans ; Incisor ; Male ; Prognosis ; Pulpotomy ; Retrospective Studies ; Root Canal Therapy ; Tooth Crown ; Tooth Fractures

Regenerative endodontic procedures (REPs) is a biologic-based treatment modality for immature permanent teeth diagnosed with pulp necrosis. The ultimate objective of REPs is to regenerate the pulp-dentin complex, extend the tooth longevity and restore the normal function. Scientific evidence has demonstrated the efficacy of REPs in promotion of root development through case reports, case series, cohort studies, and randomized controlled studies. However, variations in clinical protocols for REPs exist due to the empirical nature of the original protocols and rapid advancements in the research field of regenerative endodontics. The heterogeneity in protocols may cause confusion among dental practitioners, thus guidelines and considerations of REPs should be explicated. This expert consensus mainly discusses the biological foundation, the available clinical protocols and current status of REPs in treating immature teeth with pulp necrosis, as well as the main complications of this treatment, aiming at refining the clinical management of REPs in accordance with the progress of basic researches and clinical studies, suggesting REPs may become a more consistently evidence-based option in dental treatment.
Humans ; Consensus ; Regenerative Endodontics ; Dental Pulp Necrosis/therapy* ; Dentists ; Professional Role ; Dental Care

Dens invaginatusis a rare malformation of the teeth, resulting in frequent pulp necrosis and chronic apical periodontitis. In this paper, the apical barrier technology was used to treat a case of chronic apical periodontitis caused by type Ⅱ dens invaginatus.
Dens in Dente ; Dental Pulp Necrosis ; Humans ; Incisor ; Periapical Periodontitis ; Root Canal Therapy

Dens invaginatus (DI) is a developmental anomaly as a result of a deepening or invagination of the enamel organ into the dental papilla during tooth development. In addition, DI is a malformation with varying anatomical features, which poses numerous challenges to treatment. Endodontic treatment of dens in dente is one of the most complica-ted cases of DI. Herein, an immature lateral incisor that employed regenerative endodontic treatment was presented. The mentioned tooth was diagnosed with DI, pulp necrosis, and chronic apical periodontitis. Hence, a favorable prognosis has been shown by a 2-year review with cone beam computed tomography. The tooth was functional with normal periodontal parameters and exhibited a normal response to the electric pulp sensibility test. Thus, regenerative endodontic treatment can also be recommended to endodontists for teeth with DI.
Humans ; Regenerative Endodontics ; Incisor/diagnostic imaging* ; Dens in Dente ; Dental Pulp Necrosis/therapy* ; Odontogenesis

Devitalization has been widely used in the root canal therapy of primary and permanent teeth in China more than ten years ago. With the development of local anesthetic drugs and injection technologies, this treatment method with high potential risks has been gradually abandoned. However, a questionnaire survey targeted all the participants at the 2018 China Pediatric Dentistry Conference showed that the devitalizer utilization proportion was still as high as 38.1% (383/1 005), even though the ratio was much lower than 75.5% (105/139) in 2003. These doctors had pay more attention to tissue burn caused by devitalizer marginal leakage or direct leakage, and know how to identify and handle with devitalizer burn. Devitalizers were usually made of arsenic trioxide, metal arsenic or paraformaldehyde, which have cytotoxicity, allergenicity, mutagenicity, carcinogenicity, and teratogenic effects on animals. Marginal leakage of devitalizers have high risks of causing soft and hard tissue necrosis. Most of the dentists have an understanding of the potential damages of arsenic containing devitalizers, so they will choose parafor maldehyde with relatively less toxicity. Paraformaldehyde has a certain self limitation, and there are few cases reported, so some dentists lack of vigilance. Paraformaldehyde can also causes tissue necrosis if leakage happens, and the treatment methods are similar to that of arsenic containing devitalizers. When handling with devitalizers burn, the necrosed soft and hard tissue, for example gingiva, alveolar bone or teeth that cannot keep, must be completely removed until fresh blood appears, then rinse with large amount of saline and seal with iodoform gauze. This paper described two cases of devitalizer burn during the root canal treatment of primary molars, both of the doctors failed to identify the devitalizer burn symptoms in the early stage, thus didn't do proper treatments immediately after burning. Resulting in the necrosis of large area of gingiva and alveolar bone, loss of primary molars and permanent tooth germs 1-2 months after devitalizer burn. This paper reported these two cases in detail in order to warn dentists the high risks of using any kind of devitalizers, help them learn how to identify and treat devitalizer burn, and remind them to stop using devitalizers as soon as possible.
Arsenic/toxicity* ; China ; Dental Pulp Devitalization ; Humans ; Necrosis ; Root Canal Therapy ; Tooth Germ ; Tooth Loss/chemically induced* ; Tooth, Deciduous

OBJECTIVETo clinically evaluate the postoperative pain level and short-term healing of one-visit endodontic treatment for infected root canals.

METHODS100 infected cases were included in one-visit root canal therapy group and 42 infected cases in two-visit group using calcium hydroxide as an interappointment medicament. A comparison of the clinical results was done between the two groups. The main assessments included postoperative pain evaluated by patients and by clinical examination, and the six months' healing response.

RESULTSThere was no statistically significance between the groups regarding pain 7 days after operation (one visit 60.0%, two visit 57.1%, P > 0.05) and six months' healing response (one visit 67.9%, two visit 61.5%, P > 0.05). The pain in the one-visit group was quickly relaxed postoperatively, as the pain in the two-visit group was given a rise because of the second treatment.

CONCLUSIONSOne-visit endodontic treatment for infected root canals has the same clinical efficacy as two-visit in regarding to postoperative pain level and short-term healing.

Adult ; Aged ; Aged, 80 and over ; Dental Pulp Necrosis ; therapy ; Humans ; Middle Aged ; Periapical Periodontitis ; therapy ; Root Canal Therapy ; methods ; Treatment Outcome

OBJECTIVETo study the clinical effects of demineralized dentin matrix (DDM) as a apexificating agent.

METHODSHuman teeth were crushed into fragments and were deflated, demineralized, lyophilized to produce DDM. The DDM was used as an apexificating agent to treat 57 teeth compared with calcium hydroxide. X-ray film and clinical observation were undertaken after half a year, one year and two years.

RESULTSOne year later, a barrier in the tooth apex was found in the X-rays film. Then permanent filling material was used. After two years, DDM group had a healing rate of 92.86%, was higher than that of 91.30% in calcium hydroxide group, but there were no statistical significance.

CONCLUSIONThe findings suggest that DDM can be used as a new apexificating agent. One year after the apexification is the best opportunity to change the apexificating agent to a permanent root canal filling material.

Adolescent ; Adult ; Child ; Dental Materials ; therapeutic use ; Dental Pulp Necrosis ; therapy ; Dentin ; Humans ; Root Canal Filling Materials ; therapeutic use ; Root Canal Therapy ; methods ; Tooth Apex ; drug effects ; Tooth Root ; growth & development

Revascularization of immature necrotic teeth is a reliable treatment alternative to conventional apexogenesis or apexification. In case 1, a 12-year-old boy had his necrotic, immature mandibular left second premolar treated with a revascularization technique. At a24-month follow-up, periapical radiolucency had disappeared and thickening of the root wall was observed. In cases 2 and 3, a10-year-old boy had his necrotic, immature, bilateral mandibular second premolars treated with the same modality. At 48-month(in case 2) and 42-month (in case 3) follow-ups, loss of periapical radiolucencies and increases in the root wall thickness were also observed.
Apexification ; Bicuspid ; blood supply ; diagnostic imaging ; pathology ; surgery ; Child ; Dental Papilla ; blood supply ; drug effects ; pathology ; Dental Pulp ; blood supply ; drug effects ; pathology ; Dental Pulp Necrosis ; pathology ; therapy ; Follow-Up Studies ; Humans ; Male ; Mandible ; Neovascularization, Physiologic ; Radiography ; Regeneration ; Root Canal Irrigants ; therapeutic use ; Root Canal Therapy ; methods ; Tooth Apex ; blood supply ; diagnostic imaging ; Tooth, Deciduous ; blood supply ; pathology ; Treatment Outcome