جستجوی مقالات مرتبط با کلیدواژه « regenerative endodontics » در نشریات گروه « پزشکی »

In this case report, the regeneration method was used to treat the previously treated first molar, which presented with symptoms of pain during chewing and secondary acute apical periodontitis.Due to the importance of preserving the patient's permanent teeth in order to maintain optimal space and function, the regeneration treatment was performed in two visits and according to the American Association of Endodontists (AAE) guidelines. The continuation of tooth root development, healing of periapical radiolucency and positive response to sensibility test (cold test) were observed during follow-up radiographs at intervals of 6 months, 1 year & 2 year.

Dental pulp regeneration is fundamental in dentistry and endodontics; however, few in vitro experimental models are available to study its biological process. This study aimed to develop a three-dimensional (3D) culture model of human dental pulp-like tissue mimicking the possible complexity of human pulp tissue. This new and innovative human-like tissue model could be used for testing drugs and materials, particularly those involved in regenerative endodontics.

Vital pulp tissue samples were obtained from human third molars (n=4) immediately after extraction and cultured in a 3D fibrin matrix to create a sustainable ex vivo experimental model. The angiogenesis degrees and the nitric oxide levels were evaluated following the culture of pulp-like tissues in the fibrin matrix for 21 days. The expression of Transforming growth factor- beta (TGF-b1), TGF-b2, TGF-b3, and their relevant receptors, tumor necrosis factor (TNF) and vascular endothelial growth factor A (VEGFA) was evaluated using a reverse transcription polymerase chain reaction (RT-PCR) method.

Pulp tissue angiogenesis was initiated, and completed on days 7 and 21, and pulp-like tissue cells expressed TGF-b1, TGF-b2, TGF-b3, and their relevant receptors, TNF and VEGFA.

This model provided a precise observation of dental pulp angiogenesis at early stages.

Shock wave‑enhanced emission photoacoustic streaming (SWEEPS) is a novel irrigation activation method based on photoacoustic streaming. The aim of this study was to look into the impact of SWEEPS on the attachment and survival of dental pulp stem cells (DPSCs).

In this in vitro study, 34 standardized root segments were randomly allocated into two groups: SWEEPS and the conventional conditioning group. After the irrigation, human DPSCs were seeded on the internal walls of these samples, and the attachment and survival of 30 of them were assessed on different days. The remaining two samples were observed using a scanning electron microscope (SEM). Independent sample t‑test, Mann–Whitney U‑test, one‑way ANOVA, Kruskal–Wallis, and two‑way ANOVA were used for data analysis with the level of significance = 0.05.

The viability of DPSCs was significantly greater in the SWEEPS group in comparison with the conventional conditioning group (P = 0.029). Both groups have shown a significant increase in the viability of DPSCs over time (P = 0.0001, P = 0.003). SEM results have shown a smear layer‑free surface with firmly attached DPSCs in the SWEEPS group.

The results of this study indicated that active irrigation using SWEEPS could provide a superior surface in terms of viability and attachment of DPSCs compared to the conventional conditioning method.

The combination of mineral trioxide aggregate (MTA) and 2% chlorhexidine (CHX) has been recently introduced as an intracanal medicament. The aim of this study was to evaluate the potential cytotoxic effects of MTA mixed with 2% chlorhexidine gel on human periodontal ligament stem cells (PDLSCs) and compare it with other common endodontic regeneration medicaments.

Minimum inhibitory concentration and minimum bactericidal concentration of six experimental groups against Enterococcus faecalis was determined. The study groups consisted of RetoMTA mixed with 2% chlorhexidine gel (MTA+CHX), calcium hydroxide (CH), CH mixed with CHX gel, two concentrations of double antibiotic paste, and 2% CHX. The direct cytotoxic effect of minimum bactericidal concentration was evaluated by MTT on PDLSCs on days 1, 3, and 7. One-way ANOVA and post hoc tests were used for data analysis (P<0.05).

The viability of cells treated with MTA+CHX decreased significantly over time (P<0.05) making this group the most cytotoxic intracanal medicament on the 3rd and 7th days of treatment. On day one, the highest viability percentage was detected in the CH+CHX group followed by the CHX group. On day 3, CH+CHX and CHX groups displayed the highest viability percentage. On day 7, the highest viability was observed in the CHX group, which showed no significant difference with the control group (P=0.12).

Regarding the antimicrobial potency of intracanal medicaments at minimum bactericidal concentration levels, CHX gel appears to be the least cytotoxic drug, while MTA+CHX shows the highest reduction in viability percentage

The objective of the current study was to develop a human treated dentin matrix (hTDM) hydrogel for use as a scaffold to allow the controlled release of an antimicrobial agent for regenerative endodontics.

Human extracted teeth were treated via chemical demineralization using ethylene diamine tetra-acetic acid solution to produce hTDM powder. Fourier transform infrared spectroscopy (FTIR) was conducted to determine the functional groups of hTDM, scanning electron microscopy (SEM) was used to define the morphology/particle size of hTDM, and energy dispersive X-ray analysis was performed to identify the superficial apatite groups. Prepared hTDM powder was added to the amoxicillin-clavulanate mixture with a mass ratio of 1:1. Then, the combination was dripped into a 5% (w/v) calcium chloride solution. Antibiotic release profiles were evaluated for 14 days via high performance liquid chromatography (HPLC). Hydrogel degradation properties were studied for 14 days using 10 mL of phosphate buffered saline (PBS). Encapsulation efficiency was determined by HPLC, while minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of amoxicillin-clavulanate were determined against Enterococcus faecalis (E. faecalis). The antibacterial activity of amoxicillin-clavulanate against E. faecalis was investigated for 14 days via agar diffusion test. Statistical analysis was performed with the Shapiro-Wilk test (P=0.05).

hTDM showed statistically a significant difference for percentage weight change (P=0.1). The encapsulation efficiencies for hTDM hydrogel with antibiotic and hydrogel with antibiotic was 96.08%±0.02 and 94.62%±0.11, respectively. MIC and MBC values of amoxicillin-clavulanate against E. faecalis were 2.4 µg/mL and 9.6 µg/mL, respectively. The antibacterial activity of antibiotic loaded hTDM hydrogels was significantly greater than loaded hydrogels alone by 31% after 4 and 100% at 14 days, respectively (P≤0.001).

This in vitro study showed antibiotic-loaded injectable hTDM hydrogel could be an alternative system to transfer antibiotic-based intracanal medicaments for use in regenerative endodontics.

Regenerative endodontics is a developing field of dentistry and aims to recover the physiological and anatomical functions of the tooth for cases of severe dental caries, pulpal pathologies and dental trauma. 

 This umbrella review seeks to discover the scientific evidence on the effectiveness and the factors result in successful regenerative endodontic therapies in teeth with necrotic pulps and with incomplete root development. The study was conducted following the PRISMA Guidelines. There were no restrictions regarding search period. A comprehensive literature search was carried out in EMBASE, LILACS, PubMed, Cochrane, Scopus, and Google Scholar. A quality evaluation was conducted by using AMSTAR-2. A descriptive analysis of the included systematic reviews and meta-analysis were conducted. 

 Thirteen descriptive systematic reviews and 7 meta-analyses were included. Three articles evidenced low methodological quality according to AMSTAR-2 tool. Overall success rates for the endodontic regeneration procedures ranged from 50% to 98% and the survival rates were between 94% and 100%. Pulp regeneration had a high success rate, evidenced by factors such as the resolution of symptoms, healing, increased root length, dentin thickening and recovery of sensitivity. Follow-up varied from 1 to 48 months for the original studies included in the systematic reviews and meta-analyses. 

 Endodontic practice offers the clinician a good treatment option in case of necrotic pulp with immature roots such as the endodontic regeneration, that is supported by high and moderate quality scientific literature.

The current case report documents the clinical approach adopted for a traumatized immature necrotic permanent upper left central incisor after a bike accident. The treatment involved regenerative endodontic procedures (REPs) using “High Plasticity Mineral Trioxide Aggregate” (MTA Repair HP) as a cervical barrier over blood clot. The preservation included three years of follow-up appointments of clinical evaluations and periapical digital radiographs. Cone beam computer tomography (CBCT) was taken at six and thirty-six months for the evaluation of root development.

This report describes a regenerative endodontic procedure of an immature permanent incisor with internal root resorption (IRR) and 4-years follow-up. A healthy 8-year-old man was referred for treatment of tooth #9 after a traumatic intrusion. The periapical radiograph showed an IRR and an open apex with periradicular lesion. A diagnosis of pulp necrosis and chronic apical abscess was achieved. In the first appointment, under local anesthesia and rubber dam isolation, an access cavity was designed and the root canal was chemically cleaned under irrigation with 10 mL 1.5% sodium hypochlorite (NaOCl). The root canal was then dried and calcium hydroxide paste was placed. During the second appointment, the root canal was irrigated with 5 mL of 17% ethylenediaminetetraacetic acid (EDTA) for 5 minutes and dried. The blood clot was established in a time of 3 minutes after the bleeding from the periapical tissue was trigged. White mineral trioxide aggregate (MTA) was placed up to the amelocemental junction and the final restoration of the access cavity was carried out. During periodic clinical and radiographic follow-up, the patient remained symptom free, the periapical region was completely healed, inhibition of the root resorption process achieved, and formation of the new periodontal ligament as well as tooth widening development observed, meeting functional expectations after 48 months. The regenerative endodontic procedures are an available option to treat IRR in severely immature teeth. The available literature on the regenerative endodontic procedures applied to IRR treatment is limited, and more research is needed in this field.

Conventional drug mixtures used in regenerative endodontic procedures have a toxic effect and no consensus has been reached about their best composition and concentration. Therefore, the aim of this study was to determine minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), and minimum biofilm inhibitory concentration (MBIC) of the antimicrobial preparations and to compare their antimicrobial efficacy on bovine dentin infected by Enterococcus faecalis.

For this original ex vivo investigation, prepared concentrations (MIC, MBC, and MBIC) of triple antibiotic paste (TAP), double antibiotic paste (DAP), modified triple antibiotic paste (MTAP)‑1, MTAP2, co‑amoxiclav, and calcium hydroxide (CH) were added to the prepared bovine dentin blocks (which incubated in E.faecalis suspension previously) and incubated for 3 days. The samples were subsequently prepared for culture and CFU counts. Statistical analysis of data was carried out using one‑way analysis of variance and post hoc tests. The statistical power was set at P < 0.05.

All medicament groups significantly showed an antimicrobial efficacy compared with negative control (without antibiotic) (P < 0.001). TAP, DAP, co‑amoxiclav, and CH (at its MBC value) were significantly capable of eliminating E. faecalis biofilm and showed no significant difference in comparison with positive control (complete biofilm removal) (P < 0.05).

TAP, DAP, co‑amoxiclav, and CH (at its MBC value) could effectively eliminate biofilm bacteria on the dentin surface. Antimicrobial efficacy of other medicaments containing cefaclor or clindamycin was limited.

Conventional drug mixtures used in regenerative endodontic procedures have a toxic effect and no consensus has been reached about their best composition and concentration. Therefore, the aim of this study was to determine minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), and minimum biofilm inhibitory concentration (MBIC) of the antimicrobial preparations and to compare their antimicrobial efficacy on bovine dentin infected by Enterococcus faecalis.

For this original ex vivo investigation, prepared concentrations (MIC, MBC, and MBIC) of triple antibiotic paste (TAP), double antibiotic paste (DAP), modified triple antibiotic paste (MTAP)‑1, MTAP2, co‑amoxiclav, and calcium hydroxide (CH) were added to the prepared bovine dentin blocks (which incubated in E.faecalis suspension previously) and incubated for 3 days. The samples were subsequently prepared for culture and CFU counts. Statistical analysis of data was carried out using one‑way analysis of variance and post hoc tests. The statistical power was set at P < 0.05.

All medicament groups significantly showed an antimicrobial efficacy compared with negative control (without antibiotic) (P < 0.001). TAP, DAP, co‑amoxiclav, and CH (at its MBC value) were significantly capable of eliminating E. faecalis biofilm and showed no significant difference in comparison with positive control (complete biofilm removal) (P < 0.05).

TAP, DAP, co‑amoxiclav, and CH (at its MBC value) could effectively eliminate biofilm bacteria on the dentin surface. Antimicrobial efficacy of other medicaments containing cefaclor or clindamycin was limited.

The aim of present study was to isolate and differentiate human adipose-derived stem cells (ASCs) into odontoblast-like cells.

In this experimental study, human adipose tissues were taken from the buccal fat pad of three individuals (mean age: 24.6 ± 2.1 years). The tissues were transferred to a laboratory in a sterile culture medium, divided into small pieces and digested by collagenase I (2 mg/mL, 60-90 minutes). ASCs were isolated by passing the cell suspension through cell strainers (70 and 40 µm), followed by incubation at 37ºC and 5% CO2 in Dulbecco’s modified eagle medium (DMEM) supplemented with fetal bovine serum (FBS 5%) and penicillin/streptomycin (P/S). After three passages, the ASCs were harvested. Subsequently, flow cytometry and reverse transcriptase polymerase chain reaction (RT-PCR) were used to detect expression levels of NANOG and OCT4 to evaluate stemness. Then, a differentiation medium that included high-glucose DMEM supplemented with 10% FBS, dexamethasone (10 nM), sodium β-glycerophosphate (5 mM) and ascorbic acid (100 µM) was added. The cells were cultivated for four weeks, and the odontogenic medium was changed every two days. Cell differentiation was evaluated with Alizarin red staining and expressions of collagen I (COL1A1), dentin sialophosphoprotein (DSPP) and dentin matrix protein-1 (DMP1).

The ASCs were effectively and easily isolated. They were negative for CD45 and positive for the CD105 and CD73 markers. The ASCs expressed OCT4 and NANOG. Differentiated cells highly expressed DSPP, COL1A1 and DMP1. Alizarin red staining revealed a positive reaction for calcium deposition.

ASCs were isolated successfully in high numbers from the buccal fat pad of human volunteers and were differentiated into odontoblast-like cells. These ASCs could be considered a new source of cells for use in regenerative endodontic treatments.

Tooth nonvitality is one of the frequently seen consequences of dental trauma that causes the arrest of root development. Amniotic membrane has received a lot of attention for its use in transplantation and regeneration procedures. This article reports a unique and novel case of successful regenerative endodontic procedure done using amniotic membrane in a traumatized immature right maxillary central incisor of an 8‑year‑old girl. The clinical and radiographic evaluation done during the recall visits at 1, 3, 6, 9 and 12 months showed a progressive root growth with apical closure.

 Stem cell-based treatment modalities have been potential strategies for tissue regenerationin many conditions. Several studies have evaluated the biologic properties of DPSCs and their efficacyin the treatment of a variety of diseases. The present study was undertaken to evaluate the adhesionbehavior of DPSCs on different endodontic materials before and after setting.

 The crowns of the selected teeth were removed, and the root canals were prepared andobturated with gutta-percha and AH26 sealer. A retrograde cavity was prepared at root ends. Differentmaterials were placed in the cavities. Then the samples were attached to the wells with the use of achemical glue. Dental pulp stem cells were allowed to proliferate to reach a count of 2 million andtransferred to -12well plates in association with a culture medium. Finally, the samples attached to thewells were exposed to the stem cells immersed in the culture medium before and after setting. Thenadhesion of the stem cells was evaluated using SEM.

 The SEM results showed cellular adhesion in the samples containing CEM cement both beforeand after setting. The samples containing MTA Angelus and ProRoot MTA exhibited cellular adhesionbefore setting, with no cellular adhesion after setting. The samples containing AH26 and MTA Fillapexsealers exhibited cellular adhesion after setting, with no adhesion before setting. The samples containingsimvastatin exhibited no cellular adhesion before setting; this material had dissolved in the culturemedium after setting evaluation.

The results of the present study showed that of all the materials tested, CEM cement hadthe highest capacity for dental pulp stem cell adhesion.

Endodontic treatment of necrotic immature teeth is quite challenging. Current concepts for revitalization of these teeth known as regenerative endodontic treatment (RET) is based on key elements necessary for tissue engineering including stem cells, three-dimensional (3D) scaffolds, and growth factors. Utilizing an applicable scaffold for narrow root canal space with adequate properties is essential for successful outcome. Fibrin-based products are materials with various advantages as a scaffold. This review article aims to discuss the properties of different types of fibrin-based products and debates whether they are appropriate scaffolds for RET or not?

An electronic search was performed using databases such as Google Scholar, PubMed, PubMed Central, Science Direct, and Scopus. Keywords such as (“scaffold”) AND (“fibrin gel” OR “fibrin sealant” OR “fibrin glue” OR “fibrin tissue adhesive” OR “fibrin hydrogel” OR “platelet concentrate”) AND (“tooth” OR “teeth”) AND/OR (“regenerative endodontics” OR “dentistry”) were used. Exclusion criteria included studies published in a language other than English and abstracts from congress.

Fibrin gel is a protein-based natural polymer hydrogel scaffold which can be easily used in the root canal. Platelet concentrates are autologous fibrin-based products used as scaffolds for RET with various favorable properties especially due to containing various growth factors.

It seems that fibrin gel and platelet concentrates have adequate properties for use in RET; however, more evidence is required regarding the clinical outcome of applying these products as scaffolds for RET.

Endodontic treatment of necrotic immature teeth poses several clinical challenges. A major problem is the elimination of microorganisms from the root canal system. This study evaluates the in vitro antibacterial efficacy of ciprofloxacin (CIP), levofloxacin (LEV), and their combination with N-acetylcysteine (NAC) in root canals infected with Enterococcus faecalis (E. faecalis). Methods and Materials: A total of 120 human extracted teeth with single canals were prepared and randomly divided into six groups: Calcium hydroxide (CH), ciprofloxacin (CIP), levofloxacin (LEV), ciprofloxacin and N-acetylcysteine (CIP+NAC), levofloxacin and N-acetylcysteine (LEV+NAC), and normal saline as a positive control. According to the name of the groups, intracanal medicaments were placed into the canals and the teeth were restored with a temporary filling. After one week, intracanal medicament was removed and the final count of bacteria was measured. Antibacterial effect of medicament was assessed by measuring the percentage reduction in the colony counts (RCC) and scanning electron microscopy (SEM). The Mann-Whitney U test and the Kruskal-Wallis test were used to compare the overall antibacterial efficacy of the intracanal medicaments at significance level of 0.05. All intracanal medicaments were significantly more effective than calcium hydroxide (P<0.05). The combination of LEV and NAC caused significantly higher reduction in colony count in comparison with other tested medicaments (P=0.001). The combination of LEV and NAC showed greater antibacterial activity compared with other tested medicaments against biofilm of E. faecalis. Thus, it has the potential to be used in regenerative endodontic treatments.