Regeneration-A new horizon in Endodontics

1. Regeneration;
A new horizon in Endodontics
Dr.Josey Mathew

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OSHO
Never born
Never Died
Only visited this planet Earth between
Dec 11, 1931 –Jan 19,1990

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Regeneration in animals
• Earth worm
• If an earthworm is cut into half- head end will grow a
new tail-
• There are few earthworm species where tail end also will
grow a new tail.
• Lizard- tails regenerate

4. Regeneration in humans
• Limited regeneration
• Finger nail- if it falls off –body grows a new one
• Fracured bone-body creates new bone to mend the
fracture
• Blood, liver, skin…..
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5. Regeneration in mythology
• Zeus the creator of the universe was angered by
human greed
• Punished humans by taking fire off
• Without fire humans started to freeze to death
• Prometheus a kind hearted God stole fire from Zeus n
gifted to humans
• Zeus punished Prometheus to eternal suffering
• Tied Prometheus to the mountains; everyday a vulture
would come, pick out his liver, leave him to regenerate
his liver, and repeat the process
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6. Hercules and many headed hydra
• Hercules was punished to perform a series of near
impossible tasks
• First task was to kill a sea creature with poisonous
breath and regenerating heads named Hydra.
• Hercules won by cauterizing Hydra’s neck so that new
head wont grow back
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7. Grow teeth?
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8. Regeneration of teeth?
• Repair and regeneration of enamel
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9. Regenerative endodontics
Regenerative endodontics is creation and
delivery of tissues to replace missing and
diseased pulp.

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11. Case 1
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IMMATURE NECROTIC TOOTH WITH SYMPTOMATIC APICAL
PERIODONTITIS IN 21

12. I YEAR FOLLOW UP
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POSITIVE RESPONSE TO COLD TEST IN 21

13. Rationale of pulp regeneration?
• CaOH apexification for immature teeth with pulp
necrosis-94% success rate
• MTA apexification-96% success rate
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14. Drawbacks of Apexification;
• Does not foster further root development- Tooth fracture
Advantages of regeneration;
• Continuation of root development-better long term
prognosis
• Regeneration of pulp dentine complex-mounting an
immune response- signaling tissue damage by sensory
neurons
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15. Key elements in regeneration
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LA under rubber dam, & Access cavity preparation
Irrigation with 20 mL of 1.5 % NaOCl/ 5 minutes & saline / EDTA(20m L/canal,5 mins)
Dry the canal with paper points
Placement of intracanal medicament
Calcium hydroxide
Temporary seal with 3-4 mm of cavit/IRM/glassionomer
Recall patient after 1-4 weeks
PROTOCOL FOR REGENERATIVE ENDODONTICSENDODONTIC
PROCEDURES
1st APPOINTMENT
Triple antibiotic paste (1:1:1)
0.1-1.0mg/ml
(Hoschino’s Paste)

23. 2ND APPOINTMENT
• Assess response to initial treatment
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Additional treatment
time with antimicrobial
paste
Signs/ symptoms of infection persist No signs & symptoms
Alternate antimicrobial
should be considered

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No signs & symptoms
LA without vasoconstrictor & rubbe rdam isolation
Irrigation with 20mL of 17% EDTA, dry with paper points
Intentionally evoke intracanal bleeding(k file – 2mm past the apical
foramen)
Canal filled with blood to the level of the CEJ
Placement of a resorbable matrix over the blood clot(PRP/PRF)
White MTA -as capping material
covered with a 3-4 mm layer of GIC Light cured for 40 seconds.

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26. CASE REPORT-1
1ST APPOINTMENT
• Access cavity preparation done
• Irrigated with 20 ml 1.5% sodium hypochlorite.
• Canal dried, Triple antibiotic paste placed in the canal.
• Sealed with GIC

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2nd APPOINTMENT

28. FOLLOW UP
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2 weeks
follow up
3 months
follow up

29. 1 YEAR FOLLOW UP
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Positive response
to cold test in 21

30. CASE REPORT 2
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31. 3 MONTHS FOLLOW UP
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32. CASE REPORT 3
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33. 6 months follow up
CASE REPORT-4

34. ADVANTAGES OF REVASCULARIZATION
• Technically simple
• Available armamentarium n medicaments only
needed.
– No costly biotechnology lab set up needed.
• Patients own blood cell used
– No possibility of immune rejection/pathogen transfer
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35. CHALLENGES IN REGENERATIVE ENDODONTICS
• Pts should be informed about chances of failure.
• Pts should be informed about chances of discolouration
of teeth.
• Replaced pulp/tissue may be susceptible to further
disease and may require further treatment.
• Complex root canal anatomy may not favour
regeneration
• Enhanced microbiological control may be needed for
promoting regeneration
• Regeneration n growth should not go beyond control
once initiated,
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