Rejeneratif Endodontide Güncel Dezenfeksiyon Stratejileri ve Biyolojik Yaklaşımlar
Özet
Rejeneratif endodonti, özellikle nekrotik ve immatür daimi dişlerin tedavisinde biyolojik iyileşmeyi merkeze alan çağdaş bir tedavi yaklaşımıdır. Bu yaklaşımın başarısı, etkin kök kanal dezenfeksiyonunun sağlanması ile kök hücre canlılığının korunması arasındaki hassas dengeye bağlıdır. Geleneksel dezenfeksiyon protokolleri yeterli antimikrobiyal etkinlik sağlamakla birlikte, yüksek konsantrasyonlarda uygulandığında rejeneratif potansiyeli olumsuz yönde etkileyebilmektedir. Bu kitap bölümünde, rejeneratif endodontinin biyolojik temelleri doku mühendisliği triadı kapsamında ele alınmış; kök kanal dezenfeksiyonunda kullanılan geleneksel antiseptikler ile yeni nesil ve hücre dostu yaklaşımlar güncel literatür ışığında değerlendirilmiştir. Nanoteknoloji temelli ajanlar, fotoaktive dezenfeksiyon, fotobiyomodülasyon, gelişmiş şelasyon protokolleri ve biyouyumlu irrigasyon ajanlarının rejeneratif süreçlere olan katkıları tartışılmıştır. Sonuç olarak, rejeneratif endodontide biyolojik uyumluluğu ön planda tutan ve çok modlu dezenfeksiyon stratejilerini içeren protokoller, tedavi başarısının artırılmasında önemli bir rol oynamaktadır. Bu alanda yapılacak ileri çalışmalar, klinik uygulamaların standardizasyonuna katkı sağlayacaktır.
Regenerative endodontics is a contemporary treatment approach centered on biological healing, particularly in the management of necrotic and immature permanent teeth. The success of this approach depends on a delicate balance between achieving effective root canal disinfection and preserving stem cell viability. While traditional disinfection protocols provide adequate antimicrobial efficacy, high concentrations can adversely affect regenerative potential. In this book chapter, the biological foundations of regenerative endodontics are examined within the framework of the tissue engineering triad. Conventional antiseptics used in root canal disinfection are evaluated alongside next-generation, cell-friendly approaches in light of current literature. The contributions of nanotechnology-based agents, photoactivated disinfection, photobiomodulation, advanced chelation protocols, and biocompatible irrigation agents to regenerative processes are discussed. In conclusion, protocols that prioritize biocompatibility and incorporate multimodal disinfection strategies play a crucial role in enhancing treatment success. Further studies in this field will contribute significantly to the standardization of clinical applications.
Referanslar
Mandras N, Pancini N, Roana J, et al. The Bactericidal Effect of Calcium Hydroxide and Triple Antibiotic Paste During Regenerative Endodontic Procedures. Applied Sciences. 2025;15(23):12478. doi:10.3390/app152312478
Takimoto K, Widbiller M, Diogenes A. Expression of toll-like receptors in stem cells of the apical papilla and its implication for regenerative endodontics. Cells. 2023;12(20):2502. doi:10.3390/cells12202502
Galler K, Krastl G, Simon S, et al. European Society of Endodontology position statement: revitalization procedures. International Endodontic Journal. 2016;49(8):717–23. doi:10.1111/iej.12629
Sedgley C, Cherkas P, Chogle S, et al. Endodontics: colleagues for excellence, vol. Spring Chicago: American Association of Endodontists Foundation. 2013:1–8.
Kakehashi S, Stanley H, Fitzgerald R. The effects of surgical exposures of dental pulps in germ-free and conventional laboratory rats. Oral Surgery, Oral Medicine, Oral Pathology. 1965;20(3):340–9. doi:10.1016/0030-4220(65)90166-0
Yanpiset K, Trope M. Pulp revascularization of replanted immature dog teeth after different treatment methods. Dental Traumatology. 2000;16(5):211–7. doi:10.1034/j.1600- 9657.2000.016005211
Kahler B, Lin LM. A review of regenerative endodontics: current protocols and future directions. Journal of Istanbul University Faculty of Dentistry. 2017;51(3 Suppl 1):41–51. doi:10.17096/jiufd.53911
Saravanan E, Ravindran V. Evaluation of Cytotoxicity of Premixed Triple Antibiotic Paste on Stem Cells of Apical Papilla Using MTT Assay: An In Vitro Study. International Journal of Clinical Pediatric Dentistry. 2025;18(9):1082. doi:10.5005/jp-journals-10005-3242
Jamshidi D, Ansari M, Gheibi N. Cytotoxicity and genotoxicity of calcium hydroxide and two antibiotic pastes on human stem cells of the apical papilla. European Endodontic Journal. 2021;6(3):303.
doi: 10.14744/eej.2021.97658.
Ramachandran VS, Radhakrishnan M, Ravindrran MB, et al. Functionalized nanoparticles: a paradigm shift in regenerative endodontic procedures. Cureus. 2022;14(12). doi:10.7759/cureus.32678
Karkehabadi H, Khoshbin E, Abbasi R, et al. Effects of Final Root Canal Irrigants in Conventional and Regenerative Endodontic Treatments: A Systematic Review. 2024. doi: 10.34172/ajdr.1764
Endodontists A A o. AAE clinical considerations for a regenerative procedure. American association of Endodontists Chicago, IL, USA; 2016.
Arya A, Marwaha J, Batra D, et al. Impact of Photoactivated Disinfection on Dentin Permeability and Bacterial Eradication. Journal of Pharmacy and Bioallied Sciences. 2025;17(Suppl 2):S1628–S30.
doi: 10.4103/jpbs.jpbs_197_25
Liu H, Lu J, Jiang Q, et al. Biomaterial scaffolds for clinical procedures in endodontic regeneration. Bioactive Materials. 2022;12:257–77. doi: 10.1016/j.bioactmat.2021.10.008
Liu S, Liang Z, Guo J, et al. Concentration-dependent effects of modified triple antibiotic paste on human periodontal ligament stem cells and antibacterial efficacy: an in vitro study. The Saudi Dental Journal. 2025;37(10):74. doi: 10.1007/s44445-025-00082-3
Şahin E, Bodrumlu EH. Daimi İmmatür Dişlerde Rejeneratif Endodontik Tedavi: Üç Olgu Sunumu. Journal of International Dental Sciences (Uluslararası Diş Hekimliği Bilimleri Dergisi). 2023;9(3):164–7 doi:10.21306/dishekimligi.1369909
Divya D, Naik SV, Raju O, et al. Conceptual combination of disinfection in regenerative endodontics: Conventional versus laser-assisted disinfection. Journal of Conservative Dentistry and Endodontics. 2021;24(3):252–9. doi: 10.4103/jcd.jcd_96_21
Baghdadi LF, Alshehri TA, Reda HA, et al. Role of Triple Antibiotic Paste in Regenerative Endodontics. 2024. doi:10.52533/JOHS.2024.41213
Zancan RF, Cavenago BC, Oda DF, et al. Antimicrobial activity and physicochemical properties of antibiotic pastes used in regenerative endodontics. Brazilian Dental Journal. 2019;30:536–41. doi:10.1590/0103-6440201902613
Karczewski A, Feitosa SA, Hamer EI, et al. Clindamycin-modified triple antibiotic nanofibers: a stain-free antimicrobial intracanal drug delivery system. Journal of Endodontics. 2018;44(1):155–62. doi:10.1016/j.joen.2017.08.024
Ariwala FI, Calcuttawala MS. Rooted in Regeneration: An Overview on Regenerative Endodontics. Medical Research Archives. 2025;13(10). doi:10.18103/mra.v13i10.6981
Dave AG, Mallya PL. Nanoparticles in Regenerative Endodontics: A Current Status Review. Trends in Biomaterials and Artificial Organs. 2025;39(1):108–12. doi:10.5281/zenodo.16793189
Wong J, Zou T, Lee AHC, et al. The potential translational applications of nanoparticles in endodontics. International Journal of Nanomedicine. 2021:2087–106. doi:10.2147/IJN.S293518
Akbarianrad N, Mohammadian F, Alhuyi Nazari M, et al. Applications of nanotechnology in endodontic: A Review. Nanomedicine Journal. 2018;5(3):121–6. doi: 10.22038/nmj.2018.005.0001
Afkhami F, Forghan P, Gutmann JL, et al. Silver nanoparticles and their therapeutic applications in endodontics: A narrative review. Pharmaceutics. 2023;15(3):715. doi:10.3390/pharmaceutics15030715
Oncu A, Huang Y, Amasya G, et al. Silver nanoparticles in endodontics: recent developments and applications. Restorative Dentistry & Endodontics. 2021;46(3). doi:10.5395/rde.2021.46.e38
Pecci-Lloret MP, Gea-Alcocer S, Murcia-Flores L, et al. Use of nanoparticles in Regenerative Dentistry: a systematic review. Biomimetics. 2024;9(4):243. doi:10.3390/biomimetics9040243
Shoaria SA, Jafarpoura A, Bagheria R, et al. Polymeric nano-biomaterials in regenerative endodontics. Nanotechnology. 2021;1:4.
doi: 10.22034/ecc.2021.122105
Antunes PVS, Flamini LES, Chaves JFM, et al. Comparative effects of final canal irrigation with chitosan and EDTA. Journal of Applied Oral Science. 2019;28:e20190005. doi:10.1590/1678-7757-2019-0005
Bhatia S, Vaidya M, Hegde V, et al. Comparative Evaluation of the Effect of EDTA, Chitosan, Etidronic Acid, and Silver Citrate on the Mineral Content of Root Canal Dentin Using Energy Dispersive X-ray Spectroscopy: An In-Vitro Study. European Endodontic Journal. 2025;10(2):173.
Nagpal R, Singh S, Singh P, et al. Photoactivated Disinfection in Endodontics. Indian Journal of Contemporary Dentistry. 2015;3(1):29–33 doi:10.5958/2320-5962.2015.00007.8
Mohan D, Maruthingal S, Indira R, et al. Photoactivated disinfection (PAD) of dental root canal system–An ex-vivo study. Saudi Journal of Biological Sciences. 2016;23(1):122–7. doi:10.1016/j.sjbs.2015.01.013
Ali IAA, Neelakantan P. Light Activated Disinfection in Root Canal Treatment—A Focused Review. Dentistry Journal. 2018;6(3):31. doi:10.3390/dj6030031
Johns DA, Shivashankar VY, Krishnamma S, et al. Use of photoactivated disinfection and platelet-rich fibrin in regenerative Endodontics. Journal of Conservative Dentistry and Endodontics. 2014;17(5):487–90. doi: 10.4103/0972-0707.139850
Chrepa V, Kotsakis GA, Pagonis TC, et al. The effect of photodynamic therapy in root canal disinfection: a systematic review. Journal of Endodontics. 2014;40(7):891–8. doi:10.1016/j.joen.2014.03.005.
Yong J, Gröger S, Wu Z, et al. Photobiomodulation therapy and pulp-regenerative endodontics: A narrative review. Bioengineering. 2023;10(3):371. doi:10.3390/bioengineering10030371
Sabeti M, Ghobrial D, Zanjir M, et al. Treatment outcomes of regenerative endodontic therapy in immature permanent teeth with pulpal necrosis: A systematic review and network meta‐analysis. International Endodontic Journal. 2024;57(3):238–55. doi:10.1111/iej.13999
Farjaminejad R, Farjaminejad S, Garcia-Godoy F. Regenerative Endodontic Therapies: Harnessing Stem Cells, Scaffolds, and Growth Factors. Polymers. 2025;17(11):1475. doi:10.3390/polym17111475
Fayek MA, Abouelenien SS. Influence of sodium hypochlorite used in combination with EDTA versus sodium hypochlorite mixed with etidronate irrigants on coronal fracture resistance of endodontically treated bleached teeth (a comparative in-vitro study). Advanced Dental Journal. 2023;5(3):651–8. doi: 10.21608/adjc.2023.209833.1306
Adham AH, Ali AH, Mannocci F. Continuous chelation concept in endodontics. Journal of Baghdad College of Dentistry. 2022;34(4):59–69.doi:10.26477/jbcd.v34i4.3287.
Cassiano AFB, Coaguila-Llerena H, Santos CS, et al. The effect of octenidine on proliferation, migration, and osteogenic differentiation of human dental pulp and apical papilla stem cells. Journal of Endodontics. 2022;48(12):1502–1510. doi:10.1016/j.joen.2022.09.010
Bukhary S, Balto H. Antibacterial efficacy of octenisept, alexidine, chlorhexidine, and sodium hypochlorite against Enterococcus faecalis biofilms. Journal of Endodontics. 2017;43(4):643–7. doi:10.1016/j.joen.2016.09.013
Durai P, Mohan M, Ramalingam H, et al. Propolis in Endodontics—Unveiling Its Therapeutic Potential: A Narrative Review. World Journal of Dentistry. 2025;16(10):959–66. doi:10.5005/jp-journals-10015-2619
Alghutaimel H, Matoug-Elwerfelli M, Nagendrababu V, et al. Endodontic applications of propolis in primary and permanent teeth: A scoping review of clinical studies. European Endodontic Journal. 2024;9(3):167. doi:10.14744/eej.2024.65487
Referanslar
Mandras N, Pancini N, Roana J, et al. The Bactericidal Effect of Calcium Hydroxide and Triple Antibiotic Paste During Regenerative Endodontic Procedures. Applied Sciences. 2025;15(23):12478. doi:10.3390/app152312478
Takimoto K, Widbiller M, Diogenes A. Expression of toll-like receptors in stem cells of the apical papilla and its implication for regenerative endodontics. Cells. 2023;12(20):2502. doi:10.3390/cells12202502
Galler K, Krastl G, Simon S, et al. European Society of Endodontology position statement: revitalization procedures. International Endodontic Journal. 2016;49(8):717–23. doi:10.1111/iej.12629
Sedgley C, Cherkas P, Chogle S, et al. Endodontics: colleagues for excellence, vol. Spring Chicago: American Association of Endodontists Foundation. 2013:1–8.
Kakehashi S, Stanley H, Fitzgerald R. The effects of surgical exposures of dental pulps in germ-free and conventional laboratory rats. Oral Surgery, Oral Medicine, Oral Pathology. 1965;20(3):340–9. doi:10.1016/0030-4220(65)90166-0
Yanpiset K, Trope M. Pulp revascularization of replanted immature dog teeth after different treatment methods. Dental Traumatology. 2000;16(5):211–7. doi:10.1034/j.1600- 9657.2000.016005211
Kahler B, Lin LM. A review of regenerative endodontics: current protocols and future directions. Journal of Istanbul University Faculty of Dentistry. 2017;51(3 Suppl 1):41–51. doi:10.17096/jiufd.53911
Saravanan E, Ravindran V. Evaluation of Cytotoxicity of Premixed Triple Antibiotic Paste on Stem Cells of Apical Papilla Using MTT Assay: An In Vitro Study. International Journal of Clinical Pediatric Dentistry. 2025;18(9):1082. doi:10.5005/jp-journals-10005-3242
Jamshidi D, Ansari M, Gheibi N. Cytotoxicity and genotoxicity of calcium hydroxide and two antibiotic pastes on human stem cells of the apical papilla. European Endodontic Journal. 2021;6(3):303.
doi: 10.14744/eej.2021.97658.
Ramachandran VS, Radhakrishnan M, Ravindrran MB, et al. Functionalized nanoparticles: a paradigm shift in regenerative endodontic procedures. Cureus. 2022;14(12). doi:10.7759/cureus.32678
Karkehabadi H, Khoshbin E, Abbasi R, et al. Effects of Final Root Canal Irrigants in Conventional and Regenerative Endodontic Treatments: A Systematic Review. 2024. doi: 10.34172/ajdr.1764
Endodontists A A o. AAE clinical considerations for a regenerative procedure. American association of Endodontists Chicago, IL, USA; 2016.
Arya A, Marwaha J, Batra D, et al. Impact of Photoactivated Disinfection on Dentin Permeability and Bacterial Eradication. Journal of Pharmacy and Bioallied Sciences. 2025;17(Suppl 2):S1628–S30.
doi: 10.4103/jpbs.jpbs_197_25
Liu H, Lu J, Jiang Q, et al. Biomaterial scaffolds for clinical procedures in endodontic regeneration. Bioactive Materials. 2022;12:257–77. doi: 10.1016/j.bioactmat.2021.10.008
Liu S, Liang Z, Guo J, et al. Concentration-dependent effects of modified triple antibiotic paste on human periodontal ligament stem cells and antibacterial efficacy: an in vitro study. The Saudi Dental Journal. 2025;37(10):74. doi: 10.1007/s44445-025-00082-3
Şahin E, Bodrumlu EH. Daimi İmmatür Dişlerde Rejeneratif Endodontik Tedavi: Üç Olgu Sunumu. Journal of International Dental Sciences (Uluslararası Diş Hekimliği Bilimleri Dergisi). 2023;9(3):164–7 doi:10.21306/dishekimligi.1369909
Divya D, Naik SV, Raju O, et al. Conceptual combination of disinfection in regenerative endodontics: Conventional versus laser-assisted disinfection. Journal of Conservative Dentistry and Endodontics. 2021;24(3):252–9. doi: 10.4103/jcd.jcd_96_21
Baghdadi LF, Alshehri TA, Reda HA, et al. Role of Triple Antibiotic Paste in Regenerative Endodontics. 2024. doi:10.52533/JOHS.2024.41213
Zancan RF, Cavenago BC, Oda DF, et al. Antimicrobial activity and physicochemical properties of antibiotic pastes used in regenerative endodontics. Brazilian Dental Journal. 2019;30:536–41. doi:10.1590/0103-6440201902613
Karczewski A, Feitosa SA, Hamer EI, et al. Clindamycin-modified triple antibiotic nanofibers: a stain-free antimicrobial intracanal drug delivery system. Journal of Endodontics. 2018;44(1):155–62. doi:10.1016/j.joen.2017.08.024
Ariwala FI, Calcuttawala MS. Rooted in Regeneration: An Overview on Regenerative Endodontics. Medical Research Archives. 2025;13(10). doi:10.18103/mra.v13i10.6981
Dave AG, Mallya PL. Nanoparticles in Regenerative Endodontics: A Current Status Review. Trends in Biomaterials and Artificial Organs. 2025;39(1):108–12. doi:10.5281/zenodo.16793189
Wong J, Zou T, Lee AHC, et al. The potential translational applications of nanoparticles in endodontics. International Journal of Nanomedicine. 2021:2087–106. doi:10.2147/IJN.S293518
Akbarianrad N, Mohammadian F, Alhuyi Nazari M, et al. Applications of nanotechnology in endodontic: A Review. Nanomedicine Journal. 2018;5(3):121–6. doi: 10.22038/nmj.2018.005.0001
Afkhami F, Forghan P, Gutmann JL, et al. Silver nanoparticles and their therapeutic applications in endodontics: A narrative review. Pharmaceutics. 2023;15(3):715. doi:10.3390/pharmaceutics15030715
Oncu A, Huang Y, Amasya G, et al. Silver nanoparticles in endodontics: recent developments and applications. Restorative Dentistry & Endodontics. 2021;46(3). doi:10.5395/rde.2021.46.e38
Pecci-Lloret MP, Gea-Alcocer S, Murcia-Flores L, et al. Use of nanoparticles in Regenerative Dentistry: a systematic review. Biomimetics. 2024;9(4):243. doi:10.3390/biomimetics9040243
Shoaria SA, Jafarpoura A, Bagheria R, et al. Polymeric nano-biomaterials in regenerative endodontics. Nanotechnology. 2021;1:4.
doi: 10.22034/ecc.2021.122105
Antunes PVS, Flamini LES, Chaves JFM, et al. Comparative effects of final canal irrigation with chitosan and EDTA. Journal of Applied Oral Science. 2019;28:e20190005. doi:10.1590/1678-7757-2019-0005
Bhatia S, Vaidya M, Hegde V, et al. Comparative Evaluation of the Effect of EDTA, Chitosan, Etidronic Acid, and Silver Citrate on the Mineral Content of Root Canal Dentin Using Energy Dispersive X-ray Spectroscopy: An In-Vitro Study. European Endodontic Journal. 2025;10(2):173.
Nagpal R, Singh S, Singh P, et al. Photoactivated Disinfection in Endodontics. Indian Journal of Contemporary Dentistry. 2015;3(1):29–33 doi:10.5958/2320-5962.2015.00007.8
Mohan D, Maruthingal S, Indira R, et al. Photoactivated disinfection (PAD) of dental root canal system–An ex-vivo study. Saudi Journal of Biological Sciences. 2016;23(1):122–7. doi:10.1016/j.sjbs.2015.01.013
Ali IAA, Neelakantan P. Light Activated Disinfection in Root Canal Treatment—A Focused Review. Dentistry Journal. 2018;6(3):31. doi:10.3390/dj6030031
Johns DA, Shivashankar VY, Krishnamma S, et al. Use of photoactivated disinfection and platelet-rich fibrin in regenerative Endodontics. Journal of Conservative Dentistry and Endodontics. 2014;17(5):487–90. doi: 10.4103/0972-0707.139850
Chrepa V, Kotsakis GA, Pagonis TC, et al. The effect of photodynamic therapy in root canal disinfection: a systematic review. Journal of Endodontics. 2014;40(7):891–8. doi:10.1016/j.joen.2014.03.005.
Yong J, Gröger S, Wu Z, et al. Photobiomodulation therapy and pulp-regenerative endodontics: A narrative review. Bioengineering. 2023;10(3):371. doi:10.3390/bioengineering10030371
Sabeti M, Ghobrial D, Zanjir M, et al. Treatment outcomes of regenerative endodontic therapy in immature permanent teeth with pulpal necrosis: A systematic review and network meta‐analysis. International Endodontic Journal. 2024;57(3):238–55. doi:10.1111/iej.13999
Farjaminejad R, Farjaminejad S, Garcia-Godoy F. Regenerative Endodontic Therapies: Harnessing Stem Cells, Scaffolds, and Growth Factors. Polymers. 2025;17(11):1475. doi:10.3390/polym17111475
Fayek MA, Abouelenien SS. Influence of sodium hypochlorite used in combination with EDTA versus sodium hypochlorite mixed with etidronate irrigants on coronal fracture resistance of endodontically treated bleached teeth (a comparative in-vitro study). Advanced Dental Journal. 2023;5(3):651–8. doi: 10.21608/adjc.2023.209833.1306
Adham AH, Ali AH, Mannocci F. Continuous chelation concept in endodontics. Journal of Baghdad College of Dentistry. 2022;34(4):59–69.doi:10.26477/jbcd.v34i4.3287.
Cassiano AFB, Coaguila-Llerena H, Santos CS, et al. The effect of octenidine on proliferation, migration, and osteogenic differentiation of human dental pulp and apical papilla stem cells. Journal of Endodontics. 2022;48(12):1502–1510. doi:10.1016/j.joen.2022.09.010
Bukhary S, Balto H. Antibacterial efficacy of octenisept, alexidine, chlorhexidine, and sodium hypochlorite against Enterococcus faecalis biofilms. Journal of Endodontics. 2017;43(4):643–7. doi:10.1016/j.joen.2016.09.013
Durai P, Mohan M, Ramalingam H, et al. Propolis in Endodontics—Unveiling Its Therapeutic Potential: A Narrative Review. World Journal of Dentistry. 2025;16(10):959–66. doi:10.5005/jp-journals-10015-2619
Alghutaimel H, Matoug-Elwerfelli M, Nagendrababu V, et al. Endodontic applications of propolis in primary and permanent teeth: A scoping review of clinical studies. European Endodontic Journal. 2024;9(3):167. doi:10.14744/eej.2024.65487
