Pulp Revascularization: Future Therapy of Tooth with Open Apex

Introduction: The endodontic management of necrotic permanent immature teeth is a challenge for the practitioner. These teeth are treated by apexification. However, because of the complications associated with this treatment, researchers have developed other therapies. Currently, a new technique called pulp revascularization has emerged. This technique allows the continuation of root completion thanks to a healthy tissue newly formed at the intra root canal level. Material and method: A literature search of articles dealing with pulp revascularization of immature permanent teeth was conducted using two types of search strategy, a literature search using keywords on databases and then a manual “bottom-up” search of references of previously identified articles. Results: 112 articles were identified based on inclusion and exclusion criteria. Discussion: This work showed that pulp revascularization is a new therapy that aims to restart root development on an immature permanent tooth. It is based on the principle of tissue engineering and uses the differentiation potential of stem cells. Conclusion: Currently, the literature values revascularization as it allows root development, sidewall thickening, apical closure and a decrease in periapical lesion and ensures a good sealing. Clinical and radiographic success rates appear to be encouraging, except that factors influencing treatment must be taken into consideration.

Comparison of dental pulp periodontal therapy and conventional simple periodontal therapy as treatment modalities for severe periodontitis

BACKGROUND Severe periodontitis is a major oral health concern today as it can lead to loss of teeth.Conventional periodontal therapy has numerous pitfalls as it does not address the pulp-periodontal complex in its entirety.AIM To investigate the effect of dental pulp periodontal therapy on the levels of interleukin-1β(IL-1β)and IL-10 in gingival crevicular fluid(GCF)in patients with severe periodontitis.METHODS Eighty-six patients with severe periodontitis were randomly divided into a research group(n=43)and a control group(n=43).The control group was treated with simple periodontal therapy,and the research group was treated with dental pulp periodontal therapy.The total effective rates of the treatments;periodontal status before and after treatment through the measurement of the periodontal pocket probing depth(PPD),gingival sulcus bleeding index(SBI),mobility(MD),and plaque index(PLI);the levels of inflammatory factors IL-1βand IL-10 in the GCF;and the incidence of complications were calculated for both groups and compared using the Student’s t test and theχ^(2) test.RESULTS The total effective rate of treatment in the study group(93.02%)was higher than that in the control group(76.74%;P<0.05).While before treatment,there was no significant difference in the PLI,MD,SBI,or PPD between the two groups,the post-treatment values of PLI,MD,SBI,and PPD(4.71±0.16 mm,0.61±0.09 mm,0.96±0.17 mm,and 0.76±0.26 mm,respectively)were significantly lower(P<0.05)in the research group than in the control group(5.35±0.24 mm,0.93±0.15 mm,1.35±0.30 mm,and 1.04±0.41 mm,respectively).There was no significant difference in the level of IL-1βor IL-10 in the GCF before treatment between the two groups;after treatment,the IL-1βlevel in the research group(139.04±15.54 pg/mL)was significantly lower than that in the control group(156.35±18.10 pg/mL),and the level of IL-10 in the research group(7.98±1.01 ug/L)was higher than that in the control group(5.56±0.96 ug/L)(P<0.05).The incidence of complications in the study group(4.65%)was significantly lower than that of the control group(18.60%;P<0.05).CONCLUSION Endodontic therapy and periodontal treatment for patients with severe periodontitis can effectively reduce the levels of inflammatory factors in the GCF and the inflammatory reaction.In addition,it can improve the periodontal condition and the overall treatment effect,reduce the risk of complications,and ensure the safety of treatment.