Tissue engineering strategies for immature teeth with apical periodontitis

Nozomu Yamauchi, Shizuko Yamauchi, Hideaki Nagaoka, Derek Duggan, Sheng Zhong, Sun Min Lee, Fabricio B. Teixeira, Mitsuo Yamauchi

Research output: Contribution to journalArticlepeer-review

136 Scopus citations


Introduction: Regenerative endodontic treatment on immature teeth with apical periodontitis is promising but still not well-established. The purpose of this study was to explore novel strategies to engineer a vital support structure within a root canal space by a combination of induced blood clot, exposure of dentin matrix, and a cross-linked collagen scaffold. Methods: Apical periodontitis was induced in 6 dogs with immature teeth (n = 64). After disinfection, the following groups were randomly assigned: blood clot (BC) alone, BC with a cross-linked collagen scaffold (CCS), BC with exposure of dentin matrix by ethylenediaminetetraacetic acid (EDTA), and BC with CCS and EDTA. Positive (infected only) and negative controls (untreated) were also included. The dogs were followed up for 3.5 months and killed. Periradicular healing and root wall thickening were radiographically analyzed and statistically evaluated. The jaws were then fixed, demineralized, and subjected to histologic analyses. Newly formed mineralized tissues were histomorphometrically analyzed, quantified, and statistically evaluated. Results: Radiographically there was significant difference in periradicular healing and root wall thickening (P < .05). Histomorphometric analysis showed significantly more mineralized tissue formation in the groups containing the scaffold (P < .05). Exposure of the dentin matrix by EDTA appeared to increase the adherence of the newly formed mineralized tissue to the root walls. Conclusions: The use of cross-linked collagen scaffold and exposure of dentin matrix combined with blood clot might provide an efficient approach to generate a vital support structure for the treatment of immature teeth with apical periodontitis.

Original languageEnglish
Pages (from-to)390-397
Number of pages8
JournalJournal of Endodontics
Issue number3
StatePublished - Mar 2011

Bibliographical note

Funding Information:
This study was supported by the AAE Foundation. The authors thank Drs Eric Rivera and Asma Khan for their insight, encouragement, and reviewing the manuscript. The authors would also like to thank Dr Ching Chang Ko, the staff of the collagen biochemistry laboratory at NC Oral Health Institute, and Ms Courtney Boyd for assisting in sample preparations.


  • Regenerative endodontics
  • revascularization
  • root canal
  • tissue engineering

ASJC Scopus subject areas

  • General Dentistry


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