Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina.
J Endod. 2020 Sep;46(9S):S105-S114. doi: 10.1016/j.joen.2020.06.030.
Regenerative endodontic therapy (RET) has gained considerable attention and wide approval. Although it is being performed routinely, the outcomes remain unpredictable, and the optimal approaches for treatment are not established. It has been shown that bacterial persistence in root canals in these cases significantly interferes with healing and root maturation. However, few objective clinical studies have evaluated the complex microflora present in the infections or the efficacy of various clinical procedures. In addition, the extent of the infection and biofilm maturation in immature teeth with necrotic pulp has been understudied. Furthermore, most models used in preclinical evaluation of these issues do not fully elucidate the complexity or variability of the clinical situation.
In this review, the main biological and clinical problems pertaining to RET will be discussed. Contemporary analysis of complex microbial communities will be reviewed with emphasis on how these types of analyses can provide clinically useful data. In addition, current and proposed approaches for the effective disinfection of the root canal environment without interference with stem cell viability or integrity of the dentin matrix in these cases will be explored. The future of research in this field, including better and more customizable approaches in RET, in light of recent technological advances and progress in endodontics, will be outlined.
再生性牙内治疗(RET)已得到广泛关注和认可。尽管它已被常规应用,但治疗效果仍难以预测,其最佳治疗方法尚未确定。已有研究表明,这些病例中根管内细菌的持续存在显著干扰了愈合和牙根成熟。然而,很少有客观的临床研究评估过这些感染中存在的复杂菌群,也没有评估过各种临床操作的疗效。此外,感染的程度和感染牙髓坏死的未成熟牙中生物膜的成熟度也研究不足。此外,这些问题的临床前评估中使用的大多数模型并不能充分阐明临床情况的复杂性或变异性。
本文将讨论与 RET 相关的主要生物学和临床问题。本文将对复杂微生物群落的当代分析进行综述,重点介绍这些分析如何为临床提供有用的数据。此外,还将探讨在不干扰这些情况下干细胞活力或牙本质基质完整性的情况下,有效消毒根管环境的当前和拟议方法。鉴于最近在牙髓学方面的技术进步和进展,将概述该领域未来的研究方向,包括更好和更可定制的 RET 方法。