The Four Pillars for Successful Regenerative Therapy in Endodontics: Stem Cells, Biomaterials, Growth Factors, and Their Synergistic Interactions
Table 3
Published randomized clinical trials.
Authors and number of cite
Study title
Institution
Sample size (teeth
Age
Etiology/type tooth
Intracanal irrigation
Intracanal medication
Groups
Follow-up time
Radiographic evaluation
Success/survival
Main findings
Vitality test
Brizuela et al.
“Cell-Based Regenerative Endodontics for Treatment of Periapical Lesions: A Randomized, Controlled Phase I/II Clinical Trial”
Centro “Activa Biosilicate Technology™” de Investigación en Biología y Regeneración Oral (CIBRO), Faculty of Dentistry, Universidad de los Andes, Santiago, Chile
36p (36 Mt)
16-58 y
Trauma 96.7% (A) Dens evaginatus 3.3% (A)
25% NaOCl 17% EDTA
Calcium hydroxide
Exp (13p/13t): REP/BC-UC-MSCs in PPP-biodentine Control (13p/13t): RC/GP
6-12 m
2D x-ray and 3D-CBCT
6 m: 94.4% (100%) 12 m: 100% (100%)
No difference between groups except for the anterior posterior healing improved for the exp. group. Increase positives vitality responses for exp group
Cold 56%, hot test 28%, EPT 50% at 12 m
ElSheshtawy et al.
“The Effect of Platelet-Rich Plasma as a Scaffold in Regeneration/Revitalization Endodontics of Immature Permanent Teeth Assessed Using 2-Dimensional”
Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
26p (31 It)
8.3-12.1 y
Trauma 96.7% (A) Dens evaginatus 3.3% (A)
5.25% NaOCl 2.5% NaOCl 17% EDTA
TAP 1:1:1
Exp (13p/13t): PRP/MTA Control (13p/13t): BC/MTA
3-6-9-12 m
2D x-ray and 3D-CBCT
87% (100%)
No difference between groups except for the influence of the diameter of the periapical lesion
100% negative response
Xuan et al.
“Deciduous Autologous Tooth Stem Cells Regenerate Dental Pulp after Implantation into Injured Teeth”
Department of Endodontics, Faculty of Dentistry, Health Sciences University, İstanbul, Turkey MS-State Key Laboratory, School of Stomatology, Fourth Military Medical University, Xi’an, China
36p (36 It)
18-30 y
Trauma 100% (A)
3% NaOCl 5% EDTA
Calcium hydroxide/iodoform
Exp (26t): RET/hDPSC/MTA Control (10t): Apx/Ca(OH)
1-2-3-6-9-12-24 m
2D x-ray and 3D-CBCT
100% (100%)
Significant difference in root length
Negative EPT test at 6 and 12 m but increase blood vessels formation
Ulusoy et al.
“Evaluation of Blood Clot, Platelet-Rich Plasma, Platelet-Rich Fibrin, and Platelet Pellet as Scaffolds in Regenerative Endodontic Treatment: A Prospective Randomized Trial”
Department of Pediatric Dentistry, Hacettepe University, Ankara Hacettepe University, Istanbul Okan University, Turkey Louisiana State University Health Sciences Center, New Orleans, Louisiana
88p (88t)
8-11 y
Trauma 100% (A)
5.25% NaOCl 2.5% NaOCl 17% EDTA
TAP 1:1:1
Exp1 (18t): PRP scaffold Exp2 (17t): PRF scaffold Exp3 (17t): PP scaffold Control (21t): BC scaffold
1-3-6-9-12-15-18 m
2D x-ray
95.6%/100%
There was no statistically significant difference in periapical healing, apical closure, but dentinal wall thickening and root length were significant for the BC group
86% positive response to EPT in all groups
Lin et al.
“Regenerative Endodontics Versus Apexification in Immature Permanent Teeth with Apical Periodontitis: A Prospective Randomized Controlled Study”
Dentistry, Operative Dentistry and Endodontics, Department of Radiology, Department of Medical Statistics and Epidemiology, Sun Yat-sen University, Guangzhou, Guangdong, China Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou
There was statistically significant difference in success rate for the RET group between the DE and trauma cases. The etiology is considered an important factor for success
N/A
Jiang et al.
“Clinical and Radiographic Assessment of the Efficacy of a Collagen Membrane in Regenerative Endodontics: A Randomized, Controlled Clinical Trial”
Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
40p (43t)
8.3-12.1y
Trauma 24% (A) Dens evaginatus 76% (P)
1.5% NaOCl 17% EDTA
Calcium hydroxide
Exp (20p/22t): Bio-Gide collagen membrane at mid root/MTA Control (20p/21t): no membrane/MTA
6 months
2D x-ray
100%
No difference between groups except for the increase in the mid third wall thickness on experimental group
Experiment group 33% (+ EPT) Control group 18% (+ EPT)
Bezgin et al.
“Efficacy of Platelet-Rich Plasma as a Scaffold in Regenerative Endodontic Treatment”
Department of Pedodontics, Faculty of Dentistry, Ankara University, Ankara, Turkey
20p (22t)
7-13 y
Trauma 70% (A) Caries 30% (P)
2.5% NaOCl 0.12% CHX 5% EDTA Sterile saline
TAP 1:1:1 with cefaclor
Exp (11t): PRP scaffold Control (11t): BC scaffold
1-3-6-9-12-15-18 m
2D x-ray
95.6%/100%
There was no statistically significant difference in periapical healing, apical closure, but dentinal wall thickening between groups
Experiment group 50% (+ EPT and + cold) Control group 20% (+ EPT and cold test)
Nagata et al.
“Traumatized Immature Teeth Treated with 2 Protocols of Pulp Revascularization”
Department of Restorative Dentistry, Endodontics Area, State University of Campinas-UNICAMP, Piracicaba, São Paulo, Brazil
Exp (11p/11t): CHP calcium hydroxide and 2% chlorhexidine Control (12p/12t): TAP
1-3-6-9-12-15-19 m
2D x-ray
95.6%/100%
There was no statistically significant difference in periapical healing, apical closure, and dentinal wall thickening between groups but CHP show less discoloration
In both groups no recovery of sensitivity
Nagy et al.
“Regenerative Potential of Immature Permanent Teeth with Necrotic Pulps after Different Regenerative Protocols”
Department of Endodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
36p (36t)
9-13 y
N/A, 100% (A)
2.6% NaOCl
TAP 1:1:1
Exp (12p/12t): hydrogel bFGF Control (12p/12t): blood clot Control (12p/12t): MTA apical plug
3-6-12-18 m
2D x-ray
80%/100%
There was no statistically significant difference in periapical healing, apical closure, and dentinal wall thickening
N/A
Jadhav et al.
“Revascularization with and without Platelet-Rich Plasma in Nonvital, Immature, Anterior Teeth: A Pilot Clinical Study”
Department of Conservative Dentistry and Endodontics, Institute of Medical Sciences, New Delhi, India
20p (20t)
15-28 y
N/A
2.5% NaOCl
TAP 1:1:1
Exp (10p/10t): PRP and metronidazole collagen (Metrogene) Control (10p/10t): blood clot
6-12 m
2D x-ray
100%/80%
There was a statistically significant difference in periapical healing, apical closure, and dentinal wall thickening
