Retrospective Analysis on Type of Scaffolds Used in Revascularisation-A Institutional Based Study

K Thirumagal and Pradeep S^*

^*Correspondence: Pradeep S, Department of Conservative Dentistry and Endodontics, Saveetha Dental College & Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India, Email:

Author info »

Introduction

Regenerative dentistry has become popular because of advancements in biologic therapies that apply growth and differentiation factors which induced natural biological regeneration. Hermann in 1920 found the application of calcium hydroxide in the vital pulp which gave a foundation for regeneration of pulp tissues. In 1961 Nygaard Ostby evaluated a revascularization process for re- establishing a pulp dentin complex in permanent teeth with pulpal necrosis. The three key ingredients for regeneration are morphogens, progenitor cells, and the extracellular matrix (ECM) scaffold [1]. Tissue engineering is based on the Regenerative endodontics concept. Regenerative endodontic procedures (REPs) is biologically-based procedures designed for replacement of damaged structures, includes dentin and root structures, and the cells of pulp-dentin complex with viable tissues of the same origin, that is capable of restoring the normal physiologic functions of the pulp-dentin complex [2]. Pulp revascularization is reintroduction of vascularity in the root canal. Even though blood vessels are indispensable constituents of dental pulp, pulp regeneration is incomplete without formation of odontoblastic layer that lines the dentin surface, nociceptive as well as sympathetic and parasympathetic nerve fibers, added to that interstitial fibroblasts and most importantly, progenitor cells that serve to allows all the pulp cells to regenerated pulp whenever undergo apoptosis and turnover [3]. Pulp tissue regeneration is an ideal alternative treatment for the root canal treatment. The present concept of pulp tissue regeneration includes two approaches [4]. One is revascularization, where a new pulp tissue grows into the root canals from the underlying remaining tissues from the root canal apex. The second one is replacement of the diseased pulp with a healthy tissue that has the ability to revitalize the tooth and restore the dentin formation process. Gene therapy, Stem cell therapy, three-dimensional (3D) cell printing, pulp implantation and scaffold implantation are suggested for this approach [5]. There is a significant difference between regeneration and revascularization. Pulp revascularization is equal to induction of angiogenesis in endodontically-treated root canal, Pulp regeneration is equal to pulp revascularization and added to that restoration of functional odontoblasts and nerve fibers [3]. Scaffolds can be classified as natural and artificial (synthetic). Natural scaffolds are more biocompatible and have the advantage of providing specific cell interactions [5,6]. Scaffolds will be biocompatible structures that support cell growth and give a correct environment for tissue formation. Good scaffolds should allow cell attachment, proliferation, migration, differentiation, and provide mechanical support for the extracellular matrix generation [7,8]. Like this various studies have been done in our institutions [9-28].

Materials and Methods

The study was conducted in the outpatient of Dental College and Hospital. The study consisted of 27 patients between the age group of 6-40yrs. This is because the available data with similar ethnicity was collected from the particular geographic location. The trends in the other location were not assessed in the study setting. Ethical approval was done by the universal ethical committee before the start of the study. The approval number given was [SDC/SIHEC/2020/DIASDATA/0619-0320]. The data was reviewed and analysed between June 2019- March 2021.The case sheet was manually reviewed and cross verified in order to avoid errors. To minimize the sampling bias all available data was included and the sorting process was done. All the samples diagnosed as revascularization patients were included. This particular time was considered as internal validity and a prescriptive pattern was followed to analyse external validity. All the data like the patient's name, age, gender and their field value was included in the study. The data which are obtained were entered in the excel sheet and Tabulated and finally SPSS imported was done including the chi square test.

Results

The majority of males patients (40.74%) CGF type of scaffolds are used whereas for female patients (22.2%) PRF type of scaffolds is used. Result showed the p value was found to be (0.082) greater than 0.05. Therefore there was no significant difference found between gender and different types of scaffolds (Figure 1). Association between age group and scaffold used showed significant difference (p =0.037), p<0.05. Patient age group of 21- 30 yrs had a maximum revascularization procedure (Figure 2). The majority of revascularization procedures (44.44%) was done in teeth number 11 followed by (40.74%) was done in teeth number 21.Where the p value was found to be greater than 0.05. Therefore there was no significant difference found between teeth number and different types of scaffolds (Figure 3).

Figure 1: Comparison between gender and scaffolds.

Figure 2: Comparison between age and scaffolds.

Figure 3: Comparison between teeth number & scaffolds.

Discussion

In our study we found that the majority of males patients (40.74%) CGF type of scaffolds are used whereas for female patients (22.2%) PRF type of scaffolds is used. Whereas in other studies they found that on clinical examination the patients were found asymptomatic throughout the study period. On Radiographic examination all cases showed an improvement in apical closure, root lengthening, and periapical healing and dentinal wall thickening. Collagen and PGF gave better results when compared with placentrex and chitosan in terms of apical closure, root lengthening, periapical healing and dentinal wall thickening. Revascularization procedure is more effective and conservative when compared with apexification in the treatment of necrotic immature permanent teeth. Their study showed that PRF and collagen are better scaffolds when compared with placentrex and chitosan for inducing apexogenesis in immature necrotic permanent teeth [29,30]. In our study the majority of patients under (21-30)yrs old used CGF (25.9%) followed by colla cota (14.8%). PRF appears to be superior to (Bio-Gide) collagen as a scaffold for human periosteal cell proliferation.

PRF membranes are correct for in vitro cultivation of periosteal cells for bone tissue engineering [31]. In other study they suggested that because of increased release of growth factors like (PDGF-AB, TGF-β1, VEGF, and EGF) from PRF for around first 60 minutes, it should be used on before the period has elapsed in the surgical sites preferred. In their study the protocol and prepared PRF was used within this period [32]. Under microscope, the morphology of cells incubated over 7 days with the scaffolds appeared healthy with COLL. Cells which are in contact with PLGA showed signs of degeneration and apoptosis. MTT assay showed that at 5.0 × 104 hDPSCs, COLL demonstrated significantly higher cell proliferation rates than cells in media only (control, p < 0.01) or cells co-incubated with PLGA (p < 0.01). In the ELISA test there are no significant differences observed between cells with media only and COLL at 1, 3, and 6 days. Cells incubated with PLGA expressed significantly higher IL-8 than the control at all-time points (p < 0.01) and compared to COLL after 1 and 3 days (p < 0.01). The COLL showed more biocompatibility and that is suitable for endodontic regeneration purposes [33]. In our study the majority of revascularization procedures (44.44%) was done in teeth number 11 followed by (40.74%) was done in teeth number 21. Yamauchi et al in their study demonstrated that use of a collagen scaffold which is cross linked can cause bleeding induction, in teeth with improper root development and periapical periodontitis significantly rise in the formation of mineralized tissues. Increase in healing of the apical periodontitis is seen when the collagen scaffold group with the osteoinductive properties of the scaffold is used [34].

Conclusion

From the present study it is clear that the majority of patients under (21-30) yrs. old used CGF followed by colla cota. Majority of males patients CGF type of scaffolds are used whereas for female patients PRF type of scaffolds are used. Majority of the patients CGF is used followed by PRF and colla cote, sustained release of growth factors resulting in more successful results on the use of CGF. Which gives more success rate in revascularization therapy? And the majority of revascularization procedures was done in teeth number 11 followed by 21.

Limitations

There are few limitations in our survey. There is a small sample size used for our survey which cannot be generated for a large population. And the survey doesn’t represent the ethnic group and population.

Future Scope

The survey should be done in a larger population. Multicenter surveys should be done including other criteria’s.

Acknowledgement

The authors sincerely acknowledge the faculty Medical record department and Information technology department of SIMATS for their tireless help in sorting out data’s pertaining to this study.

Funding

The present project is supported/funded/sponsored by Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College and Hospital, Saveetha Dental College and Hospitals, Saveetha University contributed by Southern Engineering Co Ltd.

References

1. Hargreaves KM, Law AS. Regenerative endodontics. Cohen’s Pathways of the Pulp 2011; 602–619.

Google Scholar

2. Murray P. A concise guide to endodontic procedures. Springer 2014; 190.

Google Scholar, Cross Ref

3. Mao JJ, Kim SG, Zhou J, et al. Regenerative endodontics: Barriers and strategies for clinical translation. Dent Clin 2012; 56:639-649.

Indexed at, Google Scholar, Cross Ref

4. Banchs F, Trope M. Revascularization of immature permanent teeth with apical periodontitis: New treatment protocol? J Endod 2004; 30:196–200.

Indexed at, Google Scholar, Cross Ref

5. Murray PE, Garcia-Godoy F, Hargreaves KM. Regenerative endodontics: A review of current status and a call for action. J Endod 2007; 33:377–390.

Indexed at, Google Scholar, Cross Ref

6. Kim BS, Mooney DJ. Development of biocompatible synthetic extracellular matrices for tissue engineering. Trends Biotechnol 1998; 16:224–230.

Indexed at, Google Scholar, Cross Ref

7. Goldberg M, Septier D, Bourd K, et al. Role of matrix proteins in signalling and in dentin and enamel mineralization. Comptes Rendus Palevol 2004; 3:573–581.

Google Scholar, Cross Ref

8. Du C, Moradian-Oldak J. Tooth regeneration: Challenges and opportunities for biomedical material research. Biomed Mater 2006; 1:10.

Indexed at, Google Scholar, Cross Ref

9. Muthukrishnan L. Imminent antimicrobial bioink deploying cellulose, alginate, EPS and synthetic polymers for 3D bioprinting of tissue constructs. Carbohydr Polym 2021; 260:117774.

Indexed at, Google Scholar, Cross Ref

10. PradeepKumar AR, Shemesh H, Nivedhitha MS, et al. Diagnosis of vertical root fractures by cone-beam computed tomography in root-filled teeth with confirmation by direct visualization: A systematic review and meta-analysis. J Endod 2021; 47:1198–1214.

Indexed at, Google Scholar, Cross Ref

11. Chakraborty T, Jamal RF, Battineni G, et al. A review of prolonged post-COVID-19 symptoms and their implications on dental management. Int J Environ Res Public Health 2021; 18.

Indexed at, Google Scholar, Cross Ref

12. Muthukrishnan L. Nanotechnology for cleaner leather production: A review. Environ Chem Lett 2021; 19:2527–2549.

Google Scholar, Cross Ref

13. Teja KV, Ramesh S. Is a filled lateral canal-A sign of superiority? J Dent Sci 2020; 15:562.

Indexed at, Google Scholar, Cross Ref

14. Narendran K, Jayalakshmi, Sarvanan A, et al. Synthesis, characterization, free radical scavenging and cytotoxic activities of phenylvilangin, a substituted dimer of embelin. Int J Pharm Sci 2020; 82.

Google Scholar

15. Reddy P, Krithikadatta J, Srinivasan V, et al. Dental caries profile and associated risk factors among adolescent school children in an Urban South-Indian City. Oral Health Prev Dent 2020; 18:379–386.

Indexed at, Google Scholar, Cross Ref

16. Sawant K, Pawar AM, Banga KS, et al. Dentinal microcracks after root canal instrumentation using instruments manufactured with different NiTi alloys and the SAF system: A systematic review. Adv Sci Inst Ser E Appl Sci 2021; 11:4984.

Google Scholar, Cross Ref

17. Bhavikatti SK, Karobari MI, Zainuddin SLA, et al. Investigating the antioxidant and cytocompatibility of Mimusops elengi linn extract over human gingival fibroblast cells. Int J Environ Res Public Health 2021; 18.

Indexed at, Google Scholar, Cross Ref

18. Karobari MI, Basheer SN, Sayed FR, et al. An in vitro stereomicroscopic evaluation of bioactivity between Neo MTA Plus, Pro Root MTA, biodentine & glass ionomer cement using dye penetration method. Materials 2021; 14.

Indexed at, Google Scholar, Cross Ref

19. Rohit Singh T, Ezhilarasan D. Ethanolic extract of Lagerstroemia speciosa (L.) Pers., induces apoptosis and cell cycle arrest in HepG2 cells. Nutr Cancer 2020; 72:146–156.

Indexed at, Google Scholar, Cross Ref

20. Ezhilarasan D. MicroRNA interplay between hepatic stellate cell quiescence and activation. Eur J Pharmacol 2020; 885:173507.

Indexed at, Google Scholar, Cross Ref

21. Romera A, Peredpaya S, Shparyk Y, et al. Bevacizumab biosimilar BEVZ92 versus reference bevacizumab in combination with FOLFOX or FOLFIRI as first-line treatment for metastatic colorectal cancer: A multicentre, open-label, randomised controlled trial. Lancet Gastroenterol Hepatol 2018; 3:845–855.

Indexed at, Google Scholar, Cross Ref

22. Raj RK. β-Sitosterol-assisted silver nanoparticles activates Nrf2 and triggers mitochondrial apoptosis via oxidative stress in human hepatocellular cancer cell line. J Biomed Mater Res A 2020; 108:1899–908.

Indexed at, Google Scholar, Cross Ref

23. Vijayashree Priyadharsini J. In silico validation of the non-antibiotic drugs acetaminophen and ibuprofen as antibacterial agents against red complex pathogens. J Periodontol 2019; 90:1441–1448.

Indexed at, Google Scholar, Cross Ref

24. Priyadharsini JV, Vijayashree Priyadharsini J, Smiline Girija AS, et al. In silico analysis of virulence genes in an emerging dental pathogen A. baumannii and related species. Arch Oral Biol 2018; 94:93–98.

Indexed at, Google Scholar, Cross Ref

25. Uma Maheswari TN, Nivedhitha MS, Ramani P. Expression profile of salivary micro RNA-21 and 31 in oral potentially malignant disorders. Braz Oral Res 2020; 34:e002.

Indexed at, Google Scholar, Cross Ref

26. Gudipaneni RK, Alam MK, Patil SR, et al. Measurement of the maximum occlusal bite force and its relation to the caries spectrum of first permanent molars in early permanent dentition. J Clin Pediatr Dent 2020; 44:423–428.

Indexed at, Google Scholar, Cross Ref

27. Chaturvedula BB, Muthukrishnan A, Bhuvaraghan A, et al. Dens invaginatus: A review and orthodontic implications. Br Dent J 2021; 230:345–350.

Indexed at, Google Scholar, Cross Ref

28. Kanniah P, Radhamani J, Chelliah P, et al. Green synthesis of multifaceted silver nanoparticles using the flower extract of Aerva lanata and evaluation of its biological and environmental applications. Chem Select 2020; 5:2322.

Google Scholar, Cross Ref

29. Mittal N, Parashar V. Regenerative evaluation of immature roots using PRF and artificial scaffolds in necrotic permanent teeth: A clinical study. J Contemp Dent Practice 2019; 20:720–726.

Indexed at, Google Scholar

30. Mittal N, Sharma S. A comparative evaluation of natural and artificial scaffolds in regenerative endodontics: A clinical study. Saudi Endod J 2016; 20:9.

Google Scholar

31. Li Q, Mai YW. Biomaterials for implants and scaffolds. Springer 2016; 466.

Google Scholar, Cross Ref

32. Sabeti MA. PRF Applications in endodontics. Quintessence Publishing (IL) 2020; 96.
33. Leong DJX, Setzer FC, Trope M, et al. Biocompatibility of two experimental scaffolds for regenerative endodontics. Restor Dent Endod 2016; 41:98–105.

Indexed at, Google Scholar, Cross Ref

34. Yamauchi N, Yamauchi S, Nagaoka H, et al. Tissue engineering strategies for immature teeth with apical periodontitis. J Endod 2011; 37:390–397.

Indexed at, Google Scholar, Cross Ref