Guided by Presented by Prof. Neelam Mittal Dr. Isha Narang Dean and Head Junior resident Faculty of dental sciences Deptt. Of Endodontics IMS, BHU IMS , BHU VARANASI VARANASI

Regenerative endodontics is the creation and delivery of tissues to replace the diseased, missing and traumatized dental tissues.

Biologically based procedures designed to replace damaged structures, including dentin and root structures, as well as cells of pulp-dentin complex.

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Regenerative endodontics has become a reality…. Approaches –Root-canal revascularizationPost-natal (adult) stem cell therapyPulp implantScaffold implantInjectable scaffolds Three-dimensional cell printing andGene therapy

REVASCULARIZATION

Introduced by Ostby in 1961 and reintroduced in 1966 by Rule and Winter.

Biologically based treatment regimen that offers, potential for continuous hard tissue formation in young permanent tooth with necrotic root canal system in addition to incompletely developed root

(Hargreaves et al 2008).

Why do we need Revascularization in Endodontics.

DENTAL TRAUMA

DENTAL CARIES

Poor crown root ratioThin dentinal walls

Calcium Hydroxide Apexification MTA apexification

Advantages

Revascularization

1] Elongation of root 2] Thickening of dentinal walls

PRINCIPLEThis is a ‘Tissue Engineering Concept’ (Nakashima & Akamine 2005).

Steps in Revascularization Disinfection of the root canal and periapical

area using Triple antibiotic paste Laceration of the periapical tissues Blood clot formation with the resultant

increase in growth factors like VEGF and platelet derived growth factors.

Huang GT, Lin LM. Letter to editor. J Endod 2008

Platelet concentrates are comprised of increased concentrations of TGF-β1 and are capable of increasing cell proliferation over time when compared with a blood clot (Lance et al 2010)

TGF-β and PDGF-AB

Soft tissue healing through collagen production Hard tissue healing through initiation of callus

formation and mineralization (Bolander 1992 and Cromack et al 1990).

SOURCES OF CONCENTRATED PLATELETS IN HAEMATOLOGY

It is further activated by adding bovine thrombin and calcium chloride for the activation.

METHOD OF PREPARATION

Division of blood sample in three layers:A base of red blood cells at the bottom, Acellular plasma on the topA clot of PRF in the middle

• In 2007, a new device for the preparation and standardization of leukocyte- and platelet-rich fibrin (L-PRF) clots and membranes was invented by Dr. Joseph Choukroun: the PRF Box (Process, Nice, France) (Ehrenfest 2010).

FIBRIN MESH OR MEMBRANE                                     

ADVANTAGE

• No use of anticoagulants, thrombin and calcium chloride activators leads to formation of natural optimized fibrin clot.

(Tsay et al 2005).

PRF PRP

Significant release of 81% of cytokines within the first day with decreased release at 3, 7, and 14 days

Release occurs before

the initiation of outgrowth of osteoblasts

Slow continuous increase of cytokines like TGF-β1 and PDGF-AB

Peak level at 14 days coninciding with the cell ingrowth

TGF-β1 levels of PRP at day 1 were statistically higher than that of PRF at day 1 (P < .05).

STUDY ON RAT CALVARIA OSTEOBLASTS

EFFECT ON CELL NUMBER WITH DAYS PRF PRP

cell mineralization at point of day 14 (P < .05)

PRF PRP

Clinical application of PRPPRP mediated regeneration of vital tissues in

teeth with necrotic pulp and periapical radiolucency has been done

Torabinezad M. Revitalization of tooth with necrotic pulp and open apex by using Platelet rich plasma: A case report. J endod 2011;37:65-8.

INFERENCE The huge potential of concentrated growth

factors in the form of PRF may provide standardized degrees of hard and soft tissue healing in the periapical region matching the biochemical criteria of the clinical situation.

 

CASE REPORT 1

CONCLUSION

The huge potential of PRF must be understood as it helps in tissue healing in a fast, continuous and well controlled manner.