today IDEM Singapore 04 April

science & practice10 IDEM Singapore 2014—4 April n According to the American Association of Endodontists, re- generative endodontics is defined as “biologically-based procedures designed to physiologically re- place damaged tooth structures, including dentin and root struc- tures, as well as cells of the pulp-dentin complex”. There are two clinical concepts for man- agement of endodontically com - promised immature permanent teeth, one of which is the revitali- sation approach to achieve tissue generation and regeneration in therootcanalsystem.Thesecond is focused on the active pursuit of pulp-dentine regeneration via tissue engineering technology to implant or regrow pulps. There is hope that in the future regenerative endodontics may be an alternative treatment method for clinical endodontics. There are case reports demonstrating that after conventional root canal treatment, an abscessed tooth can heal and its root continue to de- velop after successful disinfec- tion. This depends on whether the root canal space can be disinfec- ted. Before the pulp becomes to- tallynecrosed,theremainingpulp tissue may be recoverable after disinfection and help to regener- ate the lost portion. Engineered pulp tissue may be inserted into the pulp space to enhance the regeneration, and to facilitate the entire recovery of pulp tissue and the generation of new dentine. When the entire pulp tissue is lost, synthesis of new pulp must take place in order to regenerate the tissue.1 Pulp tissue regeneration has been difficult so far because the tissue is encased in dentine with- out collateral blood supply ex- cept from the root apical end.1 Now, with modern tissue engi- neering and the discovery of dental stem cells, regeneration of pulp and dentine appears fi- nally achievable. Several differ- ent stem cells from pulp tissue have been discovered, including dental pulp stem cells from the pulp of permanent teeth, human exfoliated deciduous teeth and apical papillae. These cells have demonstrated characteristics of mesenchymal stem cells with multiple differentiation poten- tials.1 The source of cells is an issue in cell-based therapy. The supply of dental stem cells is limited, especially when derived from autologous sources. Not every individual who needs re- generation treatment has ready- to-use cells available. Infection or trauma can lead to a total loss of pulp tissue. In order to generate pulp tissue from scratch, pulp stem cells have to be seeded into a scaffold and im- planted into the canal space.1 Dental pulp stem cells, stem cells from apical papillae and pulp stem cells from human exfoliated deciduous teeth demonstrate the capability to de novo regenerate pulp and the former two are also capable of generating new dentine. Tissue engineering processes involve developing an engineered construct in the laboratory, which is preceded by isolating stem cells from the body, expanding them in a culture and seeding these cultured cells on to nano-fibrous scaffolds in culture medium sup- plemented with growth factors. The engineered tissue is then transplanted into the recipient site. Three elements critical to the success of tissue engineering are stem cells, morphogens/growth factors and a scaffold.2 The four factors that can lead to the growth of pulp tissue within the root canal space by inducing stem cells from the ad- jacent site to populate the area are thorough disinfection of the root canal, the presence of a ma- trix within the canal on which new tissue can grow, appropriate factors or stimuli present locally in the desired concentration and for the desired period, and the bacteria-impermeable seal of the access opening.2 In order to replace conven- tional root canal treatment, regen- erative endodontics should be economical, clinically practical, non-lengthy and patient condu - cive so that it can be performed routinely. A list of references is available from the publisher. Prof. Beena Rani Goel is the President of the International Academy for Rotary Endodontics and a well-known endodontist from India. 5 Prof. Beena Rani Goel, India Is regenerative endodontics the future? By Prof.Beena Rani Goel,India (DTI/Photo courtesy of Prof.Beena Rani Goel) AD Event tip Insights into the field of regenera- tiveendodonticswillbegiventoday at a SDA Masterclass Presentation by Prof. Ken Hargreaves, Professor and Chair of Endodontics at the University of Texas Health Science Center.Thelecturestartsat11a.m. in hall 406. TDI0614_10_Goel 28.03.14 12:25 Seite 1