New biological approaches in cariesology and endodontics
The development of science and technology has led to new tools and methods in dentistry. In cariesology, this is the chemical-mechanical removal of carious tissue in treating dental caries. In the field of endodontics, this is regenerative endodontic therapy.
Painless removal of infected dentin in treating dental caries by obturation is difficult. Pain is a leading factor in creating a negative attitude for visits to the dental specialist by children and some adult patients. The possibility of atraumatic removal of infected dentin by introducing chemical-mechanical agents such as the enzyme papain is a successful prospect in dentistry. The mode of action of papain, advantages, disadvantages, protocols for application in different clinical cases is presented.
The regenerative endodontic therapy replaces damaged tissues, including dentin, root structures, and cells in the pulp-dentin complex via biologically activated products. Biologically active products are blood plasma containing growth factors within the platelets and graft materials. The methods used as regenerative endodontic therapy are apexification of teeth with incomplete root development; preservation of the biological integrity of the diseased dental pulp; treatment of chronic apical periodontitis by growth factors prepared from the patient’s blood. This is bioengineering in dentistry.
Preservation of the biological integrity of the dental pulp and the creation of conditions for normal formation of the tooth root in patients with incomplete root development is not always successful. The introduction of methods of regenerative dentistry creates opportunities for successful biological treatment of dental pulp and apexification. Advantages, disadvantages, and clinical protocols are discussed.
Successful treatment of chronic apical periodontitis creates many difficulties in daily clinical practice – expensive and long-term treatment, possible exacerbations, long-term discomfort for our patients with uncertain results. The combination of endodontic-surgical treatment of chronic apical periodontium with the methods of regenerative endodontic therapy creates conditions for faster regeneration of the apical periodontium with a significant reduction in pain symptoms. Methods of application are considered.