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Pulp regeneration: follow the guide Volume 94, issue 3-4, Septembre-Décembre 2023

Authors
1 Service d’Odontologie Pédiatrique et CCMR O-Rares, CHRU Nancy, Hôpitaux de Brabois, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
2 Département d’Odontologie Pédiatrique, Faculté d’Odontologie, Université de Lorraine, 7 avenue de la forêt de Haye, 54500 Vandœuvre-lès-Nancy, France
3 Laboratoire Stress, Immunité, Pathogènes, EA 7300, Faculté de Médecine, Université de Lorraine, 7 avenue de la Forêt de Haye, 54500 Vandœuvre-lès-Nancy, France
Correspondance : magali.hernandez@univ-lorraine.fr

Introduction

What if we changed our point of view? What if we approached endodontics from a biological perspective rather than a mechanistic one? What if, in the case of pulpal tissue necrosis, we were to consider an alternative to apexification therapies? Is pulp tissue regeneration now possible?

Objective

Regenerative endodontic therapy (RET) aims to regenerate the pulp-dentin complex damaged by infection, trauma, or developmental anomaly of immature permanent teeth with necrotic pulp. The new intracanal tissue formation is expected to display pulp-like architecture and functions. There are two different based to tissue engineering approaches described to perform RET: cell-free CF-RET that attempt to induce host endogenous cells or stem cells to migrate into the root canal for regeneration or cell-based CB-RET which introduce exogenously prepared cells or stem cells into the canal for regeneration.

Material and Method

CB-RET is the basis of current protocols recommended by the American Association of Endodontists (AAE) and the European Society of Endodontology (ESE) for the treatment of necrotic immature permanent teeth, with or without LIPOE. In this article, after defining the above-mentioned concepts, we will describe the ESE protocol and discuss the key steps for “getting started with endodontic regeneration”.

Conclusion

Each stage of the protocol must be carried out rigorously so as not to compromise the stages of the various biological processes involved. The practitioner has to stay informed of advances in knowledge resulting from research and new protocols to be published.