Root Canal Treatment (RCT): From Traditional Endodontic Therapies to Innovating Pulp Regeneration

Abstract

Traditional protocols involve the cleaning of the pulp chamber and root canals, the removal of bacteria and of the smear layer, and ultimately to the sealing of endodontic materials filling the pulp, and root lumen. Disinfection combined with mechanical enlargement allows occluding the lumen of the dental pulp with a central master cone, and lateral condensation using a series of small accessory cones. Innovative approaches propose bioengineered scaffolds, growth and transcription factors. Removal of the smear layer reveals different types of globular and non-globular dentins (osteodentin, osteodentin, fibrodentin), cleaning the dentinal walls before chemical or mechanical enlargement of the lumen. Three distinct options open gates for classical endodontic therapies before conventional filling. New pulp therapies derived from apexogenesis and apexification contributes to the formation of a renewed dental pulp, involving totipotent, multipotent and unipotent stem cell. Proliferation of structural cells, signaling factors, transcription factors, metalloproteinases, and cytokines are involved in pulp renewal. Coronal and root microvascularization participate to pulp regeneration and ultimately to pulp mineralization. BMP-2, TGF-β1, MTA and Portland cement may also contribute to the requirements for pulp bioengineering, leading to the future of innovating biological pulp therapies. axial and lateral condensation the root chamber was gradually filled. These steps include the sealing of lateral, secondary and accessory canals [4]. In addition to conventional protocols, more recently attempts were made to regenerate the dental pulp. A few pulp cells proliferate, and renewed the pulp tissue. We envision the formation of a dental pulp and furthermore its mineralization occluding the root lumen. Part of the endodontic cavity was still alive, or proliferation of pulp cells was requested to restore the biology of the dental pulp. Extracellular matrix molecules and/or other growth or transcription factors contributed to regenerate the pulp. In contrast with mechanical methods, biological options were considerate. The innovative approaches proposed were envisaging the implication of structural cells and signaling factors. In this context, we used stem cells, bioengineered scaffolds, growth factors, transcription factors, and cytokines. Altogether, the molecules were implicated in the different procedures that pave the way as biological substitutes for root canal treatments [5]. In the first part of this review, we summarize the basic concepts and related methods devoted to the traditional Root Canal Treatment (RCT). In the second part, we focus on recent concepts aiming to regenerate the dental pulp, leading to pulp renewal that further underwent mineralization. Along these lines of evidences, biological concepts provide the basis of innovating pulp therapies.