Endodontic regeneration idc mumbai

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Endodontic regeneration
Apical regeneration & Revascularization(in vivo)
DR ASHWIN R KOLHE
SHIVAM DENTAL CLINIC
JAJU CHOWK,YAVATMAL-445001
drashwinkolhe@gmail.com

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Endodontic regeneration idc mumbai

  1. 1. Apical regeneration & revascularization
  2. 2.  Human immature permanent tooth is a developing organ ,any trauma ,caries ,anatomic anomaly etc leading to pulpal necrosis ,leaves us with a Open apex Short apex infected necrotic pulp with blunder bass canals fragile & weak dentinal walls In short a dead tooth which has ceased to grow.
  3. 3.  Achieve continuous root end development & gain apical closure ensuring a proper crown- root ratio & a natural apical seal. Strengthen dentinal walls ,thus normal fracture resistance Regenerate cells of pulp –dentin complex Biologic solution to biologic problem.
  4. 4.  Adult stem cells have been isolated from dental tissues-the mesenchymal stem cells(MSCs) SCAP(stem cells of apical papilla) SHED(stem cells from human exfoliated dec teeth) DPSC(dental pulp stem cells) etc
  5. 5.  MSCs are multipotent –ability to differentiate and form different tissues. Osteoblasts Odontoblasts Chondrocytes Adipocytes Neural cells This has been experimentally proved
  6. 6.  Young pts-tremendous healing potential Open apex-allows in growth of tissues Multi potent differentiation of MSCs Creating a environment conducive for regeneration in the canals. Use of growth factors, scaffolds and signaling molecules.
  7. 7.  To create a environment conducive for regeneration a decontamination and disinfected root canal space is essential which is achieved by 1-use of irrigation( sodium hypo 5.2% , endodontic hexidene & saline) 2-use of triple antibiotic paste (ciprofloxacin+ metronidazole+minocycline +carrier )
  8. 8.  All the standard precautions related with the use of irrigation must be fallowed. Triple mix antibiotic should be packed 2 mm below the CEJ .kept for 3 weeks All the care pertaining to preservation of Apical Papilla should be carried out. Cavit as a intermediary restoration should be used.
  9. 9.  Probably the most important step is inducing MSCs to grow into the canal space to produce dentin and cells of pulp-dentin complex. Simply carried out with over instrumentation or a sharp explorer Wait for 15 min for the blood to clot
  10. 10.  What this procedure does is to induce the MSCs to grow into the canal to promote continuous root end development & allows thickening of dentinal walls by forming dentin & cells of pulp dentin complex. At this stage we are not absolutely sure about the source of cells but in all likely hood the Apical papilla, surviving pulpal remnants even the PA bone may play a role in initiation & differentiation of MSCs.
  11. 11.  Stimulation of the stem cells by certain modifying & growth factors under suitable conditions along with appropriate scaffolds can lead to growth ,development & differentiation of a specific linage of cells which can be utilized for tissue engineering to create & restore specific organs ,muscles ,nerves & vessels in a predictable manner for functional efficiency & growth.

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