ENDO, 04/2019

Vital pulp therapy is a minimally invasive procedure designed to preserve the dental pulp when it is affected by dental caries, trauma, restorative procedures or dental anomalies. The treatment can be completed in both asymptomatic and symptomatic teeth, including those diagnosed with reversible or irreversible pulpitis. Teeth with necrotic pulps should be treated by root canal treatment, otherwise they may have to be extracted. The type of intervention to be used can vary from a direct pulp cap to a pulpotomy depending on the extent of affected tissue and level of inflammatory response; thus, depending on the amount of pulp tissue to be preserved. Mineral trioxide aggregate (MTA) is recommended for use as a pulp capping or pulpotomy agent or alternatively, another pure calcium silicate cement (CSC) may be used, not combined with any resin or resin-modified material. Parole chiave: calcium silicate cement (CSC), clinical guidelines, mineral trioxide aggregate (MTA), pulp capping, pulpotomy, vital pulp therapy

The Cvek pulpotomy procedure has been in use for over 40 years since the technique was first published in 1978. The original technique remains unchanged; however, the materials used have evolved considerably. This article explores the developments in materials and the clinical procedure since the late 1970s and discusses how they might influence outcome. Two cases are presented to demonstrate common clinical scenarios that a general dental practitioner may encounter in everyday clinical practice. The treatment performed with the available materials is critiqued. Parole chiave: Cvek pulpotomy, direct pulp cap, mineral trioxide aggregate (MTA)

The development of future dental and regenerative endodontic therapies requires a fundamental understanding of both the biology of the tooth and the key clinical questions that need to be addressed. Therefore, productive partnerships between clinicians and basic scientists are essential to drive the field forward and to enable improved treatment outcomes for patients. The aim of this review is to provide a scientific background to dentine-pulp biology, including how developmental processes relate to the innate ability of the dentine-pulp to repair itself and regenerate, as well as to analyse the interaction between tooth repair and the inflammatory response. Furthermore, the way in which calcium hydroxide and calcium silicate-based restorative materials interact with the tooth to facilitate dental tissue repair processes is described, and finally, several emerging scientific areas with the potential for exploitation and clinical translation are highlighted. The exciting development of 'smart' dental materials, which work in synchrony with the body's repair response are also discussed, as well as how these therapeutic adjuncts may supplement current dental treatments. The potential of other 'regenerative treatments', including growth factor-, stem cell- or physical sciences-based therapies involving low-level light and ultrasound are discussed. The final section highlights recent experimental data on the current state of the relatively novel area of epigenetics and how developing an understanding of related processes within the dentine-pulp complex can be exploited for patient benefit. Parole chiave: mesenchymal stem cells, regenerative endodontics, tissue engineering, vital pulp therapy

Regenerative endodontic treatment (RET) has been described as a 'paradigm shift' in the treatment of immature teeth with pulp necrosis. It has been suggested that RET should be the first option for treating immature teeth when the roots are not yet fully developed. The European Society of Endodontology and the American Association of Endodontists have released position statements and clinical considerations for RET. Treatment modalities rely on the tissue engineering concept components stem cells, scaffolds and signalling molecules. Clinically, the treatment involves disinfection of, and often the introduction of a blood clot into, the root canal space. RET has three goals: 1) resolution of clinical signs and symptoms; 2) further root maturation; and 3) restoration of neurogenesis. To date, RET has been unable to establish a real regeneration of the pulp tissue and dentine space. Histologically, healing is achieved with repair from tissues derived primarily for the periodontal and osseous tissues such as bone-like tissue and cementum, rather than pulp tissue and odontoblasts. This review aims to present a clinical focus on RET and to provide a current view on this emerging clinical technique. Parole chiave: immature teeth, pulp necrosis, regenerative endodontic treatment, stem cells, tissue engineering

Regenerative endodontic therapy (RET) could result in continued root development, with possible occupancy of the root canal system by vital tissues. RET should be considered for young patients with immature teeth with incomplete root formation. However, much is still unknown about the clinical and biological aspects of RET, especially the long-term effects in the growing child. Several guidelines have been published advocating the use of RET for the management of non-vital immature permanent teeth. An electronic search using electronic databases MEDLINE, EMBASE and EMBASE Classic, and PubMed was undertaken; there are currently 12 published randomised controlled clinical trials on RET. This review discusses current knowledge with respect to RET protocols, as well as survival, success rates and predictability of RET outcomes. Patient-centred outcomes in relation to the young patient, such as tooth discolouration, and orthodontic treatment of RET-treated teeth are discussed. The most current and accepted clinical protocols for RET are outlined. Parole chiave: immature permanent teeth, non-vital, regenerative endodontic therapy

Restorative treatments often entail significant tooth tissue removal, the use of chemical agents and multiple interventions, potentially causing chronic trauma to the pulp. These factors may impact on the health of the pulp and, consequently, lead to a need for root canal treatment. This article examines common restorative procedures and their likely pulpal effects and considers measures to help reduce the risk of pulpal complications. Parole chiave: dentine-pulp complex, dentine sensitivity, pulp, trauma