Vital dental pulp tissue is essential for maintenance of homeostasis and long term survival of the tooth. Stem cell based regeneration with/without gene modification has a promising potential to develop as an essential approach to treat pulpitis while regenerating the pulp’s vitality. Stem cell based tissue engineering requires the interplay of three key elements:
1. progenitor cells
2. inductive morphogenetic signals
3. extracellular matrix scaffold
Periradicular surgery is commonly performed to remove a portion of the root with undebrided canal space or to retroseal the canal when a complete seal cannot be obtained with an orthograde (through the crown) approach. The main indications for periradicular surgery are (1) nonsurgical root canal therapy is unfeasible (2) retreatment of failed root canal therapy is impossible or would not produce a better result (3) biopsy is indicated.
Specifically, periapiacal surgery may be neccesary in the folowing situations: (a) anatomic problems (b) procedural accidents requiring surgery (c) irretrievable materials in the canal (d) persistent symptoms (e) horizontal root fractures with apical necroses (f) irretrievable material preventing canal treatment (g) procedural error during treatment (h) large unresolved lessions following root canal treatment.
One goal we have in our dental practice is to reach as close to 100% successrate in our root canal treatment cases. To be able to achieve this, we need to effectively and thoroughly debride and disinfect the root canal system – bilogically, mechanically and chemically. Biological: we need to understand the nature of the biofilm in the root canal system to be able to reduce bacterial populations to a level below that which is necessary to induce or sustain disease.
Patency in endodontics is the ability of a root canal instrument to freely pass through the entire canal without obstructions or blockages. Obtaining patency during root canal treatment is viable to be able to establish the working length that would reach the apical constriction of a root canal and thereby must be maintained during the entire cleaning and shaping, an obturation.
Tissue engineering is the science of design and manufacture of new tissues to replace damaged one. The main factors for tissue regeneration are stem cells, growth factors that regulate cellular differentiation and scaffold of extracellular matrix that serves as micro milieu for their growth.