Elnawam Hisham, Abdelmougod Menatallah, Mobarak Ahmed, Hussein Mai, Aboualmakarem Hamdy, Girgis Michael, El Backly Rania
Endodontics, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
Tissue Engineering Laboratories, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
Front Bioeng Biotechnol. 2022 Feb 8;10:837639. doi: 10.3389/fbioe.2022.837639. eCollection 2022.
Regenerative endodontic procedures have been described for over a decade as a paradigm shift in the treatment of immature necrotic permanent teeth, owing to their ability to allow root maturation with subsequent enhancement of the tooth's fracture resistance in addition to the potential for regeneration of vital intracanal tissues. Concomitantly, minimally invasive endodontics is another rising concept with the main concern of preservation of tooth structure. Stemming from their potential to preserve the original tooth structure, both regenerative and minimally invasive endodontics could be considered as two revolutionary sciences with one common goal. Achieving this goal would entail not only employing the appropriate strategies to recreate the ideal regenerative niche but modifying existing concepts and protocols currently being implemented in regenerative endodontics to address two important challenges affecting the outcome of these procedures; conservation of tooth structure and achieving effective disinfection. Therefore, the search for new biomimetic cell-friendly disinfecting agents and strategies is crucial if such a novel integratory concept is to be foreseen in the future. This could be attainable by advocating a new merged concept of "minimally invasive regenerative endodontic procedures (MIREPs)," through modifying the clinical protocol of REPs by incorporating a minimally invasive access cavity design/preparation and biomimetic disinfection protocol, which could enhance clinical treatment outcomes and in the future; allow for personalized disinfection/regeneration protocols to further optimize the outcomes of MIREPs. In this review, we aim to introduce this new concept, its realization and challenges along with future perspectives for clinical implementation.
十多年来，再生牙髓治疗方法一直被视为治疗未成熟坏死恒牙的一种范式转变，这是因为它不仅能够使牙根发育成熟，进而增强牙齿的抗折能力，还具有使根管内重要组织再生的潜力。与此同时，微创牙髓治疗是另一个新兴概念，其主要关注点是保留牙齿结构。鉴于再生牙髓治疗和微创牙髓治疗都有保留原始牙齿结构的潜力，二者可被视为有着共同目标的两门革命性科学。要实现这一目标，不仅需要采用适当策略来重建理想的再生微环境，还需要修改目前再生牙髓治疗中正在实施的现有概念和方案，以应对影响这些治疗结果的两个重要挑战：保留牙齿结构和实现有效消毒。因此，如果要在未来预见这样一种新颖的整合概念，寻找新型仿生细胞友好型消毒剂和策略至关重要。这可以通过倡导一种新的“微创再生牙髓治疗程序（MIREPs）”合并概念来实现，即通过纳入微创开髓腔设计/制备和仿生消毒方案来修改再生牙髓治疗程序的临床方案，这可以提高临床治疗效果，并且在未来允许采用个性化消毒/再生方案，以进一步优化微创再生牙髓治疗程序的效果。在这篇综述中，我们旨在介绍这一新概念、其实现方式和挑战以及临床应用的未来前景。
