Clinical and CBCT Comparison of MTA Revascularization Versus Apexification for Immature Permanent Incisors (original) (raw)
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Geometric root changes following two different techniques for immature permanent incisors
Egyptian Dental Journal
Aim: for evaluation and comparison of pulp revascularization and apexification in immature non-vital permanent incisors by CBCT. Material and methods: 15 immature permanent incisors of children (7-9 years old) had irreversible pulpitis or necrotic pulp were selected and randomly divided into 2 groups; Group I: 7 teeth were treated with Pulp revascularization and group II: 7 teeth were treated with MTA apexification. Each tooth was completely isolated with a rubber dam then access opening was done. Irrigation of the pulp chamber with 2.5% NaOCl then sterile saline and water. The root canal was then dried with paper points, triple antibiotic paste (TAP) was administered, and it was removed two weeks later with saline irrigation. In group I (revascularization) bleeding enhancement was done and MTA material was performed over the formed blood clot while in group II (apexification) the whole root canal space was filled with MTA. Finally, pulp chamber was filled with GIC filling in both groups. Conclusions: Both groups are resemble in all CBCT criteria except in dentin volume and root length in mesiodistal direction which significant in Revascularization group.
Background: Management of the immature non vital anterior tooth with apical pathosis represent several treatment challenges. Lack of apical closure complicates the root filling procedure and the attainment of an apical ?seal?(Shah et al., 2008; Cehreli et al., 2011). The goal from pulp revascularization is to regenerate a pulp-dentine complex that restores functional properties of this tissue and allow continued root development for immature teeth (Hargreaves et al., 2008). Objective: The aim of this systematic review was to evaluate and demonstrate comprehensive data about pulp revascularization and mineral trioxide aggregate apexification in treating necrotic immature teeth. Method: An extensive search was performed on PubMed, Cochrane Library, and EBSCO. The assessed primary outcome was resolution of clinical symptoms. The secondary outcome was root development. Result: Three articles of clinical trials met the inclusion criteria and were included. For patients who have necrotic immature permanent teeth, pulp revascularization is more effective in furthering root development of necrotic immature permanent teeth compared to MTA apexification
Apexification of Immature Permanent Incisors using MTA and Calcium hydroxide-Case Report
In young pediatric patient the endodontic management of immature non vital permanent teeth is a great challenge to dentist. There is difficulty in debridement and obturation as the walls of the root canals are frequently divergent and open apexes are present. Apexification is a technique to generate a calcific barrier in a root with an open apex or the sustained apical development of an incomplete root in teeth with necrotic pulp. The most commonly advocated medicament is calcium hydroxide although recently considerable interest has been expressed in the use of MTA. In this case series both calcium hydroxide and MTA were used successfully for apexification procedure in teeth with open apex.
Introduction: The purpose of the study was to compare the effectiveness of pulp revascularization and MTA apexification in the treatment of necrotic anterior teeth with periapical abscess. Methods: twenty-two patients, each with necrotic immature permanent anterior teeth were randomly divided into 2 groups (Group A apexification and group B regeneration) 11 patient per each group. A triantibiotic paste (metronidazole, ciprofloxacin and doxycycline) was used to disinfect the canal for 21 days. MTA plug was used for apexification for group A. Blood clot regeneration was used for the group B. The patients were recalled periodically for follow up. Results: The regeneration group showed better results in, increase in root length, increase in dentin thickness in mm, and in percentage, while MTA apexification group showed better results in decrease in apical diameter in millimeter. Conclusions: Both regeneration and MTA apexification are reliable procedures for treating necrotic immature anterior teeth with open apices.
2015
OBJECTIVE: To compare the clinical outcome between mineral trioxide aggregate apical plug and mineral trioxide monoblock technique of endodontic apexification procedure of non vital permanent incisors with open apexes. STUDY DESIGN: Clinical in vivo Cross sectional comparative study PLACE AND DURATION: Endodontic department/College of Dentistry Ziauddin University, Karachi. Study duration was from January 2010 to January 2013. METHODOLOGY: Total fifty patients of male or female visited Endodontic department with non vital permanent maxillary incisors with open apexes were selected. The selected teeth were divided into 2 groups by simple random method. Group A was treated with MTA apical plugtechnique and the group B was treated with MTA monoblock technique. The assessment of clinical outcome was carried out at12 and 24 month follow-up appointments. The presence of signs and symptoms with treated cases were considered as clinical failure, while treated cases without symptoms were con...
Journal of Endodontics, 2013
Introduction: Endodontic treatment of immature permanent teeth with necrotic pulp, with or without apical pathosis, poses several clinical challenges. There is a risk of inducing a dentin wall fracture or extending gutta-percha into the periapical tissue during compaction of the root canal filling. Although the use of calcium hydroxide apexification techniques or the placement of mineral trioxide aggregate as an apical stop has the potential to minimize apical extrusion of filling material, they do little in adding strength to the dentin walls. It is a well-established fact that in reimplanted avulsed immature teeth, revascularization of the pulp followed by continued root development can occur under ideal circumstances. At one time it was believed that revascularization was not possible in immature permanent teeth that were infected. Methods: An in-depth search of the literature was undertaken to review articles concerned with regenerative procedures and revascularization and to glean recommendations regarding the indications, preferred medications, and methods of treatment currently practiced. Results: Disinfection of the root canal and stimulation of residual stem cells can induce formation of new hard tissue on the existing dentin wall and continued root development. Conclusions: Although the outcome of revascularization procedures remains somewhat unpredictable and the clinical management of these teeth is challenging, when successful, they are an improvement to treatment protocols that leave the roots short and the walls of the root canal thin and prone to fracture. They also leave the door open to other methods of treatment in addition to extraction, when they fail to achieve the desired result.
Analysis of Root Canal Treated Primary Incisor After Trauma
2012
The low number of clinical studies of traumatized teeth submitted to root canal treatment is completely out of proportion to the seriousness that dental trauma imposes on children in early years. Aim. This study evaluates the outcomes of root canal treatment (RCT) in traumatized primary incisors and identifies the predisposing factors associated with therapy success. Methods: This is a retrospective study conducted with all dental records of 704 patients who had one or more teeth with traumatic injuries. Patients with irreversible pulp changes in primary teeth leading to RCT with a 24 month follow-up met the inclusion criteria. Results: Twenty-five maxillary incisors of 17 children were evaluated. The children's age at the time of therapy ranged from 24 to 72 months (mean 47.3). Pulp necrosis was the most common disorder (84.0%) and pre-operative periapical lesions were observed in 52.0%. Coronal discoloration was found in 48.0%. The roots were filled with ZOE paste (68.0%) or Guedes-Pinto paste (32.0%). Overall RCT success rate was 68.0%. The absence of pre-operative periapical lesions (p =0.02) and pathological root resorption (p = 0.02) presented positive association with therapy success. Success was not associated to filling paste (p = 0.49), filling extent (p = 0.44), of discoloration (p = 0.39) nor the patients' age (p = 0.59). Conclusions: RCT was considered successful in 68.0% of the cases at the 24 month follow-up. Failure of RCT in traumatized primary incisors was associated with pre-operatory periapical lesions and pathological root resorption. The filling paste, the filling extent and the patient's age were unrelated with therapy success.
Journal of Evolution of Medical and Dental Sciences, 2021
Traumatic injuries to an immature permanent tooth may result in cessation of dentin deposition and root maturation. Novel revascularisation endodontic procedure (REP) has been considered as an option for treatment of immature teeth with damaged pulp tissue. The continuous development of the root and the root canal has been recognised as a major advantage of this technique over traditional apexification approach. Traditional apexification procedures may resolve pathology but have not been able to prove tooth survival due to absence of continued root development and risk of root fracture. A successful REP results in resolution of signs and symptoms of pathology, radiographic signs of healing, proof of continued root development as well as presence of pulp vitality due to the regeneration of pulp tissue in the root canal. Currently, repair rather than true regeneration of the ‘pulp-dentine complex’ is achieved and further root maturation is variable. According to Glossary of Endodontic...