Elsevier

Journal of Endodontics

Volume 41, Issue 2, February 2015, Pages 146-154
Journal of Endodontics

Review Article
Regenerative Endodontic Therapy: A Data Analysis of Clinical Protocols

https://doi.org/10.1016/j.joen.2014.08.003Get rights and content

Highlights

  • 1.

    The variability of the clinical protocols in regenerative endodontic procedures is extremely high.

  • 2.

    It is essential for clinicians to standardize the clinical protocol for regenerative procedures.

  • 3.

    An analysis of published protocols may be a source to provide clinical considerations.

Abstract

Introduction

The aim of the present study was to systematically analyze the protocols that have been used in regenerative endodontic therapy and to detect any variations in clinical procedures.

Methods

An electronic search was executed in PubMed using appropriate Medical Subject Heading terms covering the period from January 1993 to May 2014. Additional publications from hand searching and the reference section of each relevant article enriched the article list. The relevance of each article was initially evaluated by scanning all titles and corresponding abstracts. The definite inclusion of each article in the study was determined by using specific criteria applied independently by 3 reviewers.

Results

Sixty relevant publications were finally included. The canal walls were not mechanically instrumented in 68% of the clinical articles. Sodium hypochlorite was included in 97% of the clinical studies either as the only irrigant or in combination with other irrigants. Antibiotic combination paste was used as the intracanal medicament in 80% of the clinical articles. Sodium hypochlorite, chlorhexidine, and EDTA were used in the final irrigation protocol in 75%, 4%, and 13% of the clinical studies, respectively. Neither the creation of a blood clot nor the use of platelet-rich plasma/platelet-rich fibrin was described in 13% of the clinical articles. Mineral trioxide aggregate was used as an intracanal coronal barrier in 85% of the relevant clinical studies.

Conclusions

The variability of the clinical protocols applied during regenerative enododontic procedures is considerably high. A thorough analysis of regenerative protocols may constitute an additional source to provide useful clinical considerations for REPs.

Section snippets

Search Methodology and Study Selection

An electronic search was conducted using the PubMed database (www.ncbi.nlm.nih.gov) covering the period from January 1993 to the second week of May 2014. The following appropriate Medical Subject Heading (MeSH) terms for the electronic search were formed by using 12 relevant guide articles: ((((((“dental pulp”[MeSH Terms] OR (“dental”[All Fields] AND “pulp”[All Fields]) OR “dental pulp”[All Fields] OR “pulp”[All Fields]) AND revascularization[All Fields]) OR ((“dental pulp”[MeSH Terms] OR

Results

Three hundred eighty-two articles were found from the electronic search and another 3 articles from hand searching and the reference sections. Three hundred twenty-five articles were discarded according to the exclusion criteria of the study. Sixty relevant publications were finally included in this review (Table 1).

The methods, agents, and medicaments used in REPs are summarized in Table 2. The canal walls were not mechanically instrumented in 68% of the clinical articles. NaOCl was included

Discussion

The concept of regenerative endodontic therapy was introduced in the early 70s. Nygaard-Ostby and Hjortdal (66) ascertained the growth of new vascularized tissue into the empty apical portion of root canals after overinstrumentation and intracanal bleeding formation. The creation of a blood clot inside the root canal was defined by the researchers as a possible prognostic factor on the formation of new vital tissue (66). However, regenerative endodontic therapy was substantially initiated in

Acknowledgments

The authors deny any conflicts of interest related to this study.

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