Journal of Prevention and Treatment for Stomatological Diseases ›› 2016, Vol. 24 ›› Issue (12): 681-687.doi: 10.12016/j.issn.2096-1456.2016.12.001

• Expert Forum • Previous Articles     Next Articles

The research progress of regenerative endodontic treatment for immature permanent teeth

Guang-tai SONG(),Qiu-chen JIN   

  1. Department of Pediatrics Dentistry, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
  • Received:2016-02-16 Revised:2016-08-01 Online:2016-12-20 Published:2016-12-20
  • Contact: Guang-tai SONG E-mail:gtsong@whu.edu.cn

Abstract:

The pulpal or periapical diseases of immature permanent teeth often lead to incomplete root development. It is a challenge for us to figure out how to ensure the continuous growth of the teeth and the formation of roots. There are many cases about pulp regeneration reported recently. With the regeneration and differentiation ability of stem cells, which exist in residual pulp tissue, periapical and periodontal tissues, the regeneration of new vital pulp tissue was induced under proper conditions, which is highly vascularized and rich in connective tissue, thus prompting continuous root growth and development, increasing root length, thickening root canal walls, and facilitating the coarctation of the apical foramen. Besides, clinical and radiographic examinations shows successful results about the regenerative treatment, which is of milestone significance. The pulp regeneration treatment is designed to replace the pathological dental pulp tissue with new regenerated pulp tissue, based on biological tissue engineering process. This process includes two key parts: one is pulp revascularization, regenerating new vital pulp tissue in the root canal to achieve the continuous root growth and development; the other is tissue engineering, new pulp dentin complex is regenerated by the stem cells under the induction of suitable biological active scaffolds and growth factors. This article reviews about the research progress and clinical characteristics of aforementioned two key parts.

Key words: Immature permanent tooth, Pulp regeneration, Pulp revascularization, Tissue engineering, Growth factor

CLC Number: 

  • R781.05
[1] 陈蕾, 叶小雅, 刘阗 , 等. 年轻恒牙根尖诱导成形术后根尖发育的影响因素[J]. 广东牙病防治, 2011,19(7):356-360.
[2] Andreasen J, Farik B, Munksgaard E . Long term calcium hydroxide as a root canal dressing may increase risk of root fracture[J]. Dent Traumatol, 2002,18(3):134-137.
doi: 10.1034/j.1600-9657.2002.00097.x
[3] Sun HH, Jin T, Yu Q , et al. Biological approaches toward dental pulp regeneration by tissue engineering[J]. J Tissue EngRegen Med, 2011,5(4):e1-e16.
doi: 10.1002/term.369 pmid: 21194063
[4] Nygaard-Ostby B, Hjortdal O . Tissue formation in the root canal folowing pulp removal[J]. Scand J Dent Res, 1971,79(5):333-349.
doi: 10.1111/j.1600-0722.1971.tb02019.x pmid: 5315973
[5] Rule DC, Winter GB . Root growth and apical repair subsequent to pulpal necrosis in children[J]. Br Dent J, 1966,120(12):586-590.
pmid: 5221182
[6] Iwaya SI, Ikawa M, Kubota M . Revascularization of an immature permanent tooth with apical periodontitis and sinus tract[J]. Dent Traumatol, 2001,17(4):185-187.
doi: 10.1034/j.1600-9657.2001.017004185.x
[7] Banchs F, Trope M . Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol?[J]. J Endod, 2004,30(4):196-200.
doi: 10.1097/00004770-200404000-00003 pmid: 15085044
[8] Andreasen JO, Paulsen HU, Yu Z , et al. A long-term study of 370 autotransplanted premolars. Part Ⅱ. Tooth survival and pulp healing subsequent to transplantation[J]. Eur J Orthod, 1990,12(1):14-24.
doi: 10.1093/ejo/12.1.25 pmid: 2318259
[9] Kling M, Cvek M, Mejare I . Rate and predictability of pulp revascularization in therapeutically reimplanted permanent incisors[J]. Endod Dent Traumatol, 1986,2(3):83-89.
doi: 10.1111/j.1600-9657.1986.tb00132.x pmid: 3460802
[10] Vijayaraghavan R, Mathian VM, Sundaram AM , et al. Triple antibiotic paste in root canal therapy[J]. J Pharm BioalliedSci, 2012,4(2):230-233.
doi: 10.4103/0975-7406.100214 pmid: 3467921
[11] Nosrat A, Seifi A, Asgary S . Regenerative endodontic treatment (revascularization) for necrotic immature permanent molars: a review and report of two cases with a new biomaterial[J]. J Endod, 2011,37(4):562-567.
doi: 10.1016/j.joen.2011.01.011 pmid: 21419310
[12] Ding RY, Cheung GS, Chen J , et al. Pulp revascularization of immature teeth with apical periodontitis: a clinical study[J]. J Endod, 2009,35(5):745-749.
doi: 10.1016/j.joen.2009.02.009 pmid: 19410097
[13] Shah N, Logani A, Bhaskar U , et al. Aggarwal, Efficacy of revascularization to induce apexification/apexogenesis in infected, non vital, immature teeth: a pilot clinical study[J]. J Endod, 2008,34(8):919-925.
doi: 10.1016/j.joen.2008.05.001 pmid: 18634921
[14] Cehreli ZC, Isbitiren B, Sara S , et al. Regenerative endodontic treatment (revascularization) of immature necrotic molars medicated with calcium hydroxide: A case series[J]. J Endod, 2011,37(9):1327-1330.
doi: 10.1016/j.joen.2011.05.033 pmid: 21846559
[15] Zehnder M . Root canal irrigants[J]. J Endod, 2006,32(5):389-398.
doi: 10.1016/j.joen.2005.09.014
[16] Geisler TM . Clinical considerations for a regenerative procedure[J]. Dent Clin North Am, 2012,56(3):603-626.
doi: 10.1016/j.cden.2012.05.010
[17] Srivastava N, Chandra S . Effect of endodontic smear layer and various solvents on the calcium ion diffusion through radicular dentin--an in vitro study[J]. J Indian Soc Pedod Prev Dent, 1999,17(3):101-106.
pmid: 10863500
[18] Aktenerand BO, Bilkay U . Smear layer removal with different concentrations of EDTA-ethylenediaminemixtures[J]. J Endod, 1993,19(5):228-231.
doi: 10.1016/S0099-2399(06)81296-3 pmid: 8360598
[19] Ring KC, Murray PE, Namerow KN , et al. The comparison of the effect of endodontic irrigation on cell adherence to root canal dentin[J]. J Endod, 2008,34(12):1474-1479.
doi: 10.1016/j.joen.2008.09.001 pmid: 19026877
[20] Trevino EG, Patwardhan AN, Henry MA , et al. Effect of irrigants on the survival of human stem cells of the apical papilla in a platelet-rich plasma scaffold in human root tips[J]. J Endod, 2011,37(8):1109-1115.
doi: 10.1016/j.joen.2011.05.013 pmid: 21763903
[21] Petrino J, Boda K, Shambarger S , et al. Challenges in regenerative endodontics: a case series[J]. J Endod, 2010,36(3):536-541.
doi: 10.1016/j.joen.2009.10.006 pmid: 20171379
[22] Zhu X, Zhang C, Huang GT , et al. Transplantation of dental pulp stem cells and platelet-rich plasma for pulp regeneration[J]. J Endod, 2012,38(12):1604-1609.
doi: 10.1016/j.joen.2012.09.001 pmid: 23146645
[23] Torabinejad M, Turman M . Revitalization of tooth with necrotic pulp and open apex by using plateletrich plasma: a case report[J]. J Endod, 2011,37(2):265-268.
doi: 10.1016/j.joen.2010.11.004 pmid: 21238815
[24] Andia I, Abate M . Platelet-rich plasma: underlying biology and clinical correlates[J]. Regen Med, 2013,8(5):645-658.
doi: 10.2217/rme.13.59 pmid: 23998756
[25] Keswani D, Pandey RK . Revascularization of an immature tooth with a necrotic pulp using platelet-rich fibrin: a case report[J]. IntEndod J, 2013,46(11):1096-1104.
doi: 10.1111/iej.12107 pmid: 23581794
[26] Rodella LF, Favero G, Boninsegna R , et al. Growth factors CD34 positive cells, and fibrin network analysis in concentrated growth factors fraction[J]. Microscopy Research and Technique, 2011,74(8):772-777.
doi: 10.1002/jemt.20968 pmid: 21780251
[27] Kim DS, Park HJ, Yeom JH , et al. Long-term folow-ups of revascularized immature necrotic teeth: three case reports[J]. Int J Oral Sci, 2012,4(2):109-113.
doi: 10.1038/ijos.2012.23 pmid: 3421481
[28] Cehreli ZC, Sara S, Aksoy B . Revascularization of immature permanent incisors after severe extrusive luxation injury[J]. J Mich Dent Assoc, 2013,95(3):58-62.
doi: 10.1563/AAID-JOI-D-10-00056.1 pmid: 23777005
[29] Forghani M, Parisay I, Maghsoudlou A . Apexogenesis and revascularization treatment procedures for two traumatized immature permanent maxilary incisors: a case report[J]. Restor Dent Endod, 2013,38(3):178-181.
doi: 10.5395/rde.2013.38.3.178 pmid: 3761128
[30] Chen MY, Chen KL, Chen CA , et al. Responses of immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscess to revascularization procedures[J]. Int Endod J, 2012,45(3):294-305.
doi: 10.1111/j.1365-2591.2011.01978.x pmid: 22077958
[31] Soares AJ, Lins FF, Agata JY , et al. Pulp revascularization after root canal decontamination with calcium hydroxide and 2% chlorhexidinegel[J]. J Endod, 2013,39(3):417-420.
doi: 10.1016/j.joen.2012.10.005
[32] Aggarwal V, Miglani S, Singla M . Conventional apexification and revascularization induced maturogenesis of two non-vital immature teeth in same patient: 24 months folow up of a case[J]. J Conserv Dent, 2012,15(1):68-72.
doi: 10.4103/0972-0707.92610 pmid: 3284018
[33] Garcia-Godoy F, Muray PE . Recommendations for using regenerative endodontic procedures in permanent immature traumatized teeth[J]. Dent Traumatol, 2012,28(1):33-41.
doi: 10.1111/j.1600-9657.2011.01044.x pmid: 21794081
[34] Kottoor J, Velmurugan N . Revascularization for a necrotic immature permanent lateral incisor: a case report and literature review[J]. Int J Paediatr Dent, 2013,23(4):310-316.
doi: 10.1111/ipd.12000 pmid: 22994878
[35] Gelman R, Park H . Pulp revascularization in an immature necrotic tooth: a case report[J]. Pediatr Dent, 2012,34(7):496-499.
doi: 10.1097/TA.0b013e3182702afc pmid: 23265169
[36] Khetarpal A, Chaudhary S, Talwar S , et al. Revascularization of immature permanent tooth with periapical lesion using a new biomaterial-a case report[J]. Nature, 2013,1(1):20-22.
[37] Langer R, Vacanti JP . Tissue engineering[J]. Science, 1993,260(5110):920-926.
doi: 10.1126/science.8493529
[38] Gronthos S, Mankani M, Brahim J , et al. Postnatal human dental pulp stem cells (DPSCs) in vitro and in vivo[J]. Proc Natl Acad Sci USA, 2000,97(25):13625-13630.
doi: 10.1073/pnas.240309797 pmid: 11087820
[39] Yu J, Wang Y, Deng Z , et al. Odontogenic capability: bone marrow stromal stem cells versus dental pulp stem cells[J]. Biol Cell, 2007,99(8):465-474.
doi: 10.1042/BC20070013 pmid: 17371295
[40] Gronthos S, Mankani M, Brahim J , et al. Postnatal human dental pulp stem cells (DPSCs) in vitro and in vivo[J]. Proc Natl Acad Sci USA, 2000,97(25):13625-13630.
doi: 10.1073/pnas.240309797 pmid: 11087820
[41] Brazelton TR, Blau HM . In vivo optimizing techniques for tracking transplanted stem cells[J]. Stem Cells, 2005,23(9):1251-1265.
doi: 10.1634/stemcells.2005-0149 pmid: 16109764
[42] Young CS, Abukawa H, Asrican R , et al. Tissue-engineered hybrid tooth and bone[J]. Tissue Eng, 2005,11(9/10):1599-1610.
doi: 10.1089/ten.2005.11.1599
[43] Karande TS, Ong JL, Agrawal CM . Diffusion in musculoskeletal tissue engineering scaffolds: Design issues related to porosity, permeability, architecture, and nutrient mixing[J]. Ann Biomed Eng, 2004,32(12):1728-1743.
doi: 10.1007/s10439-004-7825-2 pmid: 15675684
[44] Trojani C, Weiss P, Michiels JF , et al. Three-dimensional culture and differentiation of human osteogenic cells in an injectable hydroxypropylmethylcellulose hydrogel[J]. Biomaterials, 2005,26(27):5509-5517.
doi: 10.1016/j.biomaterials.2005.02.001 pmid: 15860207
[45] Matsuno T, Hashimoto Y, Adachi S , et al. Preparation of injectable 3D-formed beta-tricalcium phosphate bead/alginate composite for bone tissue engineering[J]. Dent Mater J, 2008,27(6):827-834.
doi: 10.4012/dmj.27.827 pmid: 19241692
[46] Guo W, He Y, Zhang X , et al. The use of dentin matrix scaffold and dental follicle cells for dentin regeneration[J]. Biomaterials, 2009,30(35):6708-6723.
doi: 10.1016/j.biomaterials.2009.08.034 pmid: 19767098
[47] Xu WP, Zhang W, Asrican R , et al. Accurately shaped tooth bud cell-derived mineralized tissue formation on silk scaffolds[J]. Tissue Eng Part A, 2008,14(4):549-557.
doi: 10.1089/tea.2007.0227 pmid: 18352829
[48] Lyngstadaas SP, Wohlfahrt JC, Brookes SJ , et al. Enamel matrix proteins: old molecules for new applications[J]. Orthod Craniofac Res, 2009,12(3):243-253.
doi: 10.1111/j.1601-6343.2009.01459.x pmid: 19627527
[49] Bazley LA, Gullick WJ . The epidermal growth factor receptor family[J]. Endocr Relat Cancer, 2005,12(Suppl 1):17-27.
doi: 10.1677/erc.1.01032 pmid: 16113093
[50] Sonoyama W, Liu Y, Fang D , et al. Mesenchymal stem cell-mediated functional tooth regeneration in swine[J]. PLoS ONE, 2006,1(1):e79-e79.
doi: 10.1371/journal.pone.0000079 pmid: 1762318
[51] Gronthos S, Brahim J, Li W , et al. Stem cell properties of human dental pulp stem cells[J]. J Dent Res, 2002,81(8):531-535.
doi: 10.1177/154405910208100806
[52] Huang GT, Yamaza T, Shea LD , et al. Stem/progenitor cell-mediated de novo regeneration of dental pulp with newly deposited continuous layer of dentin in an in vivo model[J]. Tissue Eng Part A, 2010,16(2):605-615.
doi: 10.1089/ten.tea.2009.0518
[1] HE Jialin, XU Yan, XIE Xianzhe, WANG Tengfei, HUO Dongmei. Effect of platelet-rich fibrin extract on the proliferation of gingival fibroblasts [J]. Journal of Prevention and Treatment for Stomatological Diseases, 2019, 27(8): 490-495.
[2] WANG Yiheng,WU Yingtao,YU Xixi,LI Lulu,DENG Songsong,LIU Mengjia,WANG Wanchun. Effect of Kamistad gel on oral ulcer healing and TNF-α, IL-6 and EGF expression in ulcer tissue of rats [J]. Journal of Prevention and Treatment for Stomatological Diseases, 2019, 27(5): 293-299.
[3] HU Huiting,YU Fenglin,ZHAO Yueping. Research progress on the factors influencing the biological characteristics of dental pulp stem cells [J]. Journal of Prevention and Treatment for Stomatological Diseases, 2019, 27(4): 268-272.
[4] CHEN Faming,GAO Lina,CHEN Fang. Current status and progress of periodontal regeneration therapy [J]. Journal of Prevention and Treatment for Stomatological Diseases, 2019, 27(1): 9-16.
[5] Xuening GU, Jiamiao QUAN, Yuqing GUO, Song LI. cAMP-responsive-element-binding protein promotes the differentiation of human stem cells from the apical papilla via inhibition of the TGF-β1 pathway [J]. Journal of Prevention and Treatment for Stomatological Diseases, 2018, 26(7): 428-433.
[6] Shuangxi LIU, Shulan XU, Binping WANG, Zhuogeng CHEN. Effects of basic fibroblast growth factor combined with a collagen membrane on soft tissue defects vascularization in the hard palates of rats [J]. Journal of Prevention and Treatment for Stomatological Diseases, 2018, 26(7): 440-444.
[7] Weimin LIN, Miao CHEN, Chen HU, Yili QU. Progress in the combined application of bone morphogenetic protein-2 and basic fibroblast growth factor in bone tissue engineering [J]. Journal of Prevention and Treatment for Stomatological Diseases, 2018, 26(5): 325-329.
[8] Xinfo PEI, Shu MENG, Yi DING. Current application of concentrated growth factors in periodontal tissue regeneration [J]. Journal of Prevention and Treatment for Stomatological Diseases, 2018, 26(5): 330-333.
[9] Jun HE, Ziliang LI, Zhigang XIE. Research progress on osteoinductive properties of bone substitute materials [J]. Journal of Prevention and Treatment for Stomatological Diseases, 2018, 26(2): 124-127.
[10] Laiping ZHONG,Wutong JU. Progress of translational research on biomarker-based oral squamous cell carcinoma treatment [J]. Journal of Prevention and Treatment for Stomatological Diseases, 2018, 26(10): 621-626.
[11] Qingsong YE, Xiaoyan WANG. Progress in storage and clinical application of dental stem cells [J]. Journal of Prevention and Treatment for Stomatological Diseases, 2018, 26(1): 15-25.
[12] Dandan HUANG. Effect of orthodontic treatment on alveolar bone density and epidermal growth factor expression in patients with periodontal disease [J]. Journal of Prevention and Treatment for Stomatological Diseases, 2017, 25(6): 389-393.
[13] Mao-bin YANG, Qian ZENG. New treatment modality for pulpititis and apical periodontitis: pathway of regenerative endodontics [J]. Journal of Prevention and Treatment for Stomatological Diseases, 2017, 25(2): 74-79.
[14] Hong-chang LAI,Jun-yu SHI. Maxillary sinus floor elevation [J]. Journal of Prevention and Treatment for Stomatological Diseases, 2017, 25(1): 8-12.
[15] Zhong-juan TAN,Yue-ping ZHAO,Yuan-yuan LUO. The research progress of dental pulp regeneration [J]. Journal of Prevention and Treatment for Stomatological Diseases, 2016, 24(6): 374-377.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!
This work is licensed under a Creative Commons Attribution 3.0 License.