Murray Peter E
Private Consultant, Fort Lauderdale, Florida, USA.
Int Endod J. 2023 Mar;56 Suppl 2:188-199. doi: 10.1111/iej.13809. Epub 2022 Aug 15.
This review guidance is a work in progress because the limitations of regenerative endodontics are still being discovered. The endodontic treatments for immature permanent teeth with a necrotic pulp can vary considerably among endodontic practitioners. Whereas, regenerative endodontic treatments are growing in popularity and are creating ever more complex treatment protocols, involving revascularization and/or autologous platelet-rich plasma and scaffolds to elicit host stem cell de novo tissue formation to reestablish the vitality of immature teeth for the purpose of continuing root maturation. Despite much evolving controversy about their potential benefits, risks, prognosis, and contraindications, this review is aimed to discuss how to ensure that regenerative endodontic treatments are successful, by strictly adhering to case selection criteria, and following precise steps to accomplish and monitor the success of the treatment. A review of the endodontic literature was performed, together with practical observations of the problems and outcomes of performing regenerative endodontic treatments. Traditionally, apexification has long been the treatment of choice provided to immature teeth with a necrotic pulp. Regenerative endodontics may be provided as an alternative to apexification, if the tooth and patient meet all the case selection criteria, and if there are no contraindications. Regenerative endodontics has the unique potential advantage of being able to continue the root development in immature permanent teeth, thereby potentially saving the teeth for the lifetime of the patient. Whereas, conventional endodontic root canal treatment, Cvek partial pulpotomy, apexogenesis, and apexification, should always be provided when these treatments are more likely to benefit the patient because they can be more successful than regenerative endodontics.
本综述指南仍在完善中，因为再生牙髓治疗的局限性仍在不断被发现。牙髓坏死的年轻恒牙的牙髓治疗方法在牙髓治疗从业者中差异很大。然而，再生牙髓治疗越来越受欢迎，并且正在产生越来越复杂的治疗方案，包括血管再生和/或自体富血小板血浆以及支架，以诱导宿主干细胞形成新的组织，从而重建年轻恒牙的活力，以继续牙根发育成熟。尽管关于其潜在益处、风险、预后和禁忌证存在诸多争议，但本综述旨在讨论如何通过严格遵守病例选择标准并遵循精确步骤来完成和监测治疗的成功，以确保再生牙髓治疗取得成功。我们对牙髓文献进行了综述，并对再生牙髓治疗的问题和结果进行了实际观察。传统上，根尖诱导成形术长期以来一直是为牙髓坏死的年轻恒牙提供的首选治疗方法。如果患牙和患者符合所有病例选择标准且无禁忌证，再生牙髓治疗可作为根尖诱导成形术的替代方法。再生牙髓治疗具有独特的潜在优势，即能够继续年轻恒牙的牙根发育，从而有可能为患者终身保留患牙。然而，当传统牙髓根管治疗、Cvek部分牙髓切断术、根尖形成术和根尖诱导成形术更有可能使患者受益时，因为它们可能比再生牙髓治疗更成功，所以应始终采用这些治疗方法。
