SlideShare una empresa de Scribd logo
1 de 29
Descargar para leer sin conexión
Regenerative
Endodontics
Ajo Babu George
IV BDS
CONTENTS
• Introduction
• Components of Regenerative Endodontics
INTRODUCTION
• Regenertive endodontics are biologically based procedures
designed to replace damaged structures ,including dentin and root
structures, as well as cells of pulp-dentin complex.
• Concept :Normal, sterile granulation tissue developed in the root
canal for revascularization will stimulate the cementoblasts/
undifferentiated mesenchymal cells (periapex) and lead to calcific
material formation at periapex or lateral dentinal walls.
• Goals :
 Primary goal- elimination of symptoms and the evidence of
bone healing.
 Secondary goal-increased root length or wall thickness.
 Tertiary goal-positive response to vitality tests.
COMPONENTS OF REGENATIVE ENDODONTICS
• The three key elements of tissue regeneration are:
 Stem cells
 Growth factors
 Scaffold
Stem cells
• According to Diogenes et al., regenerative procedures are all stem cell
based therapies.
• Stem cells are undifferentiated cells that are capable of differentiating
into various specialized cell types. They can be pluripotent or
multipotent in nature. They are located in stem cell niches.
• Types of stem cells:
 Dental pulp stem cells (DPSC)
 stem cells of the apical papilla (SCAP)
 Stem cells from human exfoliated deciduous teeth (SHED)
 Dental follicle stem cells (DFSC)
 Bone marrow stem cells (BMSC)
 Periodontal ligament stem cells (PDLSCs)
 Inflamed periapical progenitor cells (iPAPCs)
 Tooth germ progenitor cells (TGPCs)
 Salivary gland stem cells (SGSCs)
 Dental pulp stem cells
• stem cells derived from the dental pulp
• can form pulp like tissue , in future it is possible to
replace infected pulp tissue of a paining tooth with newly
generated pulp like tissue instead of doing RCT ,thus
preserving the vitality of the tooth
• It also has the ability to form bone that is useful for the
osseointegration of dental implants, thus increasing its
success rate .
 Stem cells of the apical papilla
• A unique population of dental stem cells known as stem cells
from the root apical papilla (SCAP) is located at the tips of
growing tooth roots . The apical papilla tissue is only present
during root development before the tooth erupts into the oral
cavity .
• SCAP have the capacity to differentiate into odontoblasts and
adipocytes .
• These cells are CD24+ but expression is down regulated upon
odontogenic differentiation in vitro coincident with alkaline
phosphatase up regulation.
Stem cells from human exfoliated deciduous teeth (SHED)
• Dental pulp of human exfolliated deciduous teeth
contains multipotent stem cells from human exfoliated
deciduous teeth (SHED). were identified to be a
population of highly proliferative, clonogenic cells
capable of differentiating into a variety of cell types
including neural cells, adipocytes, and odontoblasts.
Thus, exfoliated teeth may be an unexpected unique
resource for stem-cell therapies including autologous
stem-cell transplantation and tissue engineering.
• have higher rate of proliferation.
• have potential to form bone which is useful during
osseointegration of dental implants
• have the potential to repair calvarial defects in
immuno-compromised mice .
Dental follicle stem cells (DFSC)
• The dental follicle is a loose ectomesenchyme-derived
connective tissue sac surrounding the enamel organ and the
dental papilla of the developing tooth germ before eruption .
• It is believed to contain progenitors for cementoblasts,PDL and
osteoblasts.
• Dental follicle cells (DFC)form the PDL by differentiating into
PDL fibroblasts that secrete collagen and interact with fibers on
the surfaces of adjacent bone and cementum.
• Dental follicles contain progenitor cells which have the
capability of differentiating into cementum forming cells
(cementoblasts), osteoblasts of the alveolar bone, and
periodontal ligament fibroblasts.
Bone marrow stem cells (BMSC)
• Bone marrow-derived cells (BMDCs) have the potential to
engraft into several tissues after injury, but whether they can
become dental tissue-specific progenitor cells under normal
conditions and the relationship of these cells to the tissue-
resident cells are unknown
• Bone marrow progenitor cells communicate with dental
tissues and become tissue-specific mesenchymal progenitor
cells to maintain tissue homeostasis.
Periodontal ligament stem cells (PDLSCs)
• have potentials of regenerating typical cementum and
periodontal ligament like structure .
• tissue of the periodontium made by stem cell can be used
as a treatment modality to replace the
• diseased periodontium around teeth so as treatment to
mobility of teeth
• According to Hargreaves,stem cells like
SCAP,DPSCs,iPAPCs,PDLSCs,BMSCs are most commonly
used in regenerative endodontics.
• These cells have te capacity of differentiating into odontoblast-
like cells facilitating a progressive repopulation of the radicular
pulp space , promoting organized tissue repair ,angiogenesis
and reinnervation.
Growth factors
• Biological factors regulate stem cells to form the desirable cell
type.
• They promote the differentiation of mesenchymal stem cells
into odontoblast-like cells.
Platelet derived growth factors
Bone morphogenetic proteins (BMPs)
Transforming growth factor b
Vascular endothelial growth factor
Fibroblast growth factors
Insulin like growth factor
Nerve growth factor
Stromal cell derived growth factor I
BONE MORPHOGENETIC PROTEINS (BMPs)
• Comprises a subgroup of the superfamily TGF(Transforming
growth factor b) and are involved in cell proliferation,
differentiation and apoptosis.
• Have strong osteoinductive and chondrogenic effects.
• BMP2,BMP4,BMP7 &BMP11 invoved in mineralization.
Scaffold
• A scaffold provides a physiochemical and biological 3-D micro
environment for cell adhesion ,growth differentiation and
migration. It contains the growth factors.
• Functions :
 Supports cell organization and vascularization.
 Aids cell proliferation and differentiation.
 Contains nutrients,antibiotics for improved and faster
tissue development.
• Classification :-
 Natural – collagen,platelet rich plasma ,fibrin,
glycosaminoglycans
 Synthetic – polylactic acid ,polyglycolic acid ,polylactic-
co-glycolic acid
REVASCULARIZATION
• Revascularization, as defined by Andreasen, is a the
restoration of the vascularity to a tissue or organ.
• Mechanism of revascularization ,according to Shah N :
 Vital pulp cells at the apical end of root canal
proliferate into newly formed matrix and
odontoblasts, under the influence of HERS. Atubular
dentin is laid in the apical end and lateral aspects of
dentinal walls leading to apexogenesis and a thus
strengthening and reinforcement of root occurs.
 Multipotent dental pulp stem cells (immature
permanent teeth)from the apical end might be
seeded on to the existing dentinal walls and
differentiate into odontoblasts and deposit tertiary or
atubular dentin.
 Stem cells in the periodontal ligament can proliferate
and grow into the apical end and within the root canal
and hence deposit hard tissue at apex and lateral walls.-
cementum and Sharpey’s fibers in newly formed
tissues.
 Extensive proliferating property of SCAP & bone
marrow- instrumentation beyond confines of root –
bleeding –mesenchymal stem cell transplantation from
bone.
Regeneration of Dentin -Pulp complex
• Three strategies to regenerate dentin-pulp complex have been
proposed:
a. Regeneration of entire tooth.
b. Local regeneration of dentin-pulp complex from
amputed dental pulp.
c. Regeneration of dental pulp from apical dental pulp or
peri- apical tissues.
• Growth factors like bone morphogenetic proteins (BMPs) and
fibroblast growth factors(FGFs), stem cells and scaffolds are
essential for tissue engineering to regenerate tissues.
• Stem cells differentiate into specific cells for tissue defects ,
growth factors like BMPs ,induce proliferation of stem cells.
• Scaffolds with extracellular matrix properties support for cell
proliferation ,differentiation and tissue formation.
a) Regeneration of entire tooth
• Accepted as a model of organ replacement and regeneration
therapy.
• Tooth germ can be bioengineered using 3D organ germ culture
method in which dental epithelial and mesenchymal cells from
isolated tooth germs cultured in scaffolds ( synthetic polymers
–polylactic-co-glycolic acid ; bio ceramics- hydroxyapatite ,
tricalcium phosphate, calcium carbonate hydroxyappatite)
b) Local regeneration of dentin-pulp complex from
amputed dental pulp
• Induction of appropriate pulp wound healing and formation of
new dentin in dentin defects are essential in regeneration of
dentin-pulp complex.
• It was reported that BMP-2 with dentin powder induced
dentinogenesis in dentin cavity with pulp exposure.Here stem
or progenitor cells where induced from residual pulp through
the exposure site in the floor of the cavity.
• Ultrasound mediated delivery of growth differentiating factor -
11 (GDF-11) in dental pulp stem cells through sonoporation
induced reparative dentinogenesis
c) Regeneration of dental pulp from apical dental pulp
or peri- apical tissues
• Begins with identication of stem cells in the apical areas of
developing teeth in which root formation is incomplete.
• mesenchymal stem cells in apical papilla (SCAPs) differentiate
into odontoblast-like-cells that participate in pulp wound
healing and regeneration.
• Bone marrow derived mesenchymal stem cells (BMMSC) has
multipotent abilities and undergoes osteogenic differentiation.
• Periapical tissues include bone marrow and PDL which is the
source BMMSCs. Localization of SCAPs & BMMSCs in the
apical region --- induction for dentin-pulp complex regeneration
CLINICAL PROTOCOL REGENERATIVE ENDODONTICS
INDICATIONS
• Teeth with necrotic pulp and an immature apex.
• Pulp space not needed for post/core ,final restoration
• Patient compliance.
• No allergy to the medicaments to be used.
ROLE OF ANTIBIOTIC PASTE
• Antibiotic pastes are a combination of more than one antibiotic
mixed into a consistency of a paste.
• The triple antibiotic paste-commonly used-
ciprofloxacin,metronidazole, minocycline(1:1:1) in a
macrogol/propyleneglycol vehicle.
• Remains below CEJ and concentration is maintained to
0.1mg/ml and chamber is sealed with dentin bonding agents.
Local anesthesia, Isolation, access cavity preparation
Irrigation with 20ml of 1.5%NaOCl/5 min and saline rinse (20ml/
canal ,5min)
Drying with paper points
Placement of intracanal medicaments
Ca(OH)2 Low conc.triple antibiotic paste
Temp sealing with cavit/IRM/GIC
Recall patient after 1-4 weeks.
FIRST APPOINTMENT REGENERATIVE ENDODONTICS THERAPY
Assess response to initial treatment.
Signs of symptoms of
infections persists
No signs
/symptoms
Addtnl Rx time with
antimicrobial pastes
Alternative antimicrobials to
be considered
Local anesthesia (3%mepivacine without
vasoconstrictor)
Irrigation with 20ml of 17% EDTA,drying with paper points
Intracanal bleeding- k file 2mm past apical foramen
Blood in cavity till CEJ, 3-4 mm restorative material
Resorbable matrix over clot
White MTA(mineral trioxide aggregate)/
Ca(OH)2,capping –3-4mm GIC
SECOND APPOINTMENT –REGENERATIVE ENDODONTIC
THERAPY
FOLLOW --UP
• Clinical and radiographic examination
• No pain ,swelling or sinum tract formation.
• Resolution of periradicular radiolucency(6-12months of Rx)
• Increase in width of canal walls (12—24months of Rx)
• Increased root length
• Pulp vitality tests.
ADVANTAGES AND DISADVANTAGES
ADVANTAGES
• Achieve continued root development (root lengthening )and
strengthening due to enforcement of lateral dentin walls with
hard tissue deposition.
• Obturation of canal is not required.
• Splitting of root during lateral condensation avoided.
• After control of infection, completed in a single visit.
DISADVANTAGES
• Discoloration due to minocyclinein antibiotic paste.
• Prolonged treatment peroid compared with MTA apical barrier
technique.
POTENTIAL CAUSES OF FAILURE
• Poor root development.
• Insufficient bleeding during procedure.
• Pulp calcifications/obliterations.
CONCLUSION
• Regenerative endodontics holds promise of restoring pulp-
dentin complex in teeth with immature roots and necrotic
pulps.
• Procedure has advantages than traditional treatment of
increasing root wall thickness as well as root length while
maintaining immune competency.
• Significant scientific hurdles need to be overcome with
continued growth in knowledge and armamentarium.
REFERENCES
• Grossman’s endodontic practices-13th edition –Suresh
Chandra,V.Gopikrishna
• Regenerative Endodontics:regeneration or repair-
Stéphane R.J. Simon, DDS, PhD, Phillip L. Tomson PhD-
Journal of Endodontics.
• Regenerative Endodontics-Biological basis of
Regeneration of Dentin-Pulp Complex- Ariane Berdal,
PhD -Journal of Endodontics

Más contenido relacionado

La actualidad más candente

"GUIDED TISSUE REGENERATION"
"GUIDED TISSUE REGENERATION""GUIDED TISSUE REGENERATION"
"GUIDED TISSUE REGENERATION"Dr.Pradnya Wagh
 
apical regeneration ppt
apical regeneration pptapical regeneration ppt
apical regeneration pptishant_kukreja
 
Recent advancements in paediatric dentistry
Recent advancements in paediatric dentistryRecent advancements in paediatric dentistry
Recent advancements in paediatric dentistryaravindhanarumugam1
 
Stem cell therapy in dentistry
Stem cell therapy in dentistryStem cell therapy in dentistry
Stem cell therapy in dentistryabdolkarim azizi
 
Removal of broken endodontic instruments
Removal of broken endodontic instrumentsRemoval of broken endodontic instruments
Removal of broken endodontic instrumentsPalaniselvi Kamaraj
 
Root Resorption
Root ResorptionRoot Resorption
Root ResorptionIAU Dent
 
Apexogenesis & apexification in pediatric dentistry
Apexogenesis & apexification in pediatric dentistryApexogenesis & apexification in pediatric dentistry
Apexogenesis & apexification in pediatric dentistryDr. Harsh Shah
 
General principles of Periodontal surgery
General principles of Periodontal surgeryGeneral principles of Periodontal surgery
General principles of Periodontal surgeryJignesh Patel
 
Endodontics periodontal lesions
Endodontics periodontal lesionsEndodontics periodontal lesions
Endodontics periodontal lesionsArshe Gs
 
Osseointegration in Dental Implants
Osseointegration in Dental ImplantsOsseointegration in Dental Implants
Osseointegration in Dental ImplantsNaveed AnJum
 

La actualidad más candente (20)

"GUIDED TISSUE REGENERATION"
"GUIDED TISSUE REGENERATION""GUIDED TISSUE REGENERATION"
"GUIDED TISSUE REGENERATION"
 
apical regeneration ppt
apical regeneration pptapical regeneration ppt
apical regeneration ppt
 
Recent advancements in paediatric dentistry
Recent advancements in paediatric dentistryRecent advancements in paediatric dentistry
Recent advancements in paediatric dentistry
 
Pulp Revascularization.pptx
Pulp Revascularization.pptxPulp Revascularization.pptx
Pulp Revascularization.pptx
 
Stem cell therapy in dentistry
Stem cell therapy in dentistryStem cell therapy in dentistry
Stem cell therapy in dentistry
 
Revascularisation
RevascularisationRevascularisation
Revascularisation
 
Removal of broken endodontic instruments
Removal of broken endodontic instrumentsRemoval of broken endodontic instruments
Removal of broken endodontic instruments
 
Root Resorption
Root ResorptionRoot Resorption
Root Resorption
 
Periodontal pack
Periodontal packPeriodontal pack
Periodontal pack
 
Apexogenesis & apexification in pediatric dentistry
Apexogenesis & apexification in pediatric dentistryApexogenesis & apexification in pediatric dentistry
Apexogenesis & apexification in pediatric dentistry
 
Regenerative endodontics
Regenerative endodontics Regenerative endodontics
Regenerative endodontics
 
General principles of Periodontal surgery
General principles of Periodontal surgeryGeneral principles of Periodontal surgery
General principles of Periodontal surgery
 
Endodontics periodontal lesions
Endodontics periodontal lesionsEndodontics periodontal lesions
Endodontics periodontal lesions
 
Osseointegration in Dental Implants
Osseointegration in Dental ImplantsOsseointegration in Dental Implants
Osseointegration in Dental Implants
 
Periodontal regeneration
Periodontal  regenerationPeriodontal  regeneration
Periodontal regeneration
 
Furcation involvement
Furcation involvementFurcation involvement
Furcation involvement
 
Periodontal flap
Periodontal flapPeriodontal flap
Periodontal flap
 
Dental splinting
Dental splintingDental splinting
Dental splinting
 
Coronoplasty
CoronoplastyCoronoplasty
Coronoplasty
 
CVEK,S PULPOTOMY
CVEK,S PULPOTOMYCVEK,S PULPOTOMY
CVEK,S PULPOTOMY
 

Destacado

Reconstructive periodontal surgery
Reconstructive periodontal surgeryReconstructive periodontal surgery
Reconstructive periodontal surgeryDr. Manish Ashtankar
 
Regenerative endodontics / endodontics courses
Regenerative endodontics / endodontics coursesRegenerative endodontics / endodontics courses
Regenerative endodontics / endodontics coursesIndian dental academy
 
PULP AND PERIAPICAL LESIONS OF THE TOOTH ppt
PULP AND PERIAPICAL LESIONS OF THE TOOTH pptPULP AND PERIAPICAL LESIONS OF THE TOOTH ppt
PULP AND PERIAPICAL LESIONS OF THE TOOTH pptK BHATTACHARJEE
 
young permanent tooth
young permanent toothyoung permanent tooth
young permanent toothJeena Paul
 
General principles of periodontal surgery
General principles of periodontal surgeryGeneral principles of periodontal surgery
General principles of periodontal surgeryMD Abdul Haleem
 

Destacado (6)

Reconstructive periodontal surgery
Reconstructive periodontal surgeryReconstructive periodontal surgery
Reconstructive periodontal surgery
 
Regenerative endodontics / endodontics courses
Regenerative endodontics / endodontics coursesRegenerative endodontics / endodontics courses
Regenerative endodontics / endodontics courses
 
Periapical periodonitis
Periapical periodonitisPeriapical periodonitis
Periapical periodonitis
 
PULP AND PERIAPICAL LESIONS OF THE TOOTH ppt
PULP AND PERIAPICAL LESIONS OF THE TOOTH pptPULP AND PERIAPICAL LESIONS OF THE TOOTH ppt
PULP AND PERIAPICAL LESIONS OF THE TOOTH ppt
 
young permanent tooth
young permanent toothyoung permanent tooth
young permanent tooth
 
General principles of periodontal surgery
General principles of periodontal surgeryGeneral principles of periodontal surgery
General principles of periodontal surgery
 

Similar a Regenerative endodontic

regenerative endodontics
regenerative endodonticsregenerative endodontics
regenerative endodonticsMaryemMohamed6
 
Tissue engineering in endodontics
Tissue engineering in endodonticsTissue engineering in endodontics
Tissue engineering in endodonticsRachna Chaurasia
 
Stem cells in Dentistry | by Dr Alaa Al-saidi
Stem cells in Dentistry | by Dr Alaa Al-saidiStem cells in Dentistry | by Dr Alaa Al-saidi
Stem cells in Dentistry | by Dr Alaa Al-saidiDenTeach
 
REGENERATIVE ENDODONTICS.pptx
REGENERATIVE ENDODONTICS.pptxREGENERATIVE ENDODONTICS.pptx
REGENERATIVE ENDODONTICS.pptxDrRutikaNaik
 
REGENERATIVE_ENDODONTICS msa.pptx
REGENERATIVE_ENDODONTICS msa.pptxREGENERATIVE_ENDODONTICS msa.pptx
REGENERATIVE_ENDODONTICS msa.pptxHinarAlMoghazy
 
Regenerative endodontics
Regenerative endodonticsRegenerative endodontics
Regenerative endodonticsSoumita Maity
 
Regenerative Endodontics
Regenerative EndodonticsRegenerative Endodontics
Regenerative EndodonticsLena Ali
 
Dental and orofacial mesenchymal stem cells in craniofacial
Dental and orofacial mesenchymal stem cells in craniofacialDental and orofacial mesenchymal stem cells in craniofacial
Dental and orofacial mesenchymal stem cells in craniofacialAamir Godil
 
PIIS009923992200646X.pdf
PIIS009923992200646X.pdfPIIS009923992200646X.pdf
PIIS009923992200646X.pdfDr.Charu Kapur
 
Tissue Engineering in restorative dentistry
Tissue Engineering in restorative dentistryTissue Engineering in restorative dentistry
Tissue Engineering in restorative dentistryLama K Banna
 
Endodontic regeneration idc mumbai
Endodontic regeneration idc mumbaiEndodontic regeneration idc mumbai
Endodontic regeneration idc mumbaiSHIVAM DENTAL CLINIC
 
Endodontic regeneration idc mumbai
Endodontic regeneration idc mumbaiEndodontic regeneration idc mumbai
Endodontic regeneration idc mumbaiSHIVAM DENTAL CLINIC
 
Dental Pulp - Comprehensive - Dr. Abhishek John Samuel
Dental Pulp - Comprehensive - Dr. Abhishek John SamuelDental Pulp - Comprehensive - Dr. Abhishek John Samuel
Dental Pulp - Comprehensive - Dr. Abhishek John SamuelDr. Abhishek John Samuel
 
ADVANCES IN STEM CELL THERAPY
ADVANCES IN STEM CELL THERAPY ADVANCES IN STEM CELL THERAPY
ADVANCES IN STEM CELL THERAPY StemadeBiotech
 

Similar a Regenerative endodontic (20)

regenerative endodontics
regenerative endodonticsregenerative endodontics
regenerative endodontics
 
Tissue engineering in endodontics
Tissue engineering in endodonticsTissue engineering in endodontics
Tissue engineering in endodontics
 
Dental stem cells
Dental stem cellsDental stem cells
Dental stem cells
 
Dental stem cells
Dental stem cellsDental stem cells
Dental stem cells
 
Stem cells in Dentistry | by Dr Alaa Al-saidi
Stem cells in Dentistry | by Dr Alaa Al-saidiStem cells in Dentistry | by Dr Alaa Al-saidi
Stem cells in Dentistry | by Dr Alaa Al-saidi
 
Regenerative Endodontics
Regenerative EndodonticsRegenerative Endodontics
Regenerative Endodontics
 
REGENERATIVE ENDODONTICS.pptx
REGENERATIVE ENDODONTICS.pptxREGENERATIVE ENDODONTICS.pptx
REGENERATIVE ENDODONTICS.pptx
 
REGENERATIVE_ENDODONTICS msa.pptx
REGENERATIVE_ENDODONTICS msa.pptxREGENERATIVE_ENDODONTICS msa.pptx
REGENERATIVE_ENDODONTICS msa.pptx
 
Regenerative endodontics
Regenerative endodonticsRegenerative endodontics
Regenerative endodontics
 
Regenerative Endodontics
Regenerative EndodonticsRegenerative Endodontics
Regenerative Endodontics
 
Dental and orofacial mesenchymal stem cells in craniofacial
Dental and orofacial mesenchymal stem cells in craniofacialDental and orofacial mesenchymal stem cells in craniofacial
Dental and orofacial mesenchymal stem cells in craniofacial
 
PIIS009923992200646X.pdf
PIIS009923992200646X.pdfPIIS009923992200646X.pdf
PIIS009923992200646X.pdf
 
Tissue Engineering in restorative dentistry
Tissue Engineering in restorative dentistryTissue Engineering in restorative dentistry
Tissue Engineering in restorative dentistry
 
Endodontic regeneration idc mumbai
Endodontic regeneration idc mumbaiEndodontic regeneration idc mumbai
Endodontic regeneration idc mumbai
 
Endodontic regeneration idc mumbai
Endodontic regeneration idc mumbaiEndodontic regeneration idc mumbai
Endodontic regeneration idc mumbai
 
REGENERATIVE ENDODONTICS
REGENERATIVE ENDODONTICSREGENERATIVE ENDODONTICS
REGENERATIVE ENDODONTICS
 
Dental Pulp - Comprehensive - Dr. Abhishek John Samuel
Dental Pulp - Comprehensive - Dr. Abhishek John SamuelDental Pulp - Comprehensive - Dr. Abhishek John Samuel
Dental Pulp - Comprehensive - Dr. Abhishek John Samuel
 
Dental pulp
Dental pulpDental pulp
Dental pulp
 
ADVANCES IN STEM CELL THERAPY
ADVANCES IN STEM CELL THERAPY ADVANCES IN STEM CELL THERAPY
ADVANCES IN STEM CELL THERAPY
 
Regenerative Endodontics.
Regenerative Endodontics. Regenerative Endodontics.
Regenerative Endodontics.
 

Último

Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.pptRamDBawankar1
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.kishan singh tomar
 
The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?Ryan Addison
 
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...Ganesan Yogananthem
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptPradnya Wadekar
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communicationskatiequigley33
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)Mohamed Rizk Khodair
 
Microbiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxMicrobiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxkitati1
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfHongBiThi1
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...Sujoy Dasgupta
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptxWINCY THIRUMURUGAN
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu Medical University
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 

Último (20)

Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosis
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.
 
The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?
 
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.ppt
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communications
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)
 
Microbiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxMicrobiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptx
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 

Regenerative endodontic

  • 2. CONTENTS • Introduction • Components of Regenerative Endodontics
  • 3. INTRODUCTION • Regenertive endodontics are biologically based procedures designed to replace damaged structures ,including dentin and root structures, as well as cells of pulp-dentin complex. • Concept :Normal, sterile granulation tissue developed in the root canal for revascularization will stimulate the cementoblasts/ undifferentiated mesenchymal cells (periapex) and lead to calcific material formation at periapex or lateral dentinal walls. • Goals :  Primary goal- elimination of symptoms and the evidence of bone healing.  Secondary goal-increased root length or wall thickness.  Tertiary goal-positive response to vitality tests.
  • 4. COMPONENTS OF REGENATIVE ENDODONTICS • The three key elements of tissue regeneration are:  Stem cells  Growth factors  Scaffold
  • 5. Stem cells • According to Diogenes et al., regenerative procedures are all stem cell based therapies. • Stem cells are undifferentiated cells that are capable of differentiating into various specialized cell types. They can be pluripotent or multipotent in nature. They are located in stem cell niches. • Types of stem cells:  Dental pulp stem cells (DPSC)  stem cells of the apical papilla (SCAP)  Stem cells from human exfoliated deciduous teeth (SHED)  Dental follicle stem cells (DFSC)  Bone marrow stem cells (BMSC)  Periodontal ligament stem cells (PDLSCs)  Inflamed periapical progenitor cells (iPAPCs)  Tooth germ progenitor cells (TGPCs)  Salivary gland stem cells (SGSCs)
  • 6.  Dental pulp stem cells • stem cells derived from the dental pulp • can form pulp like tissue , in future it is possible to replace infected pulp tissue of a paining tooth with newly generated pulp like tissue instead of doing RCT ,thus preserving the vitality of the tooth • It also has the ability to form bone that is useful for the osseointegration of dental implants, thus increasing its success rate .
  • 7.  Stem cells of the apical papilla • A unique population of dental stem cells known as stem cells from the root apical papilla (SCAP) is located at the tips of growing tooth roots . The apical papilla tissue is only present during root development before the tooth erupts into the oral cavity . • SCAP have the capacity to differentiate into odontoblasts and adipocytes . • These cells are CD24+ but expression is down regulated upon odontogenic differentiation in vitro coincident with alkaline phosphatase up regulation.
  • 8. Stem cells from human exfoliated deciduous teeth (SHED) • Dental pulp of human exfolliated deciduous teeth contains multipotent stem cells from human exfoliated deciduous teeth (SHED). were identified to be a population of highly proliferative, clonogenic cells capable of differentiating into a variety of cell types including neural cells, adipocytes, and odontoblasts. Thus, exfoliated teeth may be an unexpected unique resource for stem-cell therapies including autologous stem-cell transplantation and tissue engineering. • have higher rate of proliferation. • have potential to form bone which is useful during osseointegration of dental implants • have the potential to repair calvarial defects in immuno-compromised mice .
  • 9. Dental follicle stem cells (DFSC) • The dental follicle is a loose ectomesenchyme-derived connective tissue sac surrounding the enamel organ and the dental papilla of the developing tooth germ before eruption . • It is believed to contain progenitors for cementoblasts,PDL and osteoblasts. • Dental follicle cells (DFC)form the PDL by differentiating into PDL fibroblasts that secrete collagen and interact with fibers on the surfaces of adjacent bone and cementum. • Dental follicles contain progenitor cells which have the capability of differentiating into cementum forming cells (cementoblasts), osteoblasts of the alveolar bone, and periodontal ligament fibroblasts.
  • 10. Bone marrow stem cells (BMSC) • Bone marrow-derived cells (BMDCs) have the potential to engraft into several tissues after injury, but whether they can become dental tissue-specific progenitor cells under normal conditions and the relationship of these cells to the tissue- resident cells are unknown • Bone marrow progenitor cells communicate with dental tissues and become tissue-specific mesenchymal progenitor cells to maintain tissue homeostasis.
  • 11. Periodontal ligament stem cells (PDLSCs) • have potentials of regenerating typical cementum and periodontal ligament like structure . • tissue of the periodontium made by stem cell can be used as a treatment modality to replace the • diseased periodontium around teeth so as treatment to mobility of teeth
  • 12. • According to Hargreaves,stem cells like SCAP,DPSCs,iPAPCs,PDLSCs,BMSCs are most commonly used in regenerative endodontics. • These cells have te capacity of differentiating into odontoblast- like cells facilitating a progressive repopulation of the radicular pulp space , promoting organized tissue repair ,angiogenesis and reinnervation.
  • 13. Growth factors • Biological factors regulate stem cells to form the desirable cell type. • They promote the differentiation of mesenchymal stem cells into odontoblast-like cells. Platelet derived growth factors Bone morphogenetic proteins (BMPs) Transforming growth factor b Vascular endothelial growth factor Fibroblast growth factors Insulin like growth factor Nerve growth factor Stromal cell derived growth factor I
  • 14. BONE MORPHOGENETIC PROTEINS (BMPs) • Comprises a subgroup of the superfamily TGF(Transforming growth factor b) and are involved in cell proliferation, differentiation and apoptosis. • Have strong osteoinductive and chondrogenic effects. • BMP2,BMP4,BMP7 &BMP11 invoved in mineralization.
  • 15. Scaffold • A scaffold provides a physiochemical and biological 3-D micro environment for cell adhesion ,growth differentiation and migration. It contains the growth factors. • Functions :  Supports cell organization and vascularization.  Aids cell proliferation and differentiation.  Contains nutrients,antibiotics for improved and faster tissue development. • Classification :-  Natural – collagen,platelet rich plasma ,fibrin, glycosaminoglycans  Synthetic – polylactic acid ,polyglycolic acid ,polylactic- co-glycolic acid
  • 16. REVASCULARIZATION • Revascularization, as defined by Andreasen, is a the restoration of the vascularity to a tissue or organ. • Mechanism of revascularization ,according to Shah N :  Vital pulp cells at the apical end of root canal proliferate into newly formed matrix and odontoblasts, under the influence of HERS. Atubular dentin is laid in the apical end and lateral aspects of dentinal walls leading to apexogenesis and a thus strengthening and reinforcement of root occurs.  Multipotent dental pulp stem cells (immature permanent teeth)from the apical end might be seeded on to the existing dentinal walls and differentiate into odontoblasts and deposit tertiary or atubular dentin.
  • 17.  Stem cells in the periodontal ligament can proliferate and grow into the apical end and within the root canal and hence deposit hard tissue at apex and lateral walls.- cementum and Sharpey’s fibers in newly formed tissues.  Extensive proliferating property of SCAP & bone marrow- instrumentation beyond confines of root – bleeding –mesenchymal stem cell transplantation from bone.
  • 18. Regeneration of Dentin -Pulp complex • Three strategies to regenerate dentin-pulp complex have been proposed: a. Regeneration of entire tooth. b. Local regeneration of dentin-pulp complex from amputed dental pulp. c. Regeneration of dental pulp from apical dental pulp or peri- apical tissues. • Growth factors like bone morphogenetic proteins (BMPs) and fibroblast growth factors(FGFs), stem cells and scaffolds are essential for tissue engineering to regenerate tissues. • Stem cells differentiate into specific cells for tissue defects , growth factors like BMPs ,induce proliferation of stem cells. • Scaffolds with extracellular matrix properties support for cell proliferation ,differentiation and tissue formation.
  • 19. a) Regeneration of entire tooth • Accepted as a model of organ replacement and regeneration therapy. • Tooth germ can be bioengineered using 3D organ germ culture method in which dental epithelial and mesenchymal cells from isolated tooth germs cultured in scaffolds ( synthetic polymers –polylactic-co-glycolic acid ; bio ceramics- hydroxyapatite , tricalcium phosphate, calcium carbonate hydroxyappatite)
  • 20. b) Local regeneration of dentin-pulp complex from amputed dental pulp • Induction of appropriate pulp wound healing and formation of new dentin in dentin defects are essential in regeneration of dentin-pulp complex. • It was reported that BMP-2 with dentin powder induced dentinogenesis in dentin cavity with pulp exposure.Here stem or progenitor cells where induced from residual pulp through the exposure site in the floor of the cavity. • Ultrasound mediated delivery of growth differentiating factor - 11 (GDF-11) in dental pulp stem cells through sonoporation induced reparative dentinogenesis
  • 21. c) Regeneration of dental pulp from apical dental pulp or peri- apical tissues • Begins with identication of stem cells in the apical areas of developing teeth in which root formation is incomplete. • mesenchymal stem cells in apical papilla (SCAPs) differentiate into odontoblast-like-cells that participate in pulp wound healing and regeneration. • Bone marrow derived mesenchymal stem cells (BMMSC) has multipotent abilities and undergoes osteogenic differentiation. • Periapical tissues include bone marrow and PDL which is the source BMMSCs. Localization of SCAPs & BMMSCs in the apical region --- induction for dentin-pulp complex regeneration
  • 22. CLINICAL PROTOCOL REGENERATIVE ENDODONTICS INDICATIONS • Teeth with necrotic pulp and an immature apex. • Pulp space not needed for post/core ,final restoration • Patient compliance. • No allergy to the medicaments to be used. ROLE OF ANTIBIOTIC PASTE • Antibiotic pastes are a combination of more than one antibiotic mixed into a consistency of a paste. • The triple antibiotic paste-commonly used- ciprofloxacin,metronidazole, minocycline(1:1:1) in a macrogol/propyleneglycol vehicle. • Remains below CEJ and concentration is maintained to 0.1mg/ml and chamber is sealed with dentin bonding agents.
  • 23. Local anesthesia, Isolation, access cavity preparation Irrigation with 20ml of 1.5%NaOCl/5 min and saline rinse (20ml/ canal ,5min) Drying with paper points Placement of intracanal medicaments Ca(OH)2 Low conc.triple antibiotic paste Temp sealing with cavit/IRM/GIC Recall patient after 1-4 weeks. FIRST APPOINTMENT REGENERATIVE ENDODONTICS THERAPY
  • 24. Assess response to initial treatment. Signs of symptoms of infections persists No signs /symptoms Addtnl Rx time with antimicrobial pastes Alternative antimicrobials to be considered Local anesthesia (3%mepivacine without vasoconstrictor) Irrigation with 20ml of 17% EDTA,drying with paper points Intracanal bleeding- k file 2mm past apical foramen Blood in cavity till CEJ, 3-4 mm restorative material Resorbable matrix over clot White MTA(mineral trioxide aggregate)/ Ca(OH)2,capping –3-4mm GIC SECOND APPOINTMENT –REGENERATIVE ENDODONTIC THERAPY
  • 25. FOLLOW --UP • Clinical and radiographic examination • No pain ,swelling or sinum tract formation. • Resolution of periradicular radiolucency(6-12months of Rx) • Increase in width of canal walls (12—24months of Rx) • Increased root length • Pulp vitality tests.
  • 26. ADVANTAGES AND DISADVANTAGES ADVANTAGES • Achieve continued root development (root lengthening )and strengthening due to enforcement of lateral dentin walls with hard tissue deposition. • Obturation of canal is not required. • Splitting of root during lateral condensation avoided. • After control of infection, completed in a single visit. DISADVANTAGES • Discoloration due to minocyclinein antibiotic paste. • Prolonged treatment peroid compared with MTA apical barrier technique.
  • 27. POTENTIAL CAUSES OF FAILURE • Poor root development. • Insufficient bleeding during procedure. • Pulp calcifications/obliterations.
  • 28. CONCLUSION • Regenerative endodontics holds promise of restoring pulp- dentin complex in teeth with immature roots and necrotic pulps. • Procedure has advantages than traditional treatment of increasing root wall thickness as well as root length while maintaining immune competency. • Significant scientific hurdles need to be overcome with continued growth in knowledge and armamentarium.
  • 29. REFERENCES • Grossman’s endodontic practices-13th edition –Suresh Chandra,V.Gopikrishna • Regenerative Endodontics:regeneration or repair- Stéphane R.J. Simon, DDS, PhD, Phillip L. Tomson PhD- Journal of Endodontics. • Regenerative Endodontics-Biological basis of Regeneration of Dentin-Pulp Complex- Ariane Berdal, PhD -Journal of Endodontics