PULP REVASCULARIZATION

K.SUSHMITHA
FINAL YEAR

CONTENTS

WHAT IS REGENERATION ????

AND REGENERATIVE ENDODONTICS???
Regenerative endodontic procedures are biologically based
procedures, designed
to
replace
damaged
structures
including
dentin and root structures as well as the cells of pulp dentin
complex.

INTRODUCTION:
Human
immature
permanent
tooth is a
developing
Organ, any trauma, carirs, anatomical anomaly etc
Leading to pulpal necrosis, leaves us with the
following:

Open apex
Short apex
Infected pulp with blunder bass canals
Fragile and weak dentinal walls
And in short the tooth ceases to grow.

TREATMENT OPTIONS:

1.Apexification
2.Apexogenesis
3. A newer advancement _ Revascularization
of pulp.

REQUISITES FOR SUCCESSFUL

TREATMENT:
Young

patients _ tremendous healing potential.

Open apex allows in growth of tissues.

Multipotent differentiation of MSCs.
Creating a proper environment conducive for
regeneration.
Use of growth factors, scaffolds, signalling

molecules.

OBJECTIVES:
To achieve continous root end development and

gain
apical closure ensuring a proper crown and root
and
a natural apical seal.
Strengthen dentinal walls, thus attaining normal
fracture
resistance.
Regenerate the cells of pulp _ dentin complex.

POTENTIAL TECHNOLOGIES OF
REGENERATIVE ENDODONTICS
a. Root canal Revascularization
b. Post natal stem cell therapy

_pulp implantation
_scaffold implantation
_injectable scaffold
delivery
_3d cell printing
c. Gene delivery.

REVASCULARIZATION IS
THROUGH:
a. By inducing blood
clot
b. By PRF

STEPS IN
REVASCULARIZATION
1.DISINFECTION OF THE ROOT

CANAL
2. PROVISION OF A SCAFFOLD
3. CORONAL SEALING.

DISINFECTION OF THE ROOT

CANAL SYSTEM:
Mainly by irrigation with sodium hypochlorite (NaOCl)
20 ml /canal and cholrhexidine followed by disinfection
with anti microbial dressings.
Best anti microbial dressing is :Triple antibiotic paste.
What is triple antibiotic paste ?????
It is a 1:1:1 combination of ciprofloxacin,
metronidazole and minoxylin.
This paste is placed into the canal and left it for 21 days,
it renders the canal sterile.

PROVISION OF A
SCAFFOLD
Prior to this step, copious, gentle irrigation with
EDTA
is recommended because it prevents biofilm
formation and encourages pulp dentin complex
regeneration.
The suggested protocol for providing a scaffold
is the
introduction of a sterile #20 precurved k_ file
2mm
past the apical foramen to allow the entire
canal to fill

Bleeding should be controlled using pressure

applied
with a cotton pellet soaked in sterile saline
until a clot
has formed.
This should occur with in 15 mins.
Bleeding and clot formation, the initial steps
in tissue
healing, lead to granulation tissue formation,
an

LIMITATIONS:
This technique is limited by the unpredictability
of
both the concentrations and the composition of
the
cells trapped in the clot, as tissue engineering
requires effective concentrations and
composition of
cells to restore function.
In addition few authors reported cases in
which it was
not possible to produce bleeding in a canal.

The above mentioned concerns have prompted

researches to look for better scaffolds that
can be
constructed regardless of whether or not
bleeding can
be evoked.
The use of fibrin matrices such as
platelet_rich
plasma and platelet rich fibrin has been
widely
reported in this regard.

PRF is a second generation platelet concenterate is an

autologous fibrin mesh that serves as a reservoir for slow,
contious release of growth factors.
PRF , is essentially, nothing more than centrifused blood
taken from the same patient.
This PRF when introduced into the apical area the HERS
signals the pluripotent stem cells of the periodontal
ligament to differentiate into cementoblasts and
Odontoblasts and cells of pulp _dentin complex.

CORONAL SEAL
Once a scaffold has been produced with in the
canal, a
bacterial seal is indicated.
The material used for this purpose currently is
MTA

MTA is a bioceramic material capable of setting

even in
the presence of blood.
Once it is set, it is highly resistant to bacterial
penetration.
To prevent over extension of MTA a collagen matrix
such
as colla plug is placed at the orifice.
Another newer material used for the same purpose
is
Biodentine and Bioaggregate.

Factors influencing:
Age of the patient.
Disinfection of the root canal.
Apical diameter.

Advantages:
Technically simple and can be completed

using currently available instruments and

medicaments without expensive
biotechnology.
Regeneration of tissue in root canal
systems by a patients own blood cells
avoids the possibility of immune rejection
and pathogen transmission from replacing
the pulp with a tissue engineered construct

OUT COMES OF REVASCULARIZATION

THERAPIES:
Can be evaluated at four level.
1.Clinical evidence of periapical healing: This

includes
absence of sensitivity to percussion .
2.Radiographic evidence of periapical healing and
root
Development: this includes complete osseous healing
of the periapical lesion