In this short discussion, Dr. Isabel Mello, an endodontist from Dalhousie University, speaks with Dr. Suham Alexander about the use of regenerative techniques in endodontics.
Regenerative techniques, although newer, have been used in apexification for teeth with necrotic pulps and open apices. This procedure is used to help revascularize teeth necrotic pulps and incomplete root formation, poor crown:root ratios, open apices and thin dentinal walls. Revascularization has the potential to improve these issues compared to other techniques. The technique still requires disinfection of the root canal system, intracanal medicaments, stem cells which are already present in the environment and a scaffolding structure such that the stem cells will differentiate into the cells required for success.
The technique requires the fundamentals of sound endodontic treatment. However, during disinfection, diluted sodium hypochlorite (NaOCl) is used so that the stem cells are preserved. Additionally, there is minimal instrumentation of the canals and no obturation of the canal space. A barrier is placed in the cervical third of the tooth. The biggest difference in this method is the introduction of bleeding into the canal space through over-instrumentation in the periapical region of the tooth up to the CEJ. Once bleeding occurs and a blood clot forms, the stem cells will have the necessary scaffolding within the canal space to differentiate and regenerate the root structure.
Case reports and retrospective studies have been published in the literature showing the high survival rates, using revascularization techniques along with root lengthening, root widening in addition to resolution of apical periodontitis.
Topçuoğlu G, Topçuoğlu HS. Regenerative Endodontic Therapy in a Single Visit Using Platelet-rich Plasma and Biodentine in Necrotic and Asymptomatic Immature Molar Teeth: A Report of 3 Cases. J Endod. 2016;42(9):1344-6. doi: 10.1016/j.joen.2016.06.005. Epub 2016 Jul 15.