Kim S G, Malek M, Sigurdsson A, Lin L M, Kahler B
Division of Endodontics, Columbia University College of Dental Medicine, New York, NY, USA.
Department of Endodontics, New York University College of Dentistry, New York, NY, USA.
Int Endod J. 2018 Dec;51(12):1367-1388. doi: 10.1111/iej.12954. Epub 2018 Jun 11.
The European Society of Endodontology and the American Association for Endodontists have released position statements and clinical considerations for regenerative endodontics. There is increasing literature on this field since the initial reports of Iwaya et al. (Dental Traumatology, 17, 2001, 185) and Banchs & Trope (Journal of Endodontics, 30, 2004, 196). Endogenous stem cells from an induced periapical bleeding and scaffolds using blood clot, platelet rich plasma or platelet-rich fibrin have been utilized in regenerative endodontics. This approach has been described as a 'paradigm shift' and considered the first treatment option for immature teeth with pulp necrosis. There are three treatment outcomes of regenerative endodontics; (i) resolution of clinical signs and symptoms; (ii) further root maturation; and (iii) return of neurogenesis. It is known that results are variable for these objectives, and true regeneration of the pulp/dentine complex is not achieved. Repair derived primarily from the periodontal and osseous tissues has been shown histologically. It is hoped that with the concept of tissue engineering, namely stem cells, scaffolds and signalling molecules, that true pulp regeneration is an achievable goal. This review discusses current knowledge as well as future directions for regenerative endodontics. Patient-centred outcomes such as tooth discolouration and possibly more appointments with the potential for adverse effects needs to be discussed with patients and parents. Based on the classification of Cvek (Endodontics and Dental Traumatology, 8, 1992, 45), it is proposed that regenerative endodontics should be considered for teeth with incomplete root formation although teeth with near or complete root formation may be more suited for conventional endodontic therapy or MTA barrier techniques. However, much is still not known about clinical and biological aspects of regenerative endodontics.
欧洲牙髓病学学会和美国牙髓病学家协会发布了关于再生牙髓病学的立场声明和临床考量。自岩谷等人（《牙外伤学》，17卷，2001年，第185页）以及班奇斯和特罗普（《牙髓病学杂志》，30卷，2004年，第196页）最初发表相关报告以来，该领域的文献日益增多。再生牙髓病学中已采用诱导根尖出血产生的内源性干细胞以及使用血凝块、富血小板血浆或富血小板纤维蛋白的支架。这种方法被描述为一种“范式转变”，并被视为牙髓坏死的未成熟牙齿的首选治疗方案。再生牙髓病学有三种治疗结果：（i）临床体征和症状的消退；（ii）牙根进一步发育成熟；（iii）神经再生的恢复。众所周知，这些目标的结果存在差异，并且未实现牙髓/牙本质复合体的真正再生。组织学研究表明，修复主要源自牙周组织和骨组织。人们希望借助组织工程的概念，即干细胞、支架和信号分子，真正的牙髓再生能够成为一个可实现的目标。本综述讨论了再生牙髓病学的当前知识以及未来方向。需要与患者及家长讨论以患者为中心的结果，如牙齿变色以及可能需要更多就诊次数且存在不良反应的可能性。基于维克（《牙髓病学与牙外伤学》，8卷，1992年，第45页）的分类，建议对于牙根未完全形成的牙齿考虑采用再生牙髓病学治疗，尽管牙根接近或完全形成的牙齿可能更适合传统牙髓治疗或MTA屏障技术。然而，关于再生牙髓病学的临床和生物学方面仍有许多未知之处。
