Outcomes of infected teeth treated with cell-homing based regenerative procedures

Abstract

Objectives: Regenerative endodontic procedures (REP) are biologically based procedures that apply engineering and life science principles to promote regeneration of tissues and organs damaged by disease, trauma or dental anomalies. The clinical outcomes of such procedures on teeth with periradicular infections have not been investigated in detail. This study aimed to quantify and evaluate the effect of cell-homing based REP in human permanent immature teeth with necrotic pulp and periradicular pathosis. Methods: Immature permanent teeth (n=50) with pulp necrosis and periradicular pathosis were treated with a cell-homing concept based REP in this prospective cohort study. The pre- and post-treatment cone-beam computed tomography (CBCT) scans were assessed for quantification of changes in root length, pulp space diameter at the coronal middle and apical third of the root, volume of the pulp space and changes in the periradicular lesion. The Pre and post-REP measurements were statistically analysed using appropriate statistical tests (P=0.05). Results: Based on the clinical signs and symptoms, 94.5% of the teeth were categorized as “successful” after 48 months. CBCT analysis showed an increase in the thickness of the canal walls and continued root maturation (37.1%), continued root development with open apical foramen (57.1 %), calcification (obliteration) of the canal space (2.9%), and hard tissue barrier formation, apical to the coronal barrier (2.9%). REP significantly increased the root length and decreased the pulp space diameter, volume and periradicular radiolucency (P<0.05). Conclusions: This study indicates that the expected outcomes of radiographic root development were less predictable when teeth with periradicular pathosis were treated with REP. Future work on this topic should clearly define the expected outcome of regeneration vs repair in REP.