![]() Moreover, it is not known to what degree the root canal system needs to be disinfected in order for clinical success to be evident. ![]() Their histological analysis demonstrated that there were remaining bacteria in the root canal. Recently, there have been a few case reports showing the recurrence of apical lesion and/or a suboptimal result such as no additional root formation from REPs. However, it should be emphasized that pulp revascularization from this biologically based approach is more favorable in a bacteria-free environment, which requires a clean and disinfected root canal system prior to cell colonization. Therefore, induced periapical bleeding provides fibrin scaffold, MSCs, and bioactive growth factors, which are three key elements for pulp tissue engineering in the canal space. In addition, blood contains many platelet-derived growth factors. Provoked periapical bleeding brings in an influx of mesenchymal stem cells (MSCs) from the periapical area to the canal space. Blood clots in the canal space could serve as a matrix or scaffold to promote pulp tissue wound healing. Induction of periapical bleeding into the canal space is a crucial step in REPs. However, there is still variable predictability of root maturation, as well as evidences that the newly formed tissues may not present root regeneration of the native pulp-dentin complex, but some degree of wound healing or repair. A growing body of evidence has showed the clinical feasibility of this approach, making it likely that REPs will become established procedures in the endodontic treatment spectrum. This optimally translates to the complete restoration of pulpal function and subsequent maturation of root development and thus, may confer a better long-term prognosis. REPs involve removing diseased or necrotic pulp tissue and replacing it with healthy pulp tissues to revitalize teeth. A better alternative in such cases would be performing regenerative endodontic procedures (REPs). ![]() Thus, immature teeth remain with thin canal walls and poor root-crown ratios, increasing susceptibility to root fractures and lower long-term survival rates. Even though these treatments often result in the resolution of clinical signs and symptoms of apical periodontitis, they do not regenerate the physiology of the pulp–dentine complex, nor do they allow for further root growth. The traditional treatment of immature teeth with necrotic pulps relied on apexification procedures involving long-term calcium hydroxide Ca(OH)2 treatment with multiple visits or on one-step apexification placing an apical plug of a mineral trioxide aggregate (MTA). Endo Careers Knowledge Center Submissions.Guidelines for Publishing Papers in the JOE.Oral, Poster & Table Clinic Presentations.
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