As root canals are primary used to treat diseased and damaged pulp, newer innovations in endodontics have provided dentists with newer methods for treating damaged root channels, infected pulp tissues, and conservative measures for protecting teeth long-term. As a new age of technology is coming, regenerative endodontics has become a relatively new form of treatment that may potentially put the traditional root canal behind us and push us towards the future.
Throughout this preview, we’ll be looking into regenerative endodontics, what it means for the endodontic field, and how regeneration may potentially save more teeth.
Regenerating Pulp Tissue and Its Methods
While traditional root canals attempt to clean and remove the tooth pulp out entirely for sanitation purposes, regenerative endodontics attempts to use stem cells as a healing source for affected pulp, defining it as a uniquely new option for patients. This biological approach to repairing teeth is focused on eliminating the symptoms experienced but is only used for limited cases. In many ways, regenerative endodontics has been used for cases such as:
- Immature Necrotic Permanent Teeth: For removing necrotic pulp tissue from the canal, minimal canal preparation is required to perform a regenerative procedure successfully. If the root canal is over-prepared, then the canal walls can become a thing and weaken the root’s internal structure. This weakened internal structure makes it more likely to fracture as a result.
- Mature Necrotic Permanent Teeth: For mature teeth with necrotic pulp, these procedures require a mechanical debridement or removal of tissue using a sterilized dressing to eliminate the presence of infection and necrosis. Through using mechanical debridement, the procedure can perform more successfully and have apical closure.
- Mature Vital Permanent Teeth: Using similar steps from procedures with mature necrotic permanent teeth, mechanical debridement, and mild preparation is needed. However, for the vital teeth, stem cells can be placed within the infected tooth pulp and eliminate the need for using calcium hydroxide to remove the infection.
- Traumatized Teeth With External Root Resorption: For teeth traumatized and have an external root channel that’s been re-sectioned, the technique is similar to immature, necrotic teeth. Thus, minimal canal preparation is required for preventing the thinning of the channel wall and weakening of the root structures.
The American Association of Endodontists has funded over $2.5 million into research regarding regenerating pulp tissues and has provided many endodontists with pulpal regeneration guides on proceeding with these new methods of treatment. The AAE even has its own Regenerative Endodontics Committee to help practices establish the best methods for treatment for necrotic and infected pulp tissues.
What Be Will A Regenerative Endodontic Procedure Like?
As the focus of these procedures is to remove decaying pulp and ensure the site is clear of infection, patients may be wondering what having a regenerative procedure may be like. For those curious about having a procedure, it can appear in the following steps:
- Diagnosis – Before beginning, your primary dentist and endodontist will need to take x-rays and examine the condition of your affected tooth before proceeding with the procedure. The results of your exams will determine your eligibility.
- Preparation – To prepare for the procedure, your endodontist will isolate the tooth using dental dams to keep the area clean and dry from saliva impact.
- Accessing the Canal – To be able to treat the pulp, the canal region must be opened through scaffolding and removing layers of enamel and dentin without damaging the affected tissues.
- Cleaning and Sterilization – The core of the tooth is sterilized using the techniques mentioned above, and incorporating stem cells act as the primary focus of this technique.
- Packing and Sealing The Tooth – Following this, the canal is filled with a temporary material to remove the infection or necrosis, and within the next four weeks, another appointment will be scheduled to observe any remaining infection and the need for possible retreatment.
- Bleeding and Sealing – The next appointment will consist of reopening the canal to observe the effects of the materials and remaining infection. If not signs of infection are present and the canal is prepared, then the final stage involved stimulating the stem cells by generating a blood clot within the pulp area. Bleeding is deliberately created in the tooth to promote natural healing, and during this session, the tooth’s blood supply is cut off to a certain point to promote the stimulation of the stem cells.
Depending on the endodontist you go to, their methods of preparing and treating infected and necrotic teeth may differentiate. If you have any questions about regenerative endodontic treatments and would like to learn more, then the best resource you can have regarding treatment is to contact your primary dentist for a recommendation.
The Future of Regenerative Endodontics
Regenerative endodontics focuses on treating the pulp of the tooth, specifically pulp that’s been infected or impacted by trauma. Most often, the pulp that was severely damaged enough would be removed completely, but with regenerative endodontics, pulp damaged by the lack of blood supply or being pulled away from the channels, the pulp, and other surrounding tissues can be replanted and serve as a scaffold for new tissue growth. In other areas of research, regenerative endodontics has also been looking into stem cell research, using immature teeth pulp to regenerate tissue and create a more effective way of cleaning the canal system.
However, for many dentists, regenerative endodontics is a huge departure from their traditional means of disinfecting the canal system and filling the root channels with gutta-percha material. Right now, most cases of regenerative endodontics are being performed on immature teeth, and questions are still being raised on whether or not these procedures can be performed on regular teeth. It’s estimated that it may take another ten years or so to revitalize this concept fully, and for many currently experimenting with regenerative endodontics, their procedures can only be truly performed on specific cases of immature teeth development.
