Effectiveness of endodontic tissue engineering in treatment of apical periodontitis: A systematic review

被引:18
作者
Widbiller, Matthias [1 ]
Knuettel, Helge [2 ]
Meschi, Nastaran [3 ,4 ]
Duran-Sindreu Terol, Fernando [5 ]
机构
[1] Univ Hosp Regensburg, Dept Conservat Dent & Periodontol, Franz Josef Str Allee 11, D-93053 Regensburg, Germany
[2] Univ Regensburg, Univ Lib, Regensburg, Germany
[3] Katholieke Univ Leuven, BIOMAT Biomat Res Grp, Dept Oral Hlth Sci, Leuven, Belgium
[4] Univ Hosp Leuven, Dent, Leuven, Belgium
[5] Univ Int Catalunya, Fac Dent, Dept Endodont, Barcelona, Spain
关键词
cell transplantation; dental pulp necrosis; periapical periodontitis; regenerative endodontics; tissue engineering; IMMATURE PERMANENT TEETH; RANDOMIZED CLINICAL-TRIALS; ROOT-CANAL TREATMENT; CALCIUM HYDROXIDE; PULP REVASCULARIZATION; SEARCH STRATEGIES; NECROTIC PULPS; APEXIFICATION; PERSPECTIVES; STATEMENT;
D O I
10.1111/iej.13784
中图分类号
R78 [口腔科学];
学科分类号
1003 ;
摘要
Background Regenerative endodontics has evolved in recent years with tissue engineering concepts in particular appearing promising. Endodontic tissue engineering (ETE) describes the various approaches based on the orthograde introduction of scaffolds or biomaterials (with or without cells) into the root canal to achieve pulp tissue regeneration. There are currently no systematic reviews investigating whether ETE is a suitable method for the treatment of endodontic disease in both mature and immature permanent teeth. Objectives The purpose of this systematic review was to determine the effectiveness of ETE in permanent teeth with pulp necrosis in comparison with conventional endodontic treatment. Methods We searched MEDLINE, Embase and the Cochrane Library for published reports as well as Google Scholar for grey literature up to November 2021. Included were studies of patients with permanent immature or mature teeth and pulp necrosis with or without signs of apical periodontitis (P) comparing ETE (I) with calcium hydroxide apexification, apical plug and root canal treatment (C) in terms of tooth survival, pain, tenderness, swelling, need for medication (analgesics and antibiotics), radiographic evidence of reduction in apical lesion size, radiographic evidence of normal periodontal ligament space, function (fracture and restoration longevity), the need for further intervention, adverse effects (including exacerbation, restoration integrity, allergy and discolouration), oral health-related quality of life (OHRQoL), presence of sinus tract and response to sensibility testing (O). An observation period of at least 12 months was mandatory (T) and the number of patients in human experimental studies or longitudinal observational studies had to be at least 20 (10 in each arm) at the end (S). Risk of bias was appraised using the Cochrane risk-of-bias (RoB 2) tool. Two authors independently screened the records, assessed full texts for eligibility and evaluated risk of bias. Heterogeneity of outcomes and limited body of evidence did not allow for meta-analysis. Results Two randomized clinical trials investigating cell transplantation approaches with a total of 76 participants (40 treated immature teeth and 36 treated mature teeth) were included for qualitative analysis. Both studies had moderate concerns in terms of risk of bias. Due to the lack of homogeneity a meta-analysis was not possible. Tooth survival for ETE, root canal treatment and apexification was 100% after 12 months. Teeth treated with ETE showed a higher number of cases with positive pulpal responses to sensitivity tests and with blood perfusion compared with root canal treatment or apexification. Discussion This systematic review highlights that there is limited evidence for ETE approaches. Even though the results of this review suggest a high survival with ETE in mature and immature teeth, there is a moderate risk of bias due to methodological limitations in the included studies, so the overall results should be interpreted with caution. Lack of a robust control group was a common problem during literature screening, and outcomes besides dental survival were reported inconsistently. Future clinical trials need to address methodical as well as assessment concerns and report long-term results. Conclusion The benefits and high survival rates reported for ETE techniques suggest that this procedure might be an alternative to conventional procedures for permanent teeth with pulpal necrosis. However, more appropriate studies are needed to derive clinical recommendations. Registration PROSPERO (CRD42021266350).
引用
收藏
页码:533 / 548
页数:16
相关论文
共 72 条
[1]   Pulp sensibility and vitality tests for diagnosing pulpal health in permanent teeth: a critical review [J].
Alghaithy, R. A. ;
Qualtrough, A. J. E. .
INTERNATIONAL ENDODONTIC JOURNAL, 2017, 50 (02) :135-142
[2]   Regenerative Endodontics: A Systematic Analysis of the Failed Cases [J].
Almutairi, Waleed ;
Yassen, Ghaeth H. ;
Aminoshariae, Anita ;
Williams, Kristin A. ;
Mickel, Andre .
JOURNAL OF ENDODONTICS, 2019, 45 (05) :567-577
[3]   Long-term calcium hydroxide as a root canal dressing may increase risk of root fracture [J].
Andreasen, JO ;
Farik, B ;
Munksgaard, C .
DENTAL TRAUMATOLOGY, 2002, 18 (03) :134-137
[4]  
[Anonymous], Face Database ATT
[5]   Regenerative Endodontic Procedures in Necrotic Mature Teeth with Periapical Radiolucencies: A Preliminary Randomized Clinical Study [J].
Arslan, Hakan ;
Ahmed, Hany Mohamed Aly ;
Sahin, Yavuz ;
Yildiz, Ezgi Doganay ;
Gundogdu, Eyup Candas ;
Guven, Yahya ;
Khalilov, Ruslan .
JOURNAL OF ENDODONTICS, 2019, 45 (07) :863-872
[6]   Comprehensive Characterization of 2 Immature Teeth Treated with Regenerative Endodontic Procedures [J].
Austah, Obadah ;
Joon, Ruchika ;
Fath, Weston M. ;
Chrepa, Vanessa ;
Diogenes, Anibal ;
Ezeldeen, Mostafa ;
Couve, Eduardo ;
Ruparel, Nikita B. .
JOURNAL OF ENDODONTICS, 2018, 44 (12) :1802-1811
[7]   Cold pulp testing is the simplest and most accurate of all dental pulp sensibility tests [J].
Balevi B. .
Evidence-Based Dentistry, 2019, 20 (1) :22-23
[8]   Efficacy of Platelet-rich Plasma as a Scaffold in Regenerative Endodontic Treatment [J].
Bezgin, Tugba ;
Yilmaz, Ayca Dilara ;
Celik, Burcu Nihan ;
Kolsuz, Mehmet Eray ;
Sonmez, Hayriye .
JOURNAL OF ENDODONTICS, 2015, 41 (01) :36-44
[9]   De-duplication of database search results for systematic reviews in EndNote [J].
Bramer, Wichor M. ;
Giustini, Dean ;
de Jonge, Gerdien B. ;
Holland, Leslie ;
Bekhuis, Tanja .
JOURNAL OF THE MEDICAL LIBRARY ASSOCIATION, 2016, 104 (03) :240-243
[10]   Cell-Based Regenerative Endodontics for Treatment of Periapical Lesions: A Randomized, Controlled Phase I/II Clinical Trial [J].
Brizuela, C. ;
Meza, G. ;
Urrejola, D. ;
Quezada, M. A. ;
Concha, G. ;
Ramirez, V. ;
Angelopoulos, I. ;
Cadiz, M. I. ;
Tapia-Limonchi, R. ;
Khoury, M. .
JOURNAL OF DENTAL RESEARCH, 2020, 99 (05) :523-529