Revascularization Surgery in Modern Dentistry: An Overview

What Is Dental Revascularization?

Revascularization is a term that is synonymous with the restoration of blood flow according to medical and dental research. In the field of dental revascularization surgery, the term is meant to imply that the pulpal tissue that has been necrosed or dead is restimulated to grow back afresh or retain its original functions for the tooth (which is possible in immature or young permanent tooth). This article explores the scope of revascularization surgery in modern dentistry in detail.

Why Regenerative Endodontics Offers a New Scope in Modern Dentistry?

Regenerative endodontic procedures are known to be the novel and new-age approaches to the prevention of tooth loss in children or adults who are affected by dental injuries. In traumatic injuries, be it in children, young adults, or adults, the fracture or impact of the tooth can result in the need for endodontic or root canal treatment.

The endodontist always aims to always primarily restore the damaged pulp tissue (that is the main vital (living) tissue or the root canal) and the dentin structures as well. These new-age procedures in modern dentistry aim to however naturally induce or create a new pulp tissue in the root canal. In children, when the immature permanent teeth are affected and require endodontic treatment or intervention, such as revascularizing surgeries can be of great scope to allow for permanent tooth root maturation as well (even if the permanent tooth is impacted by trauma).

What Are the Indications for Revascularization Surgery?

• The main rationale behind these surgeries is to promote the regrowth of dental tissues because, by the potent effect of utilizing stem cells (versatile cells with the potential to differentiate into various cell types in the body), a sterile tissue matrix formation can be ensured along with the restoration of pulp tissue vitality according to the current definition of revascularization in dentistry.

• The indications for this procedure are mainly a necrosed (dead due to lack of blood supply) or avulsed (completely dislodged from its socket) primary or permanent tooth. After any traumatic or accidental injuries where the face red tooth (tooth causing severe pain) or the tooth in question is impacted post avulsion or after the dentist replants the tooth in the oral cavity, there is still a wide possibility of regeneration that can occur within the necrosed or the infected tooth tissue.

• The main rationale of this procedure is that by inducing bleeding in the root canal space by over-instrumenting it, a fibrin matrix would be formed because of the induced blood clot that acts as a ‘scaffold’. This scaffolding applied with stem cells that can potently differentiate into dental pulp tissue as well as help regenerate the apical (root end) root formation (such as in young immature teeth) would be the basis of revascularization success.

What Are the Objectives or Methods for Revascularizing Dental Pulp Tissue?

Currently, dental researchers, oral pathologists as well as endodontists have collaborated in a multi-specialty training or research methodology to seek out the ideal treatment methods in current or modern dentistry using these regenerative endodontic procedures. Some of the most widely studied methods in this area involve the following fields or aims to establish these aspects:

• Root canal revascularization.

• Stem cell therapies.

• Dental pulpal implants.

• Dental soft tissue scaffold implants.

• Alternative Injectable scaffold applications.

• Three-dimensional software applications in revascularizing surgery.

• Gene therapies to promote revascularizing surgery.

Based on the patient's requirements, revascularization surgery can offer dentists scope to regenerate the necrosed pulpal tissue or aid in the completion of the root apex formation in permanent teeth.

What Are the Drawbacks of Revascularization Surgery?

Though revascularizing surgeries currently focus on dental research in aiming to fulfill all these objectives, these surgeries have a major drawback. These would be as of now deemed successful only in the young permanent tooth or necrotized permanent teeth in children and young adults (as opposed to adults). This is because the biggest impediment or obstacle to the phenomenon of revascularization of dental pulp tissue cells in permanent teeth as in the case of mature adults and older individuals is that, the permanent tooth root formation would be completed and allow no scope for this purpose. Currently, only the root canal revascularization therapies that are being used clinically in modern dentistry are implemented for the treatment of traumatized or necrotized young or immature permanent teeth.

What Are the Important Steps in Revascularization Surgeries?

The main steps in these surgeries are over-instrumenting the root canal and encouraging a blood clot formation or fibrin matrix. Stem cells are utilized lastly during the procedure as well to promote dental pulp tissue formation.

• This is the crucial element in this field, which is utilizing the ‘blood clot’ that is formed by over-instrumenting the root canal space. Blood clots naturally can be a great source of growth factors and they play an important role in the human body. This is because of their potency or their ability to undergo the processes of cell differentiation, maturation as well as regeneration. For example, the dental tissue cells of fibroblast (cells that play a crucial role in the synthesis of connective tissue) , odontoblast (specialized cells in the dental pulp responsible for dentin formation) as well as cementoblast (these are the specialized cells that helps in formation of cementum) can be differentiated, matured, and regenerated using blood clots.

• Stem cells are mainly utilized in these surgeries. These are the nondifferentiated cells that are potent and capable of differentiating into any specialized cell that has a function for the body. So stem cells basically, can be transformed into many different cells or cell types under the proper laboratory conditions and are used in the field of regenerative endodontics. One of the great benefits associated with dental revascularization surgeries is that they can be easily completed by the dentist or endodontist within a single session.

• The only focus however is on achieving the proper infection control in patients. Infection control is mandatory to avoid repeated sessions for the patients and to reduce chair time as well. If persistent infection is present during the course or timeline of dental revascularization surgeries, then the dentist will use repeated dressings of calcium hydroxide over the root canal preparation till the infection is controlled.

Conclusion

In conclusion, revascularization surgery stands as a promising and innovative approach in modern dentistry, offering a viable alternative for the treatment of immature permanent teeth with necrotic pulps. Revascularization surgery is hence amongst the most potent modern-day dental surgeries that can effectively regenerate tooth vitality in children and young adults. It can also have the added benefit of supporting or encouraging the proper root development in immature permanent teeth.