The American Association of Endodontists Foundation has awarded $1.7 million to the University of Maryland School of Dentistry (UMSOD) and two collaborating institutions to fund an innovative, multi-center clinical trial. The trial, "Regeneration of pulp-dentin development in teeth with necrotic pulps and immature roots," is being developed at UMSOD by the Department of Endodontics, Prosthodontics and Operative Dentistry in collaboration with Loma Linda University and the University of Texas Health Science Center at San Antonio.
The goal of the clinical trial is to evaluate whether dental pulp can be successfully regenerated in immature teeth of pediatric patients. "Children are frequently exposed to trauma and decay, or develop congenital anomalies in their teeth. These conditions may render the dental pulp, which is the tissue inside the tooth, dead," explains Professor Ashraf Fouad, BDS, DDS, MS, chair of the Department of Endodontics, Prosthodontics and Operative Dentistry.
Treating pediatric patients who suffer from dead tooth pulp is technically difficult, and may render the tooth susceptible to fracture. After permanent teeth erupt in the mouth of a patient, which usually starts at age 6 and continues through adolescence, it takes about three years before the teeth reach complete maturation and can be treated using conventional endodontic techniques and materials.
Fouad and his collaborators will evaluate the effectiveness of two different regenerative approaches for the dental pulp, compared with the traditional method: MTA apexification. The latter involves using MTA, a calcium silicate-based material, to create a barrier between the tissues that surround the root end and a conventional dental restoration placed in the root canal. This traditional technique tends to leave teeth with thin walls that are very weak.
The second method to be evaluated, called revascularization, involves cleaning out the root canal, using topical antibiotics to fight the infection and then inducing a blood clot that allows new tissue to grow inside the root canal. This method is problematic because the new tissue is not comprised of dentin and pulp, which are the hard and soft tissues that form the normal root structure.
The third method is a novel approach that utilizes the same tooth-disinfection method as revascularization, but adds commercially-available growth factors into the root canal that may induce the growth of dentin and pulp. If true regeneration occurs, it would offer a major benefit for patients because tooth pulp would resist new bacterial infections. In addition, dentin would strengthen the root and allow conventional endodontic treatment.
Fouad and his colleagues will evaluate the treatment provided to pediatric patients to determine the success of each procedure. They will also examine how thick the root develops with time and determine if there are different healing patterns for each technique. The trial, which is planned to begin later this spring, will continue for six years. "Our short-term goal is to address a condition that is very difficult to treat in a way that will hopefully make the long-term outcomes for these children much better. Down the road, if we are successful in regenerating pulp and dentin, we will start to think about whether we can apply the regenerative technique to permanent teeth," states Fouad.
Source: University of Maryland