Effect of Er:YAG laser in pulp revascularization in miniature pigs

doi:10.19439/j.sjos.2022.04.006

Abstract

Abstract: PURPUSE: To compare the effectiveness of Er:YAG laser and Ca(OH)₂ in pulp revascularization in miniature pigs. METHODS: The second and third premolars of three 14-15-month-old miniature pigs were randomly divided into three groups: laser group, medication group and negative control group. After establishment of pulp necrosis model in each group, the negative control group had no more procedures, while the laser group and medication group were treated with pulp revascularization. Intracanal antisepsis operation was conducted using Er:YAG laser in laser group and Ca(OH)₂ in medication group. The maxillary first premolars, as a positive control group, were left untreated and grew naturally. Three months after surgery, X-ray and cone-beam CT(CBCT) were taken. The animals were sacrificed, and the teeth were used to make H-E staining sections. The development of the teeth and the histological manifestations in the root canals of both groups were compared and evaluated by radiographic and histological assessment. SPSS 24.0 software package was used for statistical analysis of the data. RESULTS: Radiographic results showed that 3 months after surgery, apical foramen was closed in the laser group and the medication group. It also showed that intracanal calcification, and some specimens manifested root absorption. There was no significant difference between the two groups in the aspects of increase of root length, root thickness, or decrease of apical foramen size(P>0.05). Histological results showed that there was dentin-like and cementum-like tissue deposition along the root canal walls; apical closure was apparent; and fibrous connective tissue and cementum-like tissue or bone-like tissue formation in the root canal space were evident in the laser group and the medication group 3 months after surgery. There was no significant difference in the histological findings between the two groups(P>0.05). CONCLUSIONS: Er: YAG laser can be applied to pulp revascularization in miniature pigs, and the effect is equivalent to that of intracanal medication using Ca(OH)₂.

Key words: Pulp revascularization, Er:YAG, CBCT, Miniature pigs

CLC Number:

R781.3

MA Zhi-fei, ZHOU Meng-qi, WANG Li-zhen, CHENG Qing, HONG Jin. Effect of Er:YAG laser in pulp revascularization in miniature pigs[J]. Shanghai Journal of Stomatology, 2022, 31(4): 367-373.

References

[1] 黄定明, 杨懋彬, 周学东. 牙髓再生治疗的临床操作管理及疗效评价[J]. 中华口腔医学杂志, 2019, 54(9): 584-590.
[2] Montero-Miralles P, Martín-González J, Alonso-Ezpeleta O, et al.Effectiveness and clinical implications of the use of topical antibiotics in regenerative endodontic procedures: a review[J]. Int Endod J, 2018, 51(9): 981-988.
[3] Yang J, Yuan G, Chen Z.Pulp regeneration: current approaches and future challenges[J]. Front Physiol, 2016, 7: 58-65.
[4] Asnaashari M, Safavi N.Disinfection of contaminated canals by different laser wavelengths, while performing root canal therapy[J]. J Lasers Med Sci, 2013, 4(1): 8-16.
[5] Meire MA, Coenye T, Nelis HJ, et al.Evaluation of Nd:YAG and Er:YAG irradiation, antibacterial photodynamic therapy and sodium hypochlorite treatment on enterococcus faecalis biofilms[J]. Int Endod J, 2012, 45(5): 482-491.
[6] Nakashima M, Iohara K, Bottino MC, et al.Animal models for stem cell-based pulp regeneration: foundation for human clinical applications[J]. Tissue Eng Part B Rev, 2019, 25(2): 100-113.
[7] Wang S, Liu Y, Fang D, et al.The miniature pig: a useful large animal model for dental and orofacial research[J]. Oral Dis, 2007, 13(6): 530-537.
[8] Wu Z, Wang F, Fan Z, et al.Whole-tooth regeneration by allogeneic cell reassociation in pig jawbone[J]. Tissue Eng Part A, 2019, 25(17-18): 1202-1212.
[9] Xuan K, Li B, Guo H, et al. Deciduous autologous tooth stem cells regenerate dental pulp after implantation into injured teeth [J]. Sci Transl Med, 2018, 10(455): eaaf3227.
[10] AAE, American Association of Endodontists. Clinical considerations for a regenerative procedures[EB/OL].[2019-07-16].https://f3f142zs0k2w1kg84k5p9i1o-wpengine.Netdna-ssl.com/specialty/wp-content/uploads/sites/2/2018/06/ConsiderationsForRegEndo_AsOfApril2018.pdf.
[11] Kahler B, Rossi-Fedele G.A review of tooth discoloration after regenerative endodontic therapy[J]. J Endod, 2016, 42(4): 563-569.
[12] Ruparel NB, Teixeira FB, Ferraz CC, et al.Direct effect of intracanal medicaments on survival of stem cells of the apical papilla[J]. J Endod, 2012, 38(10): 1372-1375.
[13] Kuzekanani M, Plotino G, Gutmann JL.Current applications of lasers in endodontics (applicazioni del laser in endodonzia)[J]. G Ital Endod, 2019, 33(2): 14-24.
[14] Meschi N, EzEldeen M, Torres Garcia AE, et al. A retrospective case series in regenerative endodontics: trend analysis based on clinical evaluation and 2- and 3-dimensional radiology[J]. J Endod, 2018, 44(10): 1517-1525.
[15] Flake NM, Gibbs JL, Diogenes A, et al.A standardized novel method to measure radiographic root changes after endodontic therapy in immature teeth[J]. J Endod, 2014, 40(1): 46-50.
[16] Song M, Cao Y, Shin SJ, et al.Revascularization-associated intracanal calcification: assessment of prevalence and contributing factors[J]. J Endod, 2017, 43(12): 2025-2033.
[17] Iwaya SI, Ikawa M, Kubota M.Revascularization of an immature permanent tooth with apical periodontitis and sinus tract[J]. Dent Traumatol, 2001, 17(4): 185-187.
[18] Altaii M, Richards L, Rossi-Fedele G.Histological assessment of regenerative endodontic treatment in animal studies with different scaffolds: a systematic review[J]. Dent Traumatol, 2017, 33(4): 235-244.
[19] Digka A, Sakka D, Lyroudia K.Histological assessment of human regenerative endodontic procedures (REP) of immature permanent teeth with necrotic pulp/apical periodontitis: a systematic review[J]. Aust Endod J, 2020, 46(1): 140-153.
[20] Austah O, Joon R, Fath WM, et al.Comprehensive characterization of 2 immature teeth treated with regenerative endodontic procedures[J]. J Endod, 2018, 44(12): 1802-1811.
[21] Peng C, Zhao Y, Wang W, et al.Histologic findings of a human immature revascularized/regenerated tooth with symptomatic irreversible pulpitis[J]. J Endod, 2017, 43(6): 905-909.
[22] Pécora JD, Brugnera A Jr, Zanin FAA, et al.Effect of energy (J) on temperature changes at apical root surface when using Er:YAG laser to enlarge root canals[J]. Proc SPIE, 2000, 3910: 90-94.
[23] 王昊明, 周梦琪, 洪瑾. Er:YAG激光对犬根尖周组织影响的组织学评价[J].上海口腔医学, 2016, 25(6): 657-662.
[24] Dhillon H, Kaushik M, Sharma R.Regenerative endodontics-creating new horizons[J]. J Biomed Mater Res B Appl Biomater, 2016, 104(4): 676-685.