Knowledge and Attitude Levels on Regenerative Endodontic Procedures among the Dental Residents in and around Puducherry

DISCUSSION

Dental pulp is the loose connective tissue with unique characteristics of encased in a rigid unyielding environment, lack of collateral vascular supply, and it is potential to regenerate throughout the life.³ The secondary dentin or the reparative dentin,⁴ which up to a certain extent remains as a barrier to bacterial invasion, is formed on encounter of an injury or an external stimuli,⁵ but in case of severe infection, dental pulp is usually amputated and is replaced by an artificial material after disinfection of the pulp cavity. Although this helps in maintaining the tooth in the position, it still cannot preserve the vitality of the tooth.⁶ Newer technologies have come up with breakthrough therapies such as regenerative endodontic procedures to overcome this issue through stem cell biology and tissue engineering.⁷

Regenerative endodontics is founded on the seminal work of Dr Nygaard-Ostby, completed in 1960s.³ Regenerative endodontics aims at cell-based therapies, particularly stem cells to repair and regenerate damaged tissues or organs. Desired specialized cells or tissues are generated using various types of stem cells.⁷ Recently, mesenchymal stem cells have been identified in the dental pulp and are found to have the capacity to regenerate dental pulp complex even in the immature necrotic tooth.⁸

At present, the most common practice is administrating a scaffold of the same required new tissue shape that is seeded with stem cells.^7–10 The supreme goal of regenerative therapies is to improve newer technologies so that restoration of lost, damaged, or aging tissues with newer tissues through regenerative and tissue engineering technologies by using either autologous or donated cells could be made possible.⁹

The evolution in dentistry have bestowed the dentists with the ability to efficiently retain, restore, and replace the teeth and other oral structures with improved technologies for the past 50 years. Now, it is high time to adapt to the novel technique of regeneration.¹⁰ A great clinical outcome is expected in endodontics on implementing biologic solutions for repair and regeneration of dental tissues. Apart from preserving the vitality of the pulp, it could even pave way for the regeneration of the pulp-dentin-enamel-like tissue with the required form and function.¹¹ Based on a survey, in the past decade, the dental practitioners have shown to readily acclimate themselves to most of the newer technologies.^11,12 This present study remains as the first to collect data on the knowledge and attitude levels of the dental residents on REPs in and around Puducherry.

A majority (82.4%) of the dental residents were already aware of the various REPs, which was in coordinate with similar studies by Ajay et al., Chitroda et al., Nitha et al., and Aishwarya Das et al.^2,13–15 In the orofacial region, there are various sources of dental stem cells such as dental pulp stem cells, dental follicle stem cells, and stem cells of apical papilla, periodontal ligament stem cells, tooth germ progenitor cells and immature dental pulp cells. A majority of the participants were able to identify more than one source of dental stem cells which was in accordance with the study by Chitroda et al.¹⁴ Although many were aware of the supremacy of stem cells, barely 9.3% of the participants were engaged in the umbilical cord or other types of stem cell banking. Many of the participants (64.8%) remained unaware of the various application of dental stem cells. In contrary, in the study conducted by Chitroda et al. and Sede et al., it was observed that an awareness of 53.9% and 81%, respectively, was present.^14,16 This might be because their study population comprised dental professionals who would have had better exposure through dental practice and conferences.¹⁶

It is observed that half the participants (55.4%) considered that they gathered knowledge through curriculum which is in accordance with the study by Aishwarya Das et al.² According to Sede et al., the primary source of information was seen to be from the conference, symposium, or seminar.¹⁶ Contradicting the above stated information, 82.9% of the participants in our study have responded that they have never attended any conference, symposium, seminar, or CDE programs regarding REPs.

The above-mentioned information indicates a hindrance among the participants to implement their knowledge into practice although they have a positive attitude toward REPs. The major hindrances found in practicing REPs in the dentistry were seen to be high cost and resulting financial burdens, low-availability of products, and poor patient compliance; comparable results were found in survey performed by Chitroda et al., Nitha Jose, Goyal et al., and Epelman et al.^14,15,17,18 Besides these hinderances, the number of participants who considered REPs as the most effective treatment option and safe were 43% and 48.7%, respectively, but about 70.5% were unaware of the guidelines related to dental stem cells given by the Indian Council of Medical Research. A majority of the participants (94.5%) showed interest in attending CDE programs related to REPs, and most (59.6%) believed that the dental professional association should regulate the use of stem cells in dentistry. This shows a gap prevailing in between the attitude toward REPs and their in-depth knowledge on REPs among the dental residents.