Regenerative endodontics in pediatric dentistry

Revaskularizacija pulpe je relativno nova i obećavajuća biološka metoda liječenja mladih trajnih zubi s nezavršenim rastom korijena. Revaskularizacija ovih zubi se temelji na ideji da matične stanice zubne papile mogu preživjeti nekrozu pulpe, čak i u prisutnosti periapikalne upale. Ove stanice imaju sposobnost stvaranja visoko vaskulariziranog tkiva. Nadalje, potrebna je minimalna mehanička instrumentacija da se očuvaju matične stanice i ionako tanki dentinski zidovi. Preporuča se kemijska dezinfekcija s NaOCl, CHX i intrakanalna uporaba trostruke antibiotske paste (TAP). TAP se smatra zlatnim standardom za ovu vrstu zahvata, a sastoji se od jednakih omjera metronidazola, ciprofloksacina i minociklina. Namjernim poticanjem krvarenja iz periapeksa i stvaranjem intrakanalnog krvnog ugruška, dobiva se matriks za stanice koje potječu iz periapikalne regije. Ne samo krv, već i plazma bogata trombocitima, te fibrin bogat trombocitima služe kao bogati izvor faktora rasta i mogući dodatak ili nadomjestak postojećem matriksu, kako bi se poboljšao ishod zahvata. Koronarno treba napraviti bakterijama nepropustan ispun, kako bi se spriječila invazija istih u prostor pulpe. MTA ima izvrsne opturirajuće sposobnosti, jer stvara tvrdu barijeru i potiče aktivnost signalnih molekula na rast matičnih stanica. Konačan ispun treba biti, što je više moguće, nepropustan i postojan. Mogu se koristiti kompoziti i smolom-modificirani staklenoionomerni cementi. Regenerativna terapija zahtijeva manji broj posjeta za razliku od apeksifikacije. Stimulira rast korijena u dužinu, zatvaranje apeksa i učvršćuje dentinske zidove odlaganjem tvrdog zubnog tkiva.Pulp revascularization is a relatively new and promising biological method in the treatment of immature permanent teeth. The revascularization of these teeth is based on the concept that vital stem cells in the apical papilla can survive pulpal necrosis, even in the presence of periapical infection. These cells have the ability to generate a highly vascularized living tissue. Therefore, a minimal mechanical instrumentation is recommended to preserve steam cells and an already thin dentinal walls. Chemical disinfection with NaOCl, CHX and intracanal placement of triple antibiotic paste (TAP) is recommended. A TAP is considered to be the golden standard for this procedure containing equal proportions of metronidazole, ciprofloxacin and minocycline. An intentional induction of bleeding from peri-apex and a formation of an intra-canal blood clot acts as a matrix for the cells from the periapical area. Not only the blood, but also the platelet-rich plasma and the platelet-rich fibrin are a rich source of growth factors and a potential addendum or substitute matrix which improve the outcome of the procedure. A bacteria-tight seal should be created coronally to inhibit bacterial invasion into the pulp space. MTA is considered to have excellent sealing ability, because it creates a hard barrier and also provides signaling molecules for the growth of stem cells. Final hermetic filling should be as airtight as possible and sustainable. Composites or resin-modified glass ionomer cements can be used. The regenerative therapy requires less dental appointments when compared to the apexification and provides root elongation, apex closure as well as reinforcement of lateral dentinal walls with deposition of hard dental tissue