The latest advances in vital pulp therapy provide innovative solutions to conserve and regenerate dental pulp
The vitality of dental pulp is essential for long-term tooth survival. Vital pulp therapy (VPT) is defined as a treatment which aims to preserve and maintain pulp tissue that has been compromised but not destroyed by caries, trauma or restorative procedures in a healthy state.[i] It is often viewed as a potential alternative to root canal treatment.[ii]
Once considered as a treatment option for primarily or exclusively young patients,[iii] it is now suggested that VPT can also be performed on permanent teeth and patients up to 60 years of age and older.iii
Indeed, in recent years, there have been significant advances in the field of VPT. For example, traditionally, calcium hydroxide has been used as the material of choice for direct pulp capping.[iv] However, newer materials such as mineral trioxide aggregate (MTA) and bioceramic materials are now gaining in popularity. MTA has shown superior biocompatibility and sealing ability, making it a preferred choice for direct pulp cappingiii and bioceramic materials, such as Biodentine,[v] have also shown promising results in terms of pulp tissue regeneration.
Laser technology
Laser technology has transformed various aspects of dentistry, including VPT. Laser-assisted pulp capping and pulpotomy procedures have shown promising results in terms of reducing post-operative pain, enhancing pulp tissue healing and minimising the risk of bacterial contamination.[vi] Advances in laser technology, such as erbium lasers,[vii] have allowed for precise removal of infected tissue while saving the healthy pulp, leading to better outcomes in VPT procedures.
Progress in stem cell research has opened up new possibilities in the field. Dental stem cells, including dental pulp stem cells and stem cells from the apical papilla, have shown potential for pulp regeneration and dentine formation.[viii] Researchers are exploring various techniques to stimulate the migration, homing, and differentiation of dental stem cells to promote pulp tissue repair and regeneration.[ix]
Pulp revascularisationx is a relatively new regenerative endodontic procedure that aims to restore the vitality and function of the infected or necrotic dental pulp (a problem that is usually treated with apexification).[x] [xi] This technique involves disinfection of the root canal system, followed by the introduction of a blood clot or stem cells into the root canal space.[xii] The blood clot serves as a scaffold for the ingrowth of new blood vessels, nerves and pulp tissue. Advances in pulp revascularisation have focused on improving the disinfection protocols, optimising the scaffolds, and enhancing the recruitment of stem cells to promote pulp tissue regeneration.[xiii]
Biomaterial scaffolds
The use of biomaterials and growth factors has been extensively studied to enhance the pulp healing process.[xiv] Biomaterial scaffolds, such as collagen-based matrices and hydrogels, can provide structural support and guide the regeneration of pulp tissue.[xv] Growth factors, such as platelet-derived growth factor and bone morphogenetic proteins, can stimulate the migration, proliferation and differentiation of cells involved in pulp regeneration.[xvi] Advances in the formulation and delivery of these biomaterials and growth factors have shown promising results in enhancing the outcomes of VPT procedures.
VPT is one of the themes being addressed at the 14th IFEA World Endodontic Congress (WEC), which takes place in Glasgow from 11th-14th September 2024. Entitled Phases & Interfaces, the biennial event of the International Federation of Endodontic Associations (IFEA) is being organised by the British Endodontic Society (BES) and will be held at the Scottish Event Campus, Glasgow.
The event will provide insights into the endodontic health of the global population and the unique challenges faced in different areas as well as presenting an opportunity for endodontists to collaboratively find solutions and inspire development. It brings together all those whose passion is endodontics, from dental specialists and general dental practitioners to students.
The WEC programme will also tackle the themes of trauma, regeneration, imaging, surgical endodontics, restorative and systemic health.
Over 80 expert speakers from around the world will be addressing delegates and include Yoshi Terauchi, Ove Peters, Daniel Černý, Adham Azim, Matthias Zehnder, Meetu Kohli, Teresa Arias, Ariadne Letra, Paul Lambrechts, Byron Tsivos and Sadia Niazi, among the most recently announced.
With over 3,000 delegates anticipated to attend, the BES advises those interested to register their attendance via the website – ifea2024glasgow.com/registration – as soon as possible.
The latest advances in VPT have provided dentists with innovative techniques and materials to conserve and regenerate the dental pulp. From the use of novel pulp capping materials to laser technology, stem cell therapy, and biomaterials, dental professionals now have a wider range of options to treat and restore the vitality of the dental pulp. These advancements hold great promise for patients, offering more effective and minimally invasive treatments for dental pulp diseases.
Register today for IFEA WEC 2024 at ifea2024glasgow.com/registration
For more information about the BES, or to join, please visit the website www.britishendodonticsociety.org.uk or call 01494 581542
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[ii] Wells C, Dulong C, McCormack S. Vital Pulp Therapy for Endodontic Treatment of Mature Teeth: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019 Jul 10. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546327/ [Accessed December 2023]
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[vi] Afkhami F, Rostami G, Xu C, Walsh LJ, Peters OA. The application of lasers in vital pulp therapy: a review of histological effects. Lasers Med Sci. 2023 Sep 21;38(1):215. doi: 10.1007/s10103-023-03854-7. PMID: 37733149; PMCID: PMC10514114. [Accessed December 2023]
[vii] van As G. Erbium lasers in dentistry. Dent Clin North Am. 2004 Oct;48(4):1017-59, viii. doi: 10.1016/j.cden.2004.06.001. PMID: 15464563. [Accessed December 2023]
[viii] Nakashima, M., Iohara, K., Murakami, M. et al. Pulp regeneration by transplantation of dental pulp stem cells in pulpitis: a pilot clinical study. Stem Cell Res Ther 8, 61 (2017). https://doi.org/10.1186/s13287-017-0506-5 [Accessed December 2023]
[ix] Kang J, Fan W, Deng Q, He H, Huang F. Stem Cells from the Apical Papilla: A Promising Source for Stem Cell-Based Therapy. Biomed Res Int. 2019 Jan 29;2019:6104738. doi: 10.1155/2019/6104738. PMID: 30834270; PMCID: PMC6374798. [Accessed December 2023]
[x] Karami, M. , Skalli, R. , Jermouni, I. and Jabri, M. (2022) Pulp Revascularization: Future Therapy of Tooth with Open Apex. Open Journal of Stomatology, 12, 327-336. doi: 10.4236/ojst.2022.1211029. [Accessed December 2023]
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[xii] Lin LM, Kahler B. A review of regenerative endodontics: current protocols and future directions. J Istanb Univ Fac Dent. 2017 Dec 2;51(3 Suppl 1):S41-S51. doi: 10.17096/jiufd.53911. PMID: 29354308; PMCID: PMC5750827. [Accessed December 2023]
[xiii] Kaushik SN, Kim B, Walma AM, Choi SC, Wu H, Mao JJ, Jun HW, Cheon K. Biomimetic microenvironments for regenerative endodontics. Biomater Res. 2016 Jun 2;20:14. doi: 10.1186/s40824-016-0061-7. PMID: 27257508; PMCID: PMC4890532. [Accessed December 2023]
[xiv] Metlerska J, Fagogeni I, Metlerski M, Nowicka A. Vital Pulp Therapy in Aesthetic Zone-Identifying the Biomaterial That Reduces the Risk of Tooth Discolouration. Materials (Basel). 2021 Oct 13;14(20):6026. doi: 10.3390/ma14206026. PMID: 34683617; PMCID: PMC8539990. [Accessed December 2023]
[xv] Pankajakshan D, Voytik-Harbin SL, Nör JE, Bottino MC. Injectable Highly Tunable Oligomeric Collagen Matrices for Dental Tissue Regeneration. ACS Appl Bio Mater. 2020 Feb 17;3(2):859-868. doi: 10.1021/acsabm.9b00944. Epub 2020 Jan 6. PMID: 32734173; PMCID: PMC7391263. [Accessed December 2023]
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