Endodontic regeneration Apical regeneration & Revascularization(in vivo) DR ASHWIN R KOLHE SHIVAM DENTAL CLINIC JAJU CHOWK,YAVATMAL-445001 drashwinkolhe@gmail.com

1. Apical regeneration
&
revascularization

2.  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.


4.  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.

5.  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

6.  MSCs are multipotent –ability to differentiate
and form different tissues.
 Osteoblasts
 Odontoblasts
 Chondrocytes
 Adipocytes
 Neural cells
 This has been experimentally proved

7.  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.

8.  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 )

11.  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.

14.  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

22.  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.

23.  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.