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Table of Contents
LETTER TO THE EDITOR
Year : 2015  |  Volume : 5  |  Issue : 1  |  Page : 57

Failure of endodontic regeneration


Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal University, Mangalore, Karnataka, India

Date of Web Publication12-Aug-2015

Correspondence Address:
Manuel S Thomas
Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal University, Mangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5194.162747

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How to cite this article:
Thomas MS. Failure of endodontic regeneration. J Interdiscip Dentistry 2015;5:57

How to cite this URL:
Thomas MS. Failure of endodontic regeneration. J Interdiscip Dentistry [serial online] 2015 [cited 2019 Dec 14];5:57. Available from: http://www.jidonline.com/text.asp?2015/5/1/57/162747

Dear Editor,

The buzz word in endodontics, in the past few years has been regenerative endodontics. Therefore, it was with a great interest that the author read the article by Bhosale et al. [1] As, the author was going through this article, two terms caught by his attention: Regeneration and failure.

The first term, "regeneration" in endodontics as per American Association of Endodontists (AAE), is defined as biologically based procedures designed to predictably replace damaged, diseased, or missing structures, including dentin and root structures as well as cells of the pulp-dentin complex, with live viable tissues, preferably of the same origin, that restore the normal physiologic functions of the pulp-dentin complex. [2] Therefore, the technique of inducing root development in immature nonvital teeth with the use of the blood clot as a scaffold, with the hope that there is release of growth factors from dentin and that adult stem cells are present at the periradicular area can only be considered as the first step in endodontics toward using stem cell therapy in regeneration. However, can this technique be considered as a true regenerative procedure as many a times the hard tissue deposition is not predicable, the cells are not from the same origin (sometimes periodontal cells) and the tissue that is formed around the root canal walls may not resemble dentin? This doubt among the endodontists is highlighted with the use of several terms interchangeably by different authors for the procedure of inducing root development in immature nonvital teeth such as, pulp regeneration, revitalization, revascularization, and maturogenesis etc. [3] To contribute to the existing confusion the author would like to term this procedure, where the thoroughly disinfected root canal is filled with patient's own blood and is sealed coronally as "Autologous root canal filling."

The second term that needs some clarification is "failure." When do we consider the regenerative task undertaken in an immature tooth a failure? There is no thorough consensus in the literature. Is a positive response to pulp vitality criteria for success? Is an increase in root length mandatory for considering the treatment successful? As per AAE, the tooth should be asymptomatic and functional. In addition, postoperative radiograph took after 6-12 should show resolution of periapical radiolucency and a 12-24 months follow-up radiograph should shows increased dentin wall thickness as well as root length. [4] With the enormous research that is going on the field of regenerative endodontics, shortly, achieving predictable pulp regeneration with negligible failure will be a reality.

 
   References Top

1.
Bhosale S, Mridula P, Rameshkumar M, Jayasree S. Management of tooth with failed regeneration procedure. J Interdiscip Dent 2014;4:152-5.  Back to cited text no. 1
    
2.
Glossary of Endodontic Terms. 8 th ed. Chicago: 2012. Available from: http://www.nxtbook.com/nxtbooks/aae/endodonticglossary/index.php. [Last accessed on 2015 Jun 05].  Back to cited text no. 2
    
3.
Wigler R, Kaufman AY, Lin S, Steinbock N, Hazan-Molina H, Torneck CD. Revascularization: A treatment for permanent teeth with necrotic pulp and incomplete root development. J Endod 2013;39:319-26.  Back to cited text no. 3
    
4.
American Association of Endodontists. Regenerative Endodontics. Chicago: Endodontics: Colleagues for Excellence; 2013. p. 1-7.  Back to cited text no. 4
    




 

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