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10 TRENDS & APPLICATIONS Dental Tribune Asia Pacific Edition | 3/2017 “The field of tissue engineering has exploded during the last decade” An Interview with Dr Ibrahim Abu Tahun, Jordan By Kristin Hübner, DTI What are the advantages of new treatment modalities compared with conventional root canal therapy? The potential benefits to pa- tients and the profession are groundbreaking. From a public health point of view, the recent advances in tissue management and wound healing, compared with the current form of root canal therapy, which is more of a mechanical and chemical pro- cess, should be reflected in our clinical management to develop more biocompatible treatment modalities and increase tooth longevity. cn the past, it was unthinkable that the tissue in the periapical re- gion of a non-vital infected tooth could regenerate. Case reports published during the last 15 years have demonstrated convincingly in humans that this type of envi- ronment may create the ideal clinical outcome if disinfection can be achieved, just as it is for the canals in the case of dental avul- When it comes to implementing new treatment modalities in daily practice, do you think the endodon- tic community is somewhat divided or is the specialty as a whole on the verge of a major paradigm shift? The debate on clinical tech- nique and the concept of regener- ation and revascularisation per se is not a product of modern medi- cine. The varying treatments for the tooth pulp during the last three centuries illustrate this clearly. Recently, various treat- ment concepts have been sug- gested using less-invasive ap- proaches. Even though an optimal treatment protocol is lacking, however, many case reports and case series on pulpal therapy have been published. Once considered taboo, vital pulpal treatment of symptomatic permanent teeth with mineral tri- oxide aggregate has been reported to be successful, and greatly im- proved prognoses for permanent retention are now possible. More high-quality cohort studies would strengthen the evi- dence-based recommendations. However, the current best availa- ble evidence allows clinicians to provide these treatment modali- ties safely to patients. Globally, what is necessary to implement this new approach to endodontic treatment? A reparative, biological ap- proach to pulpal therapy is not only welcome, but also abso- lutely essential. cdeally, the de- livery of biologically based endo- dontic procedures must be more clinically effective than current treatments and the method of delivery must also be efficient, cost-effective and free of health hazards or side-effects for pa- tients. A recent study has sug- gested that endodontic practi- tioners are supportive and opti- mistic about the future use of regenerative endodontic proce- dures. dodontic treatment means endo- dontics that is more ethical than today. In your opinion, what innovations will influence endodontists most in the years to come? The tremendous and exciting new research on regenerative en- dodontics from Japan, the US and other countries has made the cul- tivation of potential in this field a strategic priority without under- mining the efficacy of conven- tional endodontic therapies, but positioning practitioners at the forefront of this field. We are changing protocols, towards going biological. This path to the future with various potential approaches based on clinical and scientific results pre- sented in the professional litera- ture will lead to predicable con- servative treatment that may en- able practitioners to fill a root canal with nature’s tissue in- Source: Ibrahim Abu-Tahun & Mahmoud Torabinejad, Management of teeth with vital pulps and open apices. Endodontic Topics 2012, 23, 79–104. a b c “In the past, it was unthinkable that the tissue in the periapical region of a non-vital infected tooth could regenerate.” sion. These novel endodontic tis- sue engineering therapies offer the possibility of restoring natu- ral function and improving the long-term outcome of teeth with a poor prognosis. A very recent study has found that regenerative endodontic treatment has the potential to be used to retreat teeth with persis- tent periapical periodontitis after root canal therapy. Best practice guidelines must be updated to include guidance to maintain the self-respect of the dental profession and the trust of the patients we serve, as the fact remains that more biological en- stead of plastic materials or arti- ficial surgical prostheses. The important challenge facing us now is to develop and adapt a safe, effective and consistent method for regenerating a func- tional pulp–dentine complex in our patients. Thank you very much for the inter- view. Editorial note: At the 19th Scientific Congress of the Asian Pacific Endodontic Confederation, which will be held from 5 to 8 April in New Delhi in India, Tahun will be addressing current endodontic challenges and conflicting priori- ties between conventional thera- pies and new treatment modalities in his lecture “Can we do it for- ever?”. Dr Ibrahim Abu Tahun, Jordan Being actively involved as a found- ing member and president of sev- eral endodontic societies, Dr Ibra- him Abu Tahun has experienced the changes in the field significantly over the last decades. Dental Trib- une had the opportunity to speak with Tahun, who is an associate professor in the Department of Conservative Dentistry at the Uni- versity of Jordan, about the most influential developments in the specialty and how these advances are changing the way endodontics is practised. Dental Tribune: Dentistry is chang- ing rapidly, with new materials, de- vices and treatment protocols be- ing introduced constantly. What is the situation in endodontics in par- ticular? What are the major devel- opments currently? sr cbrahim Abu Tahun: At the beginning of the 21st century, we have greater understanding of the pulp biology, pathophysiology and its powers of healing. The field of tissue engineering has ex- ploded during the last decade, and extensive reviews on dental appli- cations are available, producing a critical mass of knowledge and methods that are likely to answer the challenge issued decades ago. Various animal and human studies have shown high success rates for vital pulpal therapy. These investigations have demon- strated that the amputated pulp can be repaired by itself or after application of bioactive materials. Recent approaches to pulpal wound treatment have essentially followed two lines: one has contin- ued the conventional path to seek- ing improved synthetic materials that provide better seals, resulting in a breakthrough in bioactive materials, while another line has taken a biological approach with the hope of identifying a biologi- cally based strategy for treatment of clinical conditions.