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Regenerative endodontic procedure of an infected immature permanent human tooth: an immunohistological study

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Abstract

Objectives

An immunohistological study of an infected immature permanent human tooth after a regenerative endodontic procedure (REP) was conducted in order to determine the histologic outcome of this procedure. Besides observed signs of angiogenesis and neurogenesis, repair and/or regeneration of the pulp-dentin complex was also investigated.

Materials and methods

A REP was performed on tooth 45 of a 10-year-old girl. Eleven months post-treatment, the tooth had to be removed for orthodontic reasons. The following investigations were performed: immunohistology and radiographic quantification of root development. After hematoxylin-eosin (HE) staining, the following immunomarkers were selected: neurofilament (NF), pan cytokeratin (PK), osteocalcin (OC), and CD34.

Results

The REP resulted in clinical and radiographic healing of the periradicular lesion and quantifiable root development. The HE staining matches with the medical imaging post-REP: underneath the mineral trioxide aggregate a calcified bridge with cell inclusions, connective pulp-like tissue (PLT) with blood vessels, osteodentin against the root canal walls, on the root surface cementum (Ce), and periodontal ligament (PDL). The PDL was PK+. The blood vessels in the PLT and PDL were CD34+. The Ce, osteodentin, and stromal cells in the PLT were OC+. The neurovascular bundles in the PLT were NF+.

Conclusions

Immunohistologically, REP of this infected immature permanent tooth resulted in an intracanalar connective tissue with a regulated physiology, but not pulp tissue.

Clinical relevance

REP of an immature permanent infected tooth may heal the periapical infection and may result in a combination of regeneration and repair of the pulp-dentin complex.

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References

  1. Lin LM, Rosenberg PA (2011) Repair and regeneration in endodontics. Int Endod J 44:889–906

    Article  PubMed  Google Scholar 

  2. Diogenes A, Henry MA, Teixeira FB, Hargreaves KM (2013) An update on clinical regenerative endodontics. Endod Top 28:2–23

    Article  Google Scholar 

  3. Huang GTJ (2009) Apexification: the beginning of its end. Int Endod J 42:855–866

    Article  PubMed  Google Scholar 

  4. Nygaard-Ostby B (1961) The role of the blood clot in endodontic therapy. An experimental histologic study. Acta Odont Scand 13:323–353

    Article  Google Scholar 

  5. Hørsted P, Nygaard-Ostby B (1978) Tissue formation in the root canal after total pulpectomy and partial root filling. Oral Surg Oral Med Oral Pathol 46:275–282

    Article  PubMed  Google Scholar 

  6. Yamauchi N, Nagaoka H, Yamauchi S, Teixeira FB, Miguez P, Yamauchi M (2011) Immunohistological characterization of newly formed tissues after regenerative procedure in immature dog teeth. J Endod 37:1636–1641

    Article  PubMed  Google Scholar 

  7. Tawfik H, Abu-Seida AM, Hashem AA, Nagy MM (2013) Regenerative potential following revascularization of immature permanent teeth with necrotic pulps. Int Endod J 46:910–922

    Article  PubMed  Google Scholar 

  8. Torabinejad M, Faras H (2012) A clinical and histological report of a tooth with open apex treated with regenerative endodontics using platelet-rich plasma. J Endod 38:864–868

    Article  PubMed  Google Scholar 

  9. Zhu W, Zhu X, Huang GTJ, Cheung GSP, Dissanayaka WL, Zhang C (2013) Regeneration of dental pulp tissue in immature teeth with apical periodontitis using platelet-rich plasma and dental pulp cells. Int Endod J 46:962–970

    Article  PubMed  Google Scholar 

  10. Shimizu E, Jong G, Partridge N, Rosenberg PA, Lin LM (2012) Histologic observation of a human immature permanent tooth with irreversible pulpitis after revascularization/regeneration procedure. J Endod 38:1293–1297

    Article  PubMed  Google Scholar 

  11. Lin LM, Shimizu E, Gibbs JL, Loghin S, Ricucci D (2014) Histologic and histobacteriologic observations of failed revascularization/revitalization therapy: a case report. J Endod 40:291–295

    Article  PubMed  Google Scholar 

  12. Martin G, Ricucci D, Gibbs JL, Lin LM (2013) Histological findings of revascularized/revitalized immature permanent molar with apical periodontitis using platelet-rich plasma. J Endod 39:138–143

    Article  PubMed  Google Scholar 

  13. Shimizu E, Ricucci D, Albert J, Alobaid AS, Gibbs JL, Huang GTJ, Lin LM (2013) Clinical, radiographic, and histological observation of a human immature permanent tooth with chronic apical abscess after revitalization treatment. J Endod 39:1078–1083

    Article  PubMed  Google Scholar 

  14. Becerra P, Ricucci D, Loghin S, Gibbs JL, Lin LM (2014) Histologic study of a human immature permanent premolar with chronic apical abscess after revascularization/revitalization. J Endod 40:133–139

    Article  PubMed  Google Scholar 

  15. Banchs F, Trope M (2004) Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol? J Endod 30:196–200

    Article  PubMed  Google Scholar 

  16. Galler KM, Simon SRJ (2014) Proceedings of the Pulp Biology and Regeneration Group Symposium 2013: Pulp regeneration—translational opportunities. J Endod 40:S1

    Article  PubMed  Google Scholar 

  17. Lovelace TW, Henry MA, Hargreaves KM, Diogenes A (2011) Evaluation of the delivery of mesenchymal stem cells into the root canal space of necrotic immature teeth after clinical regenerative endodontic procedure. J Endod 37(2):133–138

    Article  PubMed  Google Scholar 

  18. Hargreaves KM, Goodis HE, Tay FR (2012) Seltzer and Bender's Dental Pulp, 2nd Edn. Quintessence Publishing Co Inc, Illinois

  19. Trope M (2008) Regenerative potential of dental pulp. J Endod 34:S13–S17

    Article  PubMed  Google Scholar 

  20. Mavridou AM, Pyka G, Kerckhofs G, Wevers M, Bergmans L, Gunst V, Huybrechts B, Schepers E, Hauben E, Lambrechts P (2015) A novel multimodular methodology to investigate external cervical tooth resorption. Int Endod J. doi:10.1111/iej.12450

    PubMed  Google Scholar 

  21. Bose R, Nummikoski P, Hargreaves K (2009) A retrospective evaluation of radiographic outcomes in immature teeth with necrotic root canal systems treated with regenerative endodontic procedures. J Endod 35:1343–1349

    Article  PubMed  Google Scholar 

  22. Fisher C (2004) Low-grade sarcomas with CD34-positive fibroblasts and low-grade myofibroblastie sarcomas. Ultrastruct Pathol 28:291–305

    Article  PubMed  Google Scholar 

  23. Huang JTG, Thesleff I (2013) Stem cells in craniofacial development and regeneration. Wiley-Blackwell, New Jersey

  24. Barry DM, Millecamps S, Julien JP, Garcia ML (2007) New movements in neurofilament transport, turnover and disease. Exp Cell Res 313:2110–2120

    Article  PubMed  Google Scholar 

  25. Henry MA, Luo S, Levinson SR (2012) Unmyelinated nerve fibers in the human dental pulp express markers for myelinated fibers and show sodium channel accumulations. BMC Neurosci 13:29

    Article  PubMed  PubMed Central  Google Scholar 

  26. Farea M, Halim AS, Abdullah NA et al (2013) Isolation and enhancement of a homogenous in vitro human Hertwig’s Epithelial Root Sheath cell population. Int J Mol Sci 14:11157–11170

    Article  PubMed  PubMed Central  Google Scholar 

  27. Shima H, Matsuzaka K, Kokubu E, Inoue T (2013) Regeneration capability of dental pulp cells after crown fracture. Dent Traumatol 29:29–33

    Article  PubMed  Google Scholar 

  28. Ranly DM, Thomas HF, Chen J, MacDougall M (1997) Osteocalcin expression in young and aged dental pulps as determined by RT-PCR. J Endod 23:374–377

    Article  PubMed  Google Scholar 

  29. Muramatsu T, Hamano H, Ogami K, Ohta K, Inoue T, Shimono M (2005) Reduction of osteocalcin expression in aged human dental pulp. Int Endod J 38:817–821

    Article  PubMed  Google Scholar 

  30. Quispe-Salcedo A, Ida-Yonemochi H, Nakatomi M, Ohshima H (2012) Expression patterns of nestin and dentin sialoprotein during dentinogenesis in mice. Biomed Res 33:119–132

    Article  PubMed  Google Scholar 

  31. Fouad AF (2011) The microbial challenge to pulp regeneration. Adv Dent Res 23:285–289

    Article  PubMed  PubMed Central  Google Scholar 

  32. Gunst V, Mavridou A, Huybrechts B, Van Gorp G, Bergmans L, Lambrechts P (2013) External cervical resorption: an analysis using cone beam and microfocus computed tomography and scanning electron microscopy. Int Endod J 46:877–887

    Article  PubMed  Google Scholar 

  33. Torabinejad M, Parirokh M (2010) Mineral trioxide aggregate: a comprehensive literature review-Part II: leakage and biocompatibility investigations. J Endod 36:190–202

    Article  PubMed  Google Scholar 

  34. Althumairy RI, Teixeira FB, Diogenes A (2014) Effect of dentin conditioning with intracanal medicaments on survival of stem cells of apical papilla. J Endod 40:521–525

    Article  PubMed  Google Scholar 

  35. Phumpatrakom P, Srisuwan T (2014) Regenerative capacity of human dental pulp and apical cells after treatment with 3-antibiotic mixture. J Endod 40:399–405

    Article  PubMed  Google Scholar 

  36. Huang JTG, Al-Habib M, Gauthier P (2013) Challenges of stem cell-based pulp and dentin regeneration: a clinical perspective. Endod Top 28:51–60

    Article  Google Scholar 

Download references

Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

This article does not contain any studies with animals performed by any of the authors.

Cnflict of interest

The authors declare that they have no competing interests.

Author information

Authors and Affiliations

  1. Department of Oral Health Sciences, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium

    Nastaran Meschi, Athina Mavridou, Olaf Strijbos, Gertrude Van Gorp & Paul Lambrechts

  2. Laboratory of Morphology, Biomedical Research Institute (BIOMED), Hasselt University, 3590, Diepenbeek, Belgium

    Petra Hilkens & Ivo Lambrichts

  3. Laboratory of Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium

    Kathleen Van den Eynde

  4. H. Horriestraat 40 a bus 13, 8800, Roeselare, Belgium

    Marieke De Ketelaere

Authors
  1. Nastaran Meschi
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  2. Petra Hilkens
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  4. Kathleen Van den Eynde
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  5. Athina Mavridou
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  8. Gertrude Van Gorp
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  9. Paul Lambrechts
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Correspondence to Nastaran Meschi.

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Meschi, N., Hilkens, P., Lambrichts, I. et al. Regenerative endodontic procedure of an infected immature permanent human tooth: an immunohistological study. Clin Oral Invest 20, 807–814 (2016). https://doi.org/10.1007/s00784-015-1555-8

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  • DOI: https://doi.org/10.1007/s00784-015-1555-8

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