Table of Contents    
LETTER TO EDITOR
Year : 2016  |  Volume : 7  |  Issue : 1  |  Page : 113-114  

Decoding of disinfection regime used in revascularization


1 Department of Conservative Dentistry and Endodontics, Sinhgad Dental College and Hospital, Pune, Maharashtra, India
2 Department of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication28-Jan-2016

Correspondence Address:
Ganesh Ranganath Jadhav
Department of Conservative Dentistry and Endodontics, Sinhgad Dental College and Hospital, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-9668.175109

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How to cite this article:
Jadhav GR, Mittal P. Decoding of disinfection regime used in revascularization. J Nat Sc Biol Med 2016;7:113-4

How to cite this URL:
Jadhav GR, Mittal P. Decoding of disinfection regime used in revascularization. J Nat Sc Biol Med [serial online] 2016 [cited 2020 Aug 3];7:113-4. Available from: http://www.jnsbm.org/text.asp?2016/7/1/113/175109

Sir,

Nowadays several cases of revascularization carried out in immature teeth irrespective of age and periapical status are published. [1] However, it is of paramount significance to emphasize on proper disinfection protocol for its successful outcome. Initially, disinfectants used in revascularization were aimed to provide maximum disinfection without seeing its adverse effects on stem cells. However, contemporary disinfection protocol considers various factors like the effect of irrigants and intra-canal medicaments on the release of growth factors from dentin, the interplay between the undifferentiated mesenchymal stem cells and disinfectant, etc. From a biological point of view, although normal saline is the best irrigant to be used in teeth with open apices, it should never be used alone because of its poor antibacterial properties and inability to remove the smear layer. In revascularization, sodium hypochlorite (NaOCl) is widely used at higher concentrations (around 5-6%). However, its higher concentration has direct and indirect detrimental effect on survival, attachment and differentiation stem cells, which would persist long after the irrigant had been removed. [2] In addition, such a high concentration has a detrimental effect on dentin elasticity and flexural strength of thin radicular walls. Hence, lower concentration of NaOCl (1.5%) is to be used. Ethylenediaminetetraacetic acid (EDTA-17%) should be used in revascularization because it increases the bioavailability of dentin-derived growth factors embedded into dentin that help in proliferation, survival, and differentiation of dental stem cells. [3] Importantly, use of EDTA after NaOCl attenuates its undesirable effects. [4] Despite satisfactory antimicrobial properties chlorhexidine (concentrations of 0.12-2%) limits the survival and adherence of stem cells to dentinal walls. Newer irrigants such as Aquatine EC, Q-mix, tetraclean, mixture of a tetracycline isomer, an acetic acid, and tween 80 detergent and herbal irrigants such as Morinda Citrifolia™, Triphala, green tea polyphenols, Arctium lappa, propolis, etc. need to be evaluated further to see its effect on stem cells to use it in revascularization routinely.

Use of various intra-canal medicaments such as calcium hydroxide and triple antibiotic paste (TAP) are recommended to ensure thorough disinfection in revascularization. Literature search reveals both destructive as wells inductive properties of calcium hydroxide. It can solubilize bioactive molecules, including growth factors of human dentin matrix that would stimulate mesenchymal pulp cells to differentiate into odontoblast-like cells. [5] However, another study showed that calcium hydroxide could damage the epithelial cell rests of Malassez that is important structure for multipotent stem cell proliferation. [6] Furthermore, TAP when in contact with the stem cells of apical papilla for a prolonged period could decrease the number of viable stem cells and stem cells delivered into the root canal system after the evoked bleeding step in revascularization. Hence, calcium hydroxide and TAP insertion should limit to the cervical third of the root canal. Moreover, photo-activated disinfection is a new, selective antimicrobial strategy that can be used successfully in revascularization. [7]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Jadhav GR, Shah N, Logani A. Platelet-rich plasma supplemented revascularization of an immature tooth associated with a periapical lesion in a 40-year-old man. Case Rep Dent 2014;2014:479584.  Back to cited text no. 1
    
2.
Essner MD, Javed A, Eleazer PD. Effect of sodium hypochlorite on human pulp cells: An in vitro study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:662-6.  Back to cited text no. 2
    
3.
Almushayt A, Narayanan K, Zaki AE, George A. Dentin matrix protein 1 induces cytodifferentiation of dental pulp stem cells into odontoblasts. Gene Ther 2006;13:611-20.  Back to cited text no. 3
    
4.
Trevino EG, Patwardhan AN, Henry MA, Perry G, Dybdal-Hargreaves N, Hargreaves KM, et al. Effect of irrigants on the survival of human stem cells of the apical papilla in a platelet-rich plasma scaffold in human root tips. J Endod 2011;37:1109-15.  Back to cited text no. 4
    
5.
Soares Ade J, Lins FF, Nagata JY, Gomes BP, Zaia AA, Ferraz CC, et al. Pulp revascularization after root canal decontamination with calcium hydroxide and 2% chlorhexidine gel. J Endod 2013;39:417-20.  Back to cited text no. 5
    
6.
Jadhav G, Shah N, Logani A. Revascularization with and without platelet-rich plasma in nonvital, immature, anterior teeth: A pilot clinical study. J Endod 2012;38:1581-7.  Back to cited text no. 6
    
7.
Jadhav G, Shah N, Logani A. Conservative management of dens evaginatus and attached supernumerary tooth/odontome in a mandibular premolar with dual radioluscency - A case-report. Contemp Clin Dent 2015;6:S269-73.  Back to cited text no. 7
    




 

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