THE HOLY GRAIL OF ENDODONTICS

REGENERATION

INTRODUCTION• There is a high rate of success in retention of teeth by endodontic therapy but

many teeth are not restorable because of apical resorption, fracture, incompletely formed roots or carious destruction of coronal structures.

• A novel approach to restore tooth structure is based on biology i.e. regenerative endodontic procedures by the

application of tissue engineering.

• Regenerative endodontics was founded by Dr. Nygaard- Ostby in 1960s.

OBJECTIVES• The goal of Regenerative Dentistry is to induce biologic replacement

of dental tissues and their supporting structures.

DEFINITION• According to American Association of Endodontists, regenerative

endodontic therapy has been defined as “biologically based procedures designed to replace damaged structures, including dentin and root structures, as well as cells of the pulp-dentin complex’’.

TISSUE ENGINEERING is an emerging multidisciplinary field that applies the principles of

engineering and life sciences for the development of biological substitutes that can restore, enhance or improve tissue function.

COMPONENTS

SCAFFOLDS

STEM CELLS GROWTH FACTORS

• Tissue engineering involves the interplay among stem cells, growth factors and scaffolds.

STEM CELLS

Stem cells are undifferentiated cells which have the capability to produce cells of the same type or more differentiated cells.

DEFINITION

CLASSIFICATION

HUMAN DENTAL STEM CELLS• Dental pulp stem cells (DPSC)• Stem cells from human exfoliated deciduous

teeth(SHED)• Stem cells from apical papilla(SCAP) • Periodontal ligament stem cells (PDLSC)• Tooth germ progenitor cells (TGPCs)• Dental follicle stem cells (DFSCs)

GROWTH FACTORS

DEFINITION:Growth factors are polypeptides which have the ability to bind to specific receptors on the target cells (in this case the stem cells and other pulpal cells) and modulate or facilitate certain activities like migration, proliferation, differentiation, and apoptosis .

DIFFERENT TYPES:• Bone morphogenetic proteins (BMPs)• Platelet derived growth factor

(PDGF)• Transforming growth factor (TGF)• Fibroblast growth factors (FGF)• Insulin like growth factors (IGF)• Nerve growth factor (NGF)• Vascular endothelial growth factor

(VEGF)

FGF TGF BMPs

SCAFFOLDSA scaffold denotes a temporary platform for repairing or erecting a building. In a similar manner, all multicellular living organisms have natural scaffolds that surround the cells and provide structural support for formation and maintenance of tissues and organs.

Natural scaffolds Synthetic scaffolds

CollagenPlatelet rich plasmaFibrinGlycosaminoglycans

Polylactic acid (PLA), Polyglycolic acid (PGA),Polycaprolactone (PCL).Polyethyleneglycol (PEG)

HYDROXYAPETITE

COLLAGEN 3- D HYDROGEL

PROCEDURES

FUTURE DEVELOPEMENT

It has the potential for regenerating both pulp and dentin tissues. Thus, may offer an alternative method to save teeth that may have compromised structural integrity.

The possibility of pulp tissue regeneration is restricted by several factors, like, the dental pulp has minimal collateral blood supply, impairing the ability of the immune system to combat infections.

ADVANTAGE

DISADVANTAGE

Shah and Logani: Sealbio: Non-obturation endodontic treatment:Journal of Conservative Dentistry | Oct-Dec 2012 |Vol 15| Issue 4

CONCLUSION• Regenerative endodontic procedures have proven to be an

invaluable tool for teeth .

• Research needs to be done in many areas so as to make the regenerative procedures more predictable.

• Nevertheless, the applicability of stem cells and biomaterial sciences for dental reconstruction cannot be understated and offers a promising future.

MY SINCERE GRATITUDE TO-• Dr. Debaprasad Das- Professor & Head of the department

• Dr. Anirban Bhattacharyya- Professor

• Dr. Asim Bikash Maity- Reader

• Dr. Sourabh Bhattacharyya- Lecturer

• Dr. Sanhita Goswami- Lecturer

• My Senior PGTs

REFERENCES• Cohen’s Pathways Of The Pulp, 11th edition: Regenerative Endodontics

• Vimal K Shikri, Essentials Of Endodontics: Regenarative Endodontics

• Murray et al; Regenerative Endodontics: JOE- Vol-33, Number 4, April 2007

• Pankaj Gupta et al; Regenerative Endodontics: J Cont Med A Dent January- April 2015, Volume-3, Issue 1.

• Regenerative Endodontics : "A Road From Dead To Alive”: ©Indian Journal of Dental Sciences. (October 2014 Supplementary Issue, Issue:4, Vol.:6)

• Shah and Logani: Sealbio: Non-obturation endodontic treatment: Journal of Conservative Dentistry | Oct-Dec 2012 | Vol 15 | Issue 4