Digitized Assessment for the Survival of Mature Anterior Teeth With Periapical Lesion After One Step Regenerative Approach Using Different Asepsis Maneuvers
Condition: Dental Pulp Necrosis; Dental Pulp Disease; Dental Pulp; Degeneration
MeSH terms: Dental Pulp Necrosis; Dental Pulp Diseases; Necrosis
Study type: Interventional

Summary: 
      Trial is designed to allow revascularization and tissue engineering in necrotic teeth with
      peripical lesion in a single visit approach. different disinfection protocols is used to
      ensure that adequate disinfection of root canals is achieved to allow stem cells to
      differentiate and proliferate generating pulp like tissue and turning back tooth to live with
      periapical healing of resorbed bone.
    

Detailed description: 
      Preservation of the natural dentition had always been a primary objective in endodontic
      practice. When the pulp is diseased or requires removal for restorative reasons, it is
      replaced with an artificial filling material during conventional root canal treatment. Root
      canal treatment has lots of controversies, starting with weakening of remaining tooth
      structure, affecting the tooth survival. Also Root canal treated teeth are considered to be
      weaker than vital tooth, requiring the placement of a post and core, which itself is doubtful
      whether it increases fracture resistance of the tooth or it weakens it.1 The most important
      controversy is that the survival of affected pulp is hindered by the conventional root canal
      treatment2. Thus a new treatment approach was introduced utilizing the body ability to
      regenerate, called Pulp Regeneration. Regeneration was first introduced in the dental field
      as a solution for immature apex treatment, as it is very difficult to treat them using the
      conventional root canal treatment3 American Dental Association adopted the tissue engineering
      concept and pulp regeneration in 20114. Regeneration was focused on the treatment of immature
      necrotic teeth so as to allow root completion, improving both the functionality and
      durability of the affected tooth. Depending on the success of pulp regeneration in treating
      immature teeth, ambitious dentists started to look forward on treating mature teeth as a
      substitution to the conventional root canal treatment. 5

      A shift to tissue engineering took place. Utilizing a blood clot in the affected tooth with
      immature roots was very beneficial, as it acts as a scaffold for the migration of stem cells
      and morphogens to allow regeneration .6 On the other hand, lots of clinicians were very
      doubtful about treating mature teeth with the same protocol, as the small apical foramen
      might not provide a good portal for the entry of stem cells and growth factors, which in turn
      is very important for the success of pulp regeneration.7

      These doubts encouraged researchers to look for an alternative to the stem cells other than
      the apical papilla, from this concept the idea for using an alternative source of stem cells
      and growth factors as platelet rich plasma (PRP) emerged. The use of Platelet Rich Plasma
      (PRP) as a potentially ideal scaffold for regenerative endodontic therapy has been
      documented8. However, the use of bovine thrombin for the activation of PRP has been an issue
      of controversy, as it requires non autologous anticoagulant known to hinder the process of
      pulp regeneration 9.

      This led to the development of the second generation, Platelet concentrate known as
      Choukroun's Platelet Rich Fibrin (PRF) which is totally autologous in nature. Platelet rich
      fibrin (PRF) was very promising, but it is debatable whether to use PRP or PRF10. One
      protocol of the regenerative approach is the use of Antibiotic paste as intra canal
      medicament in a 2 step procedures, due to the world wide trend of limitation of the use of
      antibiotics systemically and locally the assessment of the outcome of single visit
      regenerative approach is mandatory, and because the main limitation for such intervention is
      adequate disinfection of root canal assessment of different asepsis maneuvers is also of
      great importance since literature and evidence based information lack any studies assessing
      such techniques.

      The clinician at the end of this study must determine which disinfection protocol allows for
      more survival of tooth, revitalization of the affected mature tooth and faster healing of
      periapical lesion following one step regenerative approach. Healing will be measured using
      digital radiography and cone beam computed topography11. Repair of the tooth neural
      innervation will be tested by electric pulp tester12.
    

Intervention name(s): Disinfection
Intervention type(s): Procedure
Intervention description(s): Disinfection maneuver using LASER and nano irrigant
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment