Revascularization: A New Hope for Necrotic Permanent Teeth with Immature Apex-A Review (original) (raw)
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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
Journal of Endodontics, 2008
Endodontic treatment options for immature, nonvital teeth conventionally include surgical endodontics, apexification with calcium hydroxide, or single visit mineral trioxide aggregate plug. A new treatment option of revascularization has recently been introduced. It involves disinfecting the root canal system, providing a matrix of blood clot into which cells could grow, and sealing of the coronal access. The present pilot clinical study was undertaken to evaluate the efficacy of revascularization in 14 cases of infected, immature teeth. Endodontic treatment was initiated, and after infection control, revascularization was performed. The access cavity was sealed with glass ionomer cement. The cases were followed up at regular intervals of 3 months; the range in follow-up was 0.5-3.5 years. The outcomes were as follows. Radiographic resolution of periradicular radiolucencies was judged to be good to excellent in 93% (13 of 14) of the cases. In the majority of cases, a narrowing of the wide apical opening was evident. In 3 cases, thickening of apical dentinal walls and increased root length were observed. The striking finding was complete resolution of clinical signs and symptoms and appreciable healing of periapical lesions in 78% (11 of 14) of cases. Thickening of lateral dentinal walls was evident in 57% (8/14) of cases, and increased root length was observed in 71% (10/14) of cases. None of the cases presented with pain, reinfection, or radiographic enlargement of preexisting apical pathology. This pilot study documented a favorable outcome of revascularization procedures conducted in immature nonvital, infected permanent teeth. (J Endod 2008;34:919 -925)
Journal of Endodontics, 2011
Introduction: Revascularization is an emerging regenerative treatment protocol with little published data available in immature molar teeth. The present case series demonstrates the outcome of revascularization treatment with intracanal medicament of calcium hydroxide in immature necrotic molars. Methods: Immature necrotic permanent first molars (n = 6) of patients 8-11 years old were treated by a revascularization protocol that used 2.5% NaOCl irrigation, medication with calcium hydroxide placed in the coronal third of the root canals, induction of apical bleeding, and coronal sealing with white mineral trioxide aggregate. Among the treated teeth, 4 molars had undergone prior root canal instrumentation by the referring dentists. National Institutes of Health Image-J program with TurboReg plug-in was used for standardization of the radiographs and to determine the increase in root length and root width. Results: After a follow-up period of 10 months, all teeth demonstrated radiographic evidence of complete periapical healing, progressive thickening of dentinal walls, and continued apical development in the absence of clinical symptoms. Two uninstrumented molars showed a positive response to cold testing at 9 months. Conclusions: On the basis of a follow-up period of 10 months, the present cases demonstrate a favorable outcome of the revascularization procedure in immature necrotic molars by using calcium hydroxide medication in the coronal third of the root canals.
Regenerative potential following revascularization of immature permanent teeth with necrotic pulps
Aim To assess the regenerative potential of immature teeth with necrotic pulps following revascularization procedure in dogs. Methodology Necrotic pulps and periapical pathosis were created by infecting 108 immature teeth, with 216 root canals in nine mongrel dogs. Teeth were divided into three equal groups according to the evaluation period. Each group was further subdivided into six subgroups according to the treatment protocol including MTA apical plug, revascularization protocol, revascularization enhanced with injectable scaffold, MTA over empty canal. All root canals were disinfected with a triple antibiotic paste prior to revascularization with the exception of control subgroups. After disinfection, the root length, thickness and apical diameter were measured from radiographs. Histological evaluation was used to assess the inflammatory reaction, soft and hard tissue formation. Results In the absence of revascularization, the length and thickness of the root canals did not change over time. The injectable scaffold and growth factor was no more effective than a revascularization procedure to promote tooth development following root canal revascularization. The tissues formed in the root canals resembled periodontal tissues. Conclusion The revascularization procedure allowed the continued development of roots in teeth with necrotic pulps.
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.
Introduction: Revascularization is a valuable treatment in immature necrotic teeth that allows the continuation of root development. In this article we describe successful revascularization treatment of 2 necrotic immature first mandibular molars. Methods: The clinical and radiographic examinations showed extensive coronal caries, immature roots, and periapical radiolucencies in mandibular first molars of a 9-year-old boy and an 8-year-old girl. The exam findings suggested revascularization treatment in both cases, which was started with irrigation of the canals by using NaOCl 5.25% for 20 minutes, followed by 3 weeks of triple antibiotic (metronidazole, ciprofloxacin, and minocycline) paste dressing. Next, the antibiotic paste was removed, bleeding was induced in the canals, and calcium enriched mixture (CEM) cement was placed over blood clots. Results: In radiographic and clinical follow-ups both cases were asymptomatic and functional, periapical radiolucencies were healed, and roots continued to develop. Conclusions: Revascularization is a realistic treatment in immature necrotic molars. In addition, placing CEM cement as a new endodontic biomaterial over the blood clot formed inside the canals provided good seal and favorable outcomes. (J Endod 2011;37:562-567)
[Revascularization: a new treatment method in endodontics]
Refuʾat ha-peh ṿeha-shinayim (1993), 2012
Recently a number of published articles concerning a new treatment method in traumatized young permanent teeth with a wide open apex that have lost vitality, with or without periapical lesions have shown success. This new treatment is entitled "Revascularization" and its aim is to promote root maturation in infected immature teeth with open apices. This procedure stimulates the formation of hard tissue as well as elongation and thickening of the dentinal walls and closure of the root apex. Sometimes the vitality of the teeth is regained. The aim of the present publication is to describe the revascularization technique and to clarify the indications of its use.
Revascularization procedure in an open apex tooth with external root resorption: A case report
Journal of Dental Materials and Techniques, 2017
External inflammatory root resorption (EIR) represents a challenge in endodontic practice. EIR commonly occurs after dental trauma that results in periodontal ligament injury, pulp necrosis and subsequent infection. Treatment of EIR is based on disinfecting the root canal system through chemomechanical procedures and then filling it with calcium hydroxide or triple antibiotic paste. Dental trauma commonly occurs in young patients whose teeth are not fully formed and have thin dentinal walls and open apices. Revascularization therapy has proven to be suitable for treatment of root canals of teeth with pulp necrosis and open apices. This case report presents successful revascularization treatment of a permanent immature tooth with external root resorption and chronic apical periodontitis. The tooth was treated by the protocol suggested by the American Association of Endodontics (AAE), consisted of disinfecting the root canal system, filling it with blood clot and sealing the root can...