ENDODONTIC REGENERATION

Apical regeneration &

revascularization

Apical regeneration

Human immature permanent tooth is a developing organ ,any trauma ,caries ,anatomic anomaly etc leading to pulpal necrosis ,leaves us with a

Open apex Short apex infected necrotic pulp with blunder bass canals fragile & weak dentinal walls In short a dead tooth which has ceased to grow.

Apical regenerationobjectives

Achieve continuous root end development & gain apical closure ensuring a proper crown-root ratio & a natural apical seal.

Strengthen dentinal walls ,thus normal fracture resistance

Regenerate cells of pulp –dentin complex Biologic solution to biologic problem.

Stem cells

Adult stem cells have been isolated from dental tissues-the mesenchymal stem cells(MSCs)

SCAP(stem cells of apical papilla) SHED(stem cells from human exfoliated

dec teeth) DPSC(dental pulp stem cells) etc

Mesenchymal stem cells

MSCs are multipotent –ability to differentiate and form different tissues.

Osteoblasts Odontoblasts Chondrocytes Adipocytes Neural cells This has been experimentally proved

Requisitzes for sucessesful regeneration

Young pts-tremendous healing potential Open apex-allows in growth of tissues Multi potent differentiation of MSCs Creating a environment conducive for

regeneration in the canals. Use of growth factors, scaffolds and

signaling molecules.

Dis infecting the root canal space

To create a environment conducive for regeneration a decontamination and disinfected root canal space is essential which is achieved by

1-use of irrigation( sodium hypo 5.2% , endodontic hexidene & saline)

2-use of triple antibiotic paste (ciprofloxacin+ metronidazole+minocycline +carrier )

precautions

All the standard precautions related with the use of irrigation must be fallowed.

Triple mix antibiotic should be packed 2 mm below the CEJ .kept for 3 weeks

All the care pertaining to preservation of Apical Papilla should be carried out.

Cavit as a intermediary restoration should be used.

Initiating bleeding

Probably the most important step is inducing MSCs to grow into the canal space to produce dentin and cells of pulp-dentin complex.

Simply carried out with over instrumentation or a sharp explorer

Wait for 15 min for the blood to clot

Apical regeneration and revascularization

based on clinical & radiographic findings

histology & biochemical analysis need to be further

done.

Continuous fallow up of the patients through out the

procedure required.

Simple ,inexpensive ,predictable , requires on special

skill ,materials and armamentarium.

Apical regeneration & revascularization

What this procedure does is to induce the MSCs to grow into the canal to promote continuous root end development & allows thickening of dentinal walls by forming dentin & cells of pulp dentin complex.

At this stage we are not absolutely sure about the source of cells but in all likely hood the Apical papilla, surviving pulpal remnants even the PA bone may play a role in initiation & differentiation of MSCs.

Stem cells

Stimulation of the stem cells by certain modifying & growth factors under suitable conditions along with appropriate scaffolds can lead to growth ,development & differentiation of a specific linage of cells which can be utilized for tissue engineering to create & restore specific organs ,muscles ,nerves & vessels in a predictable manner for functional efficiency & growth.