Regenerative Endodontics: a review of clinical protocols.

In case of necrotic and immature teeth, the regenerative endodontics procedures aim to replace damage pulp-dentin complex and normal pulpal physiologic functions that include root development and immunocompetency. These procedures are based on three principle of tissue engineering: appropriate source of stem cell; presence of growth factors for stem cell differentiation and an appropriate scaffold. The aim of the present study was to systematically analysed the Regenerative Endodontic protocols and the relative results. Methods: an electronic search was conducted in PubMed using appropriate Medical Subject Heading terms (regenerative endodontics, regenerative endodontic) covering a period until to April 2015. Additional hand searching was conducted, and reference section of each relevant articles were included in the search. In order to identified the relevant articles the scanning of titles, abstracts and ultimately full texts were scanned. Only Randomized Controlled Trials (RCTs) that reported the type of treated teeth, the causes of necrosis, a precise description of the operative protocols used, and the analysis of the results without limit on the time of follow-ups period were included for systematic review. Results: In the 51 studies selected a total of 357 treated teeth were analysed. For 20 teeth the authors (12) did not specified the type (anterior, premolar or posterior), for the remaining 337 teeth 24.3% were premolar (n°82), 2,4% were molar (n°8) and 73.3% were anterior teeth (n°247). No correlation has been recorded between the successful outcome of the therapy and the tooth type or the causes of pulp necrosis. No correlation has been observed between a satisfactory results and tooth type or causes of pulp necrosis. In conclusion, this review has several limitation: first of all the quality of the studies is very low. The section materials and methods often present bias for the description of PICOS terms. The major obstacle met has been represented by incomplete outcome data reported. RCTs adhering to the Consort guidelines could be encouraged to better guide the clinicians in the decision-making process.