JOVD 2017: Regenerative Endodontics

Question 1

who is the author?

Answer 1

kristina feigin DMV; Bonnie Shope, AVDC

Question 2

what are the 3 core principals of tissue engineering?

Answer 2

1. appropriate source of stem cells 2. growth factors that are capable of promoting stem cell differentiation 3. appropriate scaffold for the regulation of cell differentiation

Question 3

what is the origin of odontoblast-like cells?

Answer 3

dental pulp apical papilla

Question 4

what are the important growth factors for pulp and dentin formation?

Answer 4

morphogenic protein transforming growth factor B fibroblastic growth factor

Question 5

what are the indications for regenerative endodontics?

Answer 5

necrotic pulp immature apex

Question 6

what must the patient (client) expect?

Answer 6

2 or more appointments staining of the crown failure of the procedure

Question 7

grossly summarize treatment in the first appointment

Answer 7

create access irrigate with 1,5% bleach, 20 ml, 5 minutes then irrigate with saline or edta (20ml, 5 minutes) dry canal place calcium hydroxide or triple atb paste restore with glass ionomer

Question 8

how long between first and second appointments?

Answer 8

1-4 weeks

Question 9

summarize the second appointment

Answer 9

check for signs of infection irrigate canal with EDTA then dry overinstrument the apex and create bleeding until the blood fills the root to the CEJ or use PRF place layer of MTA place layer of glass ionomer

Question 10

what is the recommended follow up?

Answer 10

resolution of sinus or draining tract positive pulp response resolution of periapical lucency within 6-12 months increased root wall within 12-24 months

Question 11

what are factors that influence success?

Answer 11

effective disinfecting and restoration of the RC diameter of the root apex should be more than 0,5mm but ideally more than 1mm patient age (not know in vet med)

Question 12

what are the advantages of using EDTA in the protocol?

Answer 12

promotes survival of stem cells exposes a reservoir of growth factors from dentin

Question 13

what is the recommendation for use of blood vs PRF?

Answer 13

not much difference use PRF if insufficient bleeding

Question 14

what is the reported survival rate of teeth treated this way?

Answer 14

100% after 14 months

Question 15

pulp usually does not fully regenerate in this cases. what is the root development due to?

Answer 15

deposition of intracanal cementum, bone and connective tissue

Question 16

what are possible complications?

Answer 16

tooth staining pain reinfection fracture absence of continued root formation partial canal obliteration

Question 17

what is the suggested follow-up?

Answer 17

3-6-12-18-24 months then annually for 5 years