Autologous Dental Pulp Stem Cell Transplantation for Mature Teeth With Apical Periodontitis and Root Perforation:
1Matsuki Dental Clinic, Fukuoka, Japan.
Introduction:
This case report is aimed at evaluate the feasibility of regenerative endodontic therapy (RET) using autologous dental pulp stem cells (DPSCs) for previously endodontically treated, nonvital mature teeth with apical periodontitis and root perforation.
Case Presentation:
RET may offer an alternative to conventional retreatment for mature teeth with persistent apical periodontitis. Two patients aged 22 and 28 years were referred for treatment of maxillary anterior teeth. After mechanical enlargement and disinfection, a cervical root perforation in Case 1 was sealed with mineral trioxide aggregate. Autologous DPSCs isolated from extracted third molars were transplanted with granulocyte colony-stimulating factor and atelocollagen into the disinfected root canals in both cases and additionally into the apical perforation site in Case 2. The tooth in Case 1 showed a positive response to electric pulp testing at 4 weeks after transplantation, whereas the tooth in Case 2 first showed positive responses to both electric pulp and cold testing at 12 weeks. Dental radiography and cone-beam computed tomography demonstrated mineralized tissue formation in the apical part of the root canal and remission of the periapical lesions after 48 weeks. In Case 2, marked narrowing of the perforation site was also observed. These clinical and radiographic changes were further enhanced during follow-up, reaching 96 weeks after transplantation. No local or systemic adverse events were observed in either patient throughout the observation period.
Conclusion:
In these two cases, RET using autologous DPSCs was feasible and safe, and was associated with favorable clinical and radiographic outcomes for up to 96 weeks. Because histological confirmation was not obtained and only two cases were included, these findings should be interpreted as preliminary evidence of feasibility rather than as proof of pulp-dentin complex regeneration and require validation in larger, controlled studies.
