Clinical Perspectives of Pulp Regeneration.
- Schmalz G Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany; Department of Periodontology, University of Bern, Bern, Switzerland. Electronic address: Gottfried.Schmalz@klinik.uni-regensburg.de.
- Widbiller M Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany.
- Galler KM Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany.
- 2020-09-20
Published in:
- Journal of endodontics. - 2020
Dental pulp necrosis
pulpectomy
pulpitis
pulpotomy
regenerative endodontics
root canal obturation
Dental Pulp
Dental Pulp Necrosis
Humans
Pulpotomy
Regeneration
Root Canal Therapy
English
INTRODUCTION
A sound and vital pulp is an essential prerequisite for long-term tooth survival and preservation. However, current endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by a synthetic biomaterial. Recently, total or partial pulp regeneration has been proposed as an alternative treatment concept. The aim of this review was to evaluate the current options of pulp treatment and regenerative approaches, both for immature and mature teeth, in a clinical context.
METHODS
Clinical success rates of classic treatment options such as pulpotomy or root canal filling after pulpectomy or the removal of necrotic tissue are compared with recent reports on regenerative approaches like revitalization or partial and total pulp regeneration.
RESULTS
Revitalization in immature teeth with pulp necrosis is an additional treatment option besides placing an apical plug, leading to clinically acceptable outcomes, although with low predictability regarding the completion of root formation. Coronal regeneration of the amputated pulp in immature teeth constitutes a promising scientific approach, but data from clinical studies are missing. Mature teeth display a reduced potential for regeneration. Regenerative procedures using cell transplantation or cell homing are mainly in the experimental phase with only 2 clinical studies on cell transplantation. In parallel to the further development of regenerative therapies, the classification of pulp diseases should be revised, and the diagnostic tools need improvement.
CONCLUSIONS
The rethinking of current concepts for biology-based treatments and improved diagnostic concepts might postpone the point of root canal filling depending on the clinical situation.
A sound and vital pulp is an essential prerequisite for long-term tooth survival and preservation. However, current endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by a synthetic biomaterial. Recently, total or partial pulp regeneration has been proposed as an alternative treatment concept. The aim of this review was to evaluate the current options of pulp treatment and regenerative approaches, both for immature and mature teeth, in a clinical context.
METHODS
Clinical success rates of classic treatment options such as pulpotomy or root canal filling after pulpectomy or the removal of necrotic tissue are compared with recent reports on regenerative approaches like revitalization or partial and total pulp regeneration.
RESULTS
Revitalization in immature teeth with pulp necrosis is an additional treatment option besides placing an apical plug, leading to clinically acceptable outcomes, although with low predictability regarding the completion of root formation. Coronal regeneration of the amputated pulp in immature teeth constitutes a promising scientific approach, but data from clinical studies are missing. Mature teeth display a reduced potential for regeneration. Regenerative procedures using cell transplantation or cell homing are mainly in the experimental phase with only 2 clinical studies on cell transplantation. In parallel to the further development of regenerative therapies, the classification of pulp diseases should be revised, and the diagnostic tools need improvement.
CONCLUSIONS
The rethinking of current concepts for biology-based treatments and improved diagnostic concepts might postpone the point of root canal filling depending on the clinical situation.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1016/j.joen.2020.06.037
- PMID 32950188
- Persistent URL
- https://sonar.ch/global/documents/46842
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