The utility and feasibility of pulp regenerative therapy with autologous dental pulp stem cells (DPSCs) in mature teeth with irreversible pulpitis were clinically demonstrated. On the other hand, there is no evidence of the utility of DPSCs in mature teeth with apical periodontitis. The aim of this case report was to describe the potential utility of regenerative cell therapy in mature teeth with apical periodontitis. A 44-year-old man was referred for pulp regeneration due to a periapical lesion in his maxillary first premolar. Root canal disinfection was performed by irrigation and intracanal medication by nanobubbles with levofloxacin and amphotericin B in addition to conventional irrigation. Autologous DPSCs isolated from an extracted third molar were transplanted into the root canal after residual bacteria and fungi were below the detection level by polymerase chain reaction assay using universal genes to amplify specific regions within bacterial 16S ribosomal DNA and fungal ribosomal DNA (ITS1), respectively. There were no adverse events or systemic toxicity assessed for clinical evaluations during the 79-week-follow-up period and laboratory evaluations after 4 weeks. The affected tooth was responsive to the electric pulp test. Cone-beam computed tomographic imaging revealed a reduced lesion size, remission of the periapical tissue, and mineralized tissue formation in the apical part of the canal after 79 weeks. The signal intensity on magnetic resonance imaging of the regenerated tissue in the affected tooth was comparable to that of the normal pulp in the adjacent teeth after 24 weeks. This case report demonstrated the potential use of DPSCs for pulp regenerative therapy in mature teeth with apical periodontitis.

The dental pulp stem cells (DPSCs) are mesenchymal stem/stromal cells (MSCs) with multilineage potential of differentiation. Different studies investigated dental pulp stones (PS), the calcified masses in the dental pulp, in regard to their prevalence, topography and structure. The etiology of PS is still unclear and, to our knowledge, the DPSCs were not attributed yet specific roles in PS formation. We report here an immunohistochemical study of a PS-embedding dental pulp from an impacted third mandibular molar of an adult patient, in which we used antibodies against CD34, Ki67, glial fibrillary acidic protein (GFAP), α-smooth muscle actin (α-SMA) and nestin. While endothelial cells expressed CD34 and pericytes or vascular smooth muscle cells expressed α-SMA, DPSCs and the osteoblasts coating the PS were exclusively labeled with nestin antibody. Stromal networks of nestin-expressing DPSCs were regarded as in situ providers of osteogenic progenitors involved in PS formation. Further experimental studies, with larger lots of tissue samples, as well as extended panels of markers, are needed in order to elucidate the DPSC hypothesis in the PS etiology.

OBJECTIVE: The aim of this article is to describe a one-visit approach to attempt revascularization in the upper right and left central incisors after traumatic injury.
BACKGROUND: A single-visit conservative revascularization approach can be used to promote root growth and maturation following traumatic dental injury and loss of pulpal tissues.
METHODS: An eight-year-old female patient presented in Dentalia Clinics, Jeddah, Kingdom of Saudi Arabia, in 2016 with traumatic dental injury. Upon clinical and radiographic examination, it was found that the trauma resulted in loss of pulp vitality in two upper central incisors. Local anesthesia was administered, and a rubber dam was placed. Access cavity was done for each tooth separately. 2% chlorhexidine followed by sterile saline was used for irrigation with no instrumentation. Mineral trioxide aggregate (MTA) was used as the sealing material after blood clot formation. Follow-up showed continuous root maturation in the right central incisor, at 6 months, one year, two years, and three years. Root canal treatment was done in 2019 due to the development of periapical lesion. The 6-month follow-up radiograph also showed loss of the crown of the left central incisor due to a second trauma with retained apical root fragment. The fragment was embedded inside the bone and showed continuous maturation during the three years.
CONCLUSIONS: A single-visit regenerative endodontic approach showed successful results in revascularizing the upper permanent central incisor after loss of pulpal tissue.
CONCLUSIONS: Immature permanent teeth can be treated by a single-visit revascularization procedure to promote root maturation and increase in radicular dentin length and width.