Revascularization medicaments of the traumatized immature permanent incisor- A case report (original) (raw)
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Australian Endodontic Journal
This report describes the second attempt at pulp revascularisation, using an association between 2% chlorhexidine (CHX) and calcium hydroxide (CH) as intracanal dressing, in an immature traumatised anterior tooth with pulp necrosis. A 21‐year‐old woman complained of pain and dental crown darkening of a permanent maxillary right central incisor. Her medical records presented a history of dental trauma, and at age 15, the first attempt at revascularisation was performed, using triple antibiotic paste (TAP) as the intracanal dressing. Recent radiographs then showed a periapical lesion associated with an immature root, which demonstrated the failure of the first attempt. The second pulp revascularisation was performed, using an association between CHX and CH as intracanal medication. The case was followed up for 24 months. Observations showed evidence of root development, dentinal wall thickening and periapical healing. In this case, the association between CHX and CH showed favourable ...
Revascularization of Immature Permanent Teeth with Apical Periodontitis New Treatment Protocol
A new technique is presented to revascularize immature permanent teeth with apical periodontitis. The canal is disinfected with copious irrigation and a combination of three antibiotics. After the disinfection protocol is complete, the apex is mechanically irritated to initiate bleeding into the canal to produce a blood clot to the level of the cementoenamel junction. The double seal of the coronal access is then made. In this case, the combination of a disinfected canal, a matrix into which new tissue could grow, and an effective coronal seal appears to have produced the environment necessary for successful revascularization.
A Review on Endodontic Management in Traumatized Permanent Teeth
The majority of accidents affect children and adolescents, often when root development of the injured teeth is not completed. Teeth with immature root development, necrotic pulps, and apical periodontitis present multiple challenges for successful treatment. The infected root canal space cannot be cleaned and disinfected with the standard root canal protocol using an aggressive procedure with endodontic files.After the disinfecting phase of treatment has been completed, filling the root canal is difficult because the open apex provides no barrier for containing the root filling material without impinging on periodontal tissues.Even after successfully completing the endodontic procedure, the roots of these teeth are still thin and have a significant risk of subsequent fracture.These problems can be managed using a disinfection protocol that minimizes root canal instrumentation, by stimulating the formation of a hard tissue barrier or providing an artificial apical barrier to allow for optimal filling of the canal, and by reinforcing the weakened root against fracture both during and after an apical barrier has been provided.
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)
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...
International endodontic journal, 2014
To discuss the clinical and radiological outcome of a revascularization procedure which was completed in a single visit (using sodium hypochlorite 5% as the sole disinfectant) in an immature tooth with a necrotic pulp and apical periodontitis. A 7-year-old girl was referred in pain following trauma to the maxillary anterior region some 6-7 weeks previously. The maxillary left central incisor tooth was diagnosed with a necrotic pulp and acute apical periodontitis. Under local anaesthesia and rubber dam isolation, an access cavity was prepared. The canal was irrigated with a 5% sodium hypochlorite solution and agitated with an ultrasonic file. A 17% EDTA solution was also used for a final rinse. Bleeding was induced into the canal space from the periapical tissues using a K-file. An MTA layer/barrier was placed directly onto the blood clot, and a further layer of GC Fuji IX cement was placed on top of the MTA to restore the access cavity. The tooth was reevaluated at 6 weeks, 3 months...
An old concept revisited- Revascularisation in endodontics-A case report
This study describes the treatment of a necrotic immature permanent central incisor with crown fracture. Instead of the conventional root canal treatment, a regenerative approach based on conservative endodontic method for revascularization was provided. The root canal was gently debrided of necrotic tissue by irrigating with sodium hypochlorite and then medicated with tri-antibiotic paste. After 28 days the sinus tract had healed, and the tooth was asymptomatic. The tooth was accessed, triantibiotic paste was removed, bleeding was stimulated to form an intracanal blood clot, and glass-ionomer cement was placed coronal to the blood clot. After 18 months, a progressive increase in the thickness of the dentinal walls and subsequent apical development was seen radiographically suggesting that appropriate biologic response can occur with this type of treatment of the necrotic immature permanent teeth.
Journal of Endodontics, 2014
Introduction-Revascularization treatment is rapidly becoming an accepted alternative for the management of endodontic pathology in immature permanent teeth with necrotic dental pulps. However, the success and timing of clinical resolution of symptoms and of radiographic outcomes of interest, such as continued hard tissue deposition within the root, are largely unknown. Methods-In this prospective cohort study, 20 teeth were treated with a standardized revascularization treatment protocol, and monitored for clinical and radiographic changes for one year. Standardized radiographs were collected at regular intervals and radiographic changes were quantified. Results-All 20 treated teeth survived during the 12 month follow up period and all 20 also met the clinical criteria for success at 12 months. As a group, the treated teeth demonstrated a statistically significant increase in radiographic width and length, and a decrease in apical diameter, although the changes in many cases were quite small such that the clinical significance is unclear. The within-case percent change in apical diameter after 3 months was 16% and had increased to 79% by 12 months, with 55% (11/20) showing complete apical closure. The withincase percent change in root length averaged less than 1% at 3 months and increased to 5% at 12 months. The within-case percent change in root thickness averaged 3% at 3 months and 21% at 12 months.
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.