Regenerative Endodontics Success Factors and their Overall Effectiveness: An Umbrella Review
Iranian Endodontic Journal,
Vol. 17 No. 3 (2022),
20 July 2022
,
Page 90-105
https://doi.org/10.22037/iej.v17i3.32703
Abstract
Introduction: Regenerative endodontics is a developing field of dentistry and aims to recover the physiological and anatomical functions of the tooth for cases of severe dental caries, pulpal pathologies and dental trauma. Materials and Methods: This umbrella review seeks to discover the scientific evidence on the effectiveness and the factors result in successful regenerative endodontic therapies in teeth with necrotic pulps and with incomplete root development. The study was conducted following the PRISMA Guidelines. There were no restrictions regarding search period. A comprehensive literature search was carried out in EMBASE, LILACS, PubMed, Cochrane, Scopus, and Google Scholar. A quality evaluation was conducted by using AMSTAR-2. A descriptive analysis of the included systematic reviews and meta-analysis were conducted. Results: Thirteen descriptive systematic reviews and 7 meta-analyses were included. Three articles evidenced low methodological quality according to AMSTAR-2 tool. Overall success rates for the endodontic regeneration procedures ranged from 50% to 98% and the survival rates were between 94% and 100%. Pulp regeneration had a high success rate, evidenced by factors such as the resolution of symptoms, healing, increased root length, dentin thickening and recovery of sensitivity. Follow-up varied from 1 to 48 months for the original studies included in the systematic reviews and meta-analyses. Conclusions: Endodontic practice offers the clinician a good treatment option in case of necrotic pulp with immature roots such as the endodontic regeneration, that is supported by high and moderate quality scientific literature.
Keywords:
- Apexification; Regenerative Endodontics; Root Canal Therapy; Systematic Review; Umbrella Review
How to Cite
1.
Rojas-Gutiérrez WJ, Pineda-Vélez E, Agudelo-Suárez AA. Regenerative Endodontics Success Factors and their Overall Effectiveness: An Umbrella Review. Iran Endod J [Internet]. 2022 Jul. 1 [cited 2023 Sep. 30];17(3):90-105. Available from: https://journals.sbmu.ac.ir/iej/article/view/32703
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2. Trope M. Regenerative potential of dental pulp. J Endod. 2008;34(7 Suppl):S13-7.
3. Burczynska A, Struzycka I, Dziewit L, Wroblewska M. Periapical abscess - etiology, pathogenesis and epidemiology. Przegl Epidemiol. 2017;71(3):417-28.
4. Cymerman JJ, Nosrat A. Regenerative Endodontic Treatment as a Biologically Based Approach for Non-Surgical Retreatment of Immature Teeth. J Endod. 2020;46(1):44-50.
5. Shah N, Logani A, Bhaskar U, Aggarwal V. Efficacy of revascularization to induce apexification/apexogensis in infected, nonvital, immature teeth: a pilot clinical study. J Endod. 2008;34(8):919-25; Discussion 1157.
6. Vidal K, Martin G, Lozano O, Salas M, Trigueros J, Aguilar G. Apical Closure in Apexification: A Review and Case Report of Apexification Treatment of an Immature Permanent Tooth with Biodentine. J Endod. 2016;42(5):730-4.
7. Lin JC, Lu JX, Zeng Q, Zhao W, Li WQ, Ling JQ. Comparison of mineral trioxide aggregate and calcium hydroxide for apexification of immature permanent teeth: A systematic review and meta-analysis. J Formos Med Assoc. 2016;115(7):523-30.
8. Morales Martínez D, Covo Morales E, Díaz Caballero A. Efectos adversos en el periápice relacionados con el uso del mineral trióxido agregado en apexificación: revisión sistemática. [Relationship between adverse effects on the peri apex with the use of mineral trioxide aggregate on apexification, systematic review]. Av Odontoestomatol. 2014;30(2):95-8.
9. Araújo PRDS, Silva LB, Neto APDS, Almeida De Arruda JA, Álvares PR, Sobral APV, et al. Pulp Revascularization: A Literature Review. Open Dent J. 2017;10(1):48-56.
10. Kahler B, Lin LM. A review of regenerative endodontics: current protocols and future directions. J Istanb Univ Fac Dent. 2017;51(3 Suppl 1):S41-S51.
11. Shamszadeh S, Asgary S, Nosrat A. Regenerative Endodontics: A Scientometric and Bibliometric Analysis. J Endod. 2019;45(3):272-80.
12. Duncan HF, Kobayashi Y, Shimizu E. Growth Factors and Cell Homing in Dental Tissue Regeneration. Curr Oral Health Rep. 2018;5(4):276-85.
13. Hashemi-Beni B, Khoroushi M, Foroughi MR, Karbasi S, Khademi AA. Tissue engineering: Dentin - pulp complex regeneration approaches (A review). Tissue Cell. 2017;49(5):552-64.
14. Kawashima N, Okiji T. Odontoblasts: Specialized hard-tissue-forming cells in the dentin-pulp complex. Congenit Anom (Kyoto). 2016;56(4):144-53.
15. Kim SG, Malek M, Sigurdsson A, Lin LM, Kahler B. Regenerative endodontics: a comprehensive review. Int Endod J. 2018;51(12):1367-88.
16. Peng C, Zhao Y, Wang W, Yang Y, Qin M, Ge L. Histologic Findings of a Human Immature Revascularized/Regenerated Tooth with Symptomatic Irreversible Pulpitis. J Endod. 2017;43(6):905-9.
17. Digka A, Sakka D, Lyroudia K. Histological assessment of human regenerative endodontic procedures (REP) of immature permanent teeth with necrotic pulp/apical periodontitis: A systematic review. Aust Endod J. 2020;46(1):140-53.
18. Martins LF, Costa RO, Pedro JR, Aguiar P, Serra SC, Teixeira FG, et al. Mesenchymal stem cells secretome-induced axonal outgrowth is mediated by BDNF. Sci Rep. 2017;7(1).
19. Abou Neel EA, Chrzanowski W, Salih VM, Kim H-W, Knowles JC. Tissue engineering in dentistry. J Dent. 2014;42(8):915-28.
20. Shi X, Mao J, Liu Y. Pulp stem cells derived from human permanent and deciduous teeth: Biological characteristics and therapeutic applications. Stem Cells Transl Med. 2020;9(4):445-64.
21. Orti V, Collart-Dutilleul PY, Piglionico S, Pall O, Cuisinier F, Panayotov I. Pulp Regeneration Concepts for Nonvital Teeth: From Tissue Engineering to Clinical Approaches. Tissue Eng Part B Rev. 2018;24(6):419-42.
22. Diogenes A, Ruparel NB, Shiloah Y, Hargreaves KM. Regenerative endodontics: A way forward. J Am Dent Assoc. 2016;147(5):372-80.
23. Ahmad P, Dummer PMH, Noorani TY, Asif JA. The top 50 most‐cited articles published in the International Endodontic Journal. Int Endod J. 2019;52(6):803-18.
24. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010;8(5):336-41.
25. Aromataris E, Fernandez R, Godfrey CM, Holly C, Khalil H, Tungpunkom P. Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach. Int J Evid Based Healthc. 2015;13(3):132-40.
26. Higgins JP, Thomas J. Cochrane handbook for systematic reviews of interventions. 6a ed: Wiley Online Library; 2019.
27. Centre for Reviews and Dissemination (CRD)- University of York. CDR Database [Available from: https://www.york.ac.uk/crd/.
28. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008.
29. Pramila R, Muthu M. Regeneration potential of pulp-dentin complex: Systematic review. J Conserv Dent. 2012;15(2):97-103.
30. Kontakiotis EG, Filippatos CG, Agrafioti A. Levels of evidence for the outcome of regenerative endodontic therapy. J Endod. 2014;40(8):1045-53.
31. Antunes LS, Salles AG, Gomes CC, Andrade TB, Delmindo MP, Antunes LA. The effectiveness of pulp revascularization in root formation of necrotic immature permanent teeth: A systematic review. Acta Odontol Scand. 2016;74(3):161-9.
32. Conde MC, Chisini LA, Demarco FF, Nor JE, Casagrande L, Tarquinio SB. Stem cell-based pulp tissue engineering: variables enrolled in translation from the bench to the bedside, a systematic review of literature. Int Endod J. 2016;49(6):543-50.
33. Lolato A, Bucchi C, Taschieri S, Kabbaney AE, Fabbro MD. Platelet concentrates for revitalization of immature necrotic teeth: a systematic review of the clinical studies. Platelets. 2016;27(5):383-92.
34. Meschi N, Castro AB, Vandamme K, Quirynen M, Lambrechts P. The impact of autologous platelet concentrates on endodontic healing: a systematic review. Platelets. 2016;27(7):613-33.
35. Ragab RA, Abellatif AE, Eldokky NA. Regeneration of Necrotic ImmatureTeeth: Systematic Review. Indian Journal of Science and Technology. 2016;9(40):1-15.
36. Bucchi C, Valdivia-Gandur I, Sánchez-Bizjak R, Tallón-Walton V, Manzanares-Céspedes C. Regenerative endodontic therapy: a systematic review of clinical protocols. Int J Clin Exp Med. 2017;10(3):2006-15.
37. Duggal M, Tong HJ, Al-Ansary M, Twati W, Day PF, Nazzal H. Interventions for the endodontic management of non-vital traumatised immature permanent anterior teeth in children and adolescents: a systematic review of the evidence and guidelines of the European Academy of Paediatric Dentistry. Eur Arch Paediatr Dent. 2017;18(3):139-51.
38. Kahler B, Rossi-Fedele G, Chugal N, Lin LM. An Evidence-based Review of the Efficacy of Treatment Approaches for Immature Permanent Teeth with Pulp Necrosis. J Endod. 2017;43(7):1052-7.
39. Nicoloso GF, Potter IG, Rocha RO, Montagner F, Casagrande L. A comparative evaluation of endodontic treatments for immature necrotic permanent teeth based on clinical and radiographic outcomes: a systematic review and meta-analysis. Int J Paediatr Dent. 2017;27(3):217-27.
40. Tong HJ, Rajan S, Bhujel N, Kang J, Duggal M, Nazzal H. Regenerative Endodontic Therapy in the Management of Nonvital Immature Permanent Teeth: A Systematic Review-Outcome Evaluation and Meta-analysis. J Endod. 2017;43(9):1453-64.
41. Torabinejad M, Nosrat A, Verma P, Udochukwu O. Regenerative Endodontic Treatment or Mineral Trioxide Aggregate Apical Plug in Teeth with Necrotic Pulps and Open Apices: A Systematic Review and Meta-analysis. J Endod. 2017;43(11):1806-20.
42. Chisini LA, Grazioli G, Francia A, San Martin AS, Demarco FF, Conde MCM. Revascularization versus apical barrier technique with mineral trioxide aggregate plug: A systematic review. Giornale italiano di endodonzia. 2018;32(1):9-16.
43. Metlerska J, Fagogeni I, Nowicka A. Efficacy of Autologous Platelet Concentrates in Regenerative Endodontic Treatment: A Systematic Review of Human Studies. J Endod. 2019;45(1):20-30 e1.
44. Murray PE. Platelet-Rich Plasma and Platelet-Rich Fibrin Can Induce Apical Closure More Frequently Than Blood-Clot Revascularization for the Regeneration of Immature Permanent Teeth: A Meta-Analysis of Clinical Efficacy. Front Bioeng Biotechnol. 2018;6(139).
45. do Couto AM, Espaladori MC, Leite APP, Martins CC, de Aguiar MCF, Abreu LG. A Systematic Review of Pulp Revascularization Using a Triple Antibiotic Paste. Pediatr Dent. 2019;41(5):341-53.
46. Nicoloso GF, Goldenfum GM, Pizzol T, Scarparo RK, Montagner F, de Almeida Rodrigues J, et al. Pulp Revascularization or Apexification for the Treatment of Immature Necrotic Permanent Teeth: Systematic Review and Meta-Analysis. J Clin Pediatr Dent. 2019;43(5):305-13.
47. Rossi-Fedele G, Kahler B, Venkateshbabu N. Limited Evidence Suggests Benefits of Single Visit Revascularization Endodontic Procedures - A Systematic Review. Braz Dent J. 2019;30(6):527-35.
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