Regenerative endodontic procedure of permanent teeth with incomplete root development after application of a devitalizing agent – a case report (original) (raw)
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Folia Medica
Introduction: The traditional treatment of immature permanent teeth with necrotic pulp involves creating an apical barrier by using calcium hydroxide or an MTA plug for an extended period of time. A novel therapeutic approach called regenerative endodontic procedures (REP) is used to allow root development to continue. Aim: To investigate the response of immature permanent teeth and necrotic pulp to REP using a modified clinical protocol involving minimal mechanical instrumentation and irrigation with 10% citric acid. Materials and methods: We treated 30 immature permanent teeth with necrotic pulp in 28 patients aged 7-14 years using a modified protocol for regenerative endodontics. The protocol included mechanical instrumentation of the root canal with the appropriate file for 2 minutes in total and irrigation with 10% citric acid. Results: The root walls increased their thickness in 28 (93%) of the treated cases. In 16 (53%) cases, we found radiographic signs of continued root dev...
Journal of Dentistry, Shiraz University of Medical Sciences, 2022
This report describes a regenerative endodontic procedure of an immature permanent incisor with internal root resorption (IRR) and 4-years follow-up. A healthy 8-year-old man was referred for treatment of tooth #9 after a traumatic intrusion. The periapical radiograph showed an IRR and an open apex with periradicular lesion. A diagnosis of pulp necrosis and chronic apical abscess was achieved. In the first appointment, under local anesthesia and rubber dam isolation, an access cavity was designed and the root canal was chemically cleaned under irrigation with 10 mL 1.5% sodium hypochlorite (NaOCl). The root canal was then dried and calcium hydroxide paste was placed. During the second appointment, the root canal was irrigated with 5 mL of 17% ethylenediaminetetraacetic acid (EDTA) for 5 minutes and dried. The blood clot was established in a time of 3 minutes after the bleeding from the periapical tissue was trigged. White mineral trioxide aggregate (MTA) was placed up to the amelocemental junction and the final restoration of the access cavity was carried out. During periodic clinical and radiographic follow-up, the patient remained symptom free, the periapical region was completely healed, inhibition of the root resorption process achieved, and formation of the new periodontal ligament as well as tooth widening development observed, meeting functional expectations after 48 months. The regenerative endodontic procedures are an available option to treat IRR in severely immature teeth. The available literature on the regenerative endodontic procedures applied to IRR treatment is limited, and more research is needed in this field.
Regenerative Endodontics as the Future Treatment of Immature Permanent Teeth
Applied Sciences, 2021
The regenerative endodontic procedure (REP) is an alternative solution for endodontic treatment of permanent teeth with incomplete root apex development. It results in angiogenesis, reinnervation, and further root formation. Indications for REP include immature permanent teeth with necrotic pulp and inflammatory lesions of the periapical tissues. The main contraindications comprise significant destruction of the tooth tissues and a lack of patient cooperation. We distinguish the following stages of this procedure: disinfection of the canal, delivery of the REP components, closure of the cavity, and follow-up appointments. For effective canal disinfection, the use of both rinsing agents and intracanal medicaments is suggested. Sodium hypochlorite and triple antibiotic paste are used most commonly. Light-activated disinfection is proposed as an alternative method. The prerequisite for the regeneration process of the pulp is the supply of its essential components: stem cells, growth fa...
South African Dental Journal, 2017
It is possible that a paradigm shift may be in the offing in the approach to treatment of immature teeth with necrotic pulp, away from traditional apexification procedures and to a biologically-based endodontic protocol intended to produce regeneration, based on the deliberate introduction of bleeding into the canal space to provide a scaffold and allow the ingress of stem cells. Methods: A patient presented with a maxillary right central incisor tooth with an open apex and periapical radiolucency. The tooth was irrigated with sodium hypochlorite and then dressed with tri-antibiotic paste consisting of ciprofloxacin, metronidazole and amoxicillin. At a subsequent visit a blood clot was produced in the canal by irritating periapical tissues and the canal then sealed with mineral trioxide aggregate and glass ionomer cement. Results: The patient was pain free, the draining sinus was resolved in two weeks, root maturation continued and apical closure occurred after two months. The tooth became responsive to cold pulp vitality testing. Conclusions: Continued root growth invoked by regenerative endodontics may reduce the risks of fracture and premature tooth loss otherwise associated with traditional CaOH 2 apexification procedures. Randomised, prospective clinical trials and long term studies are required before the technique becomes standard practice.
Regenerative Endodontic Treatment: A Case Report
2017
Endodontic intervention in necrotic immature permanent teeth is usually a clinical challenge. With appropriate case selection, regenerative treatment can be effective, providing a desirable outcome. However, there is still no consensus on the optimal disinfection protocol or the method to achieve predictable clinical outcome. This article presents a case report of regenerative treatment in necrotic immature teeth, using mineral trioxide aggregate (MTA) as coronal barriers which led to successfull clinical outcomes.
Background: This paper analyzed the distribution of treatments for permanent teeth with necrotic pulps and open apices according to the stage of root development. Material and Methods: Dental records from all root canal procedures performed in permanent teeth with necrotic pulps and open apices over a period of 14 years by residents of the Speciality of Endodontics, University of Gua-dalajara, Mexico, were analized. Results: Records from 206 treatments were mainly divided into the following 3 different stages according to criteria described by Cvek: stage IV (n = 79, 38.3%), stage V (n = 66, 32%) and stage III (n = 53, 25.7%). Few cases involved the initial stages of root development (stages I and II) (n = 8, 3.8%). Such teeth were submitted to four different treatments: MTA apical barrier (n = 69), Ca(OH) 2 replacements (n = 34), gutta-percha (n = 67) and a plug of Ca(OH) 2 /gutta-percha (n = 36). The teeth with intermediate root development (Cvek stage III) showed a predi-lection for the MTA apical barrier and Ca(OH) 2 replacement techniques (P ≤ 0.001). Furthermore, the stage of root development did not influence the apical extent of the root filling. Conclusions: The finding of permanent teeth with necrotic pulp and open apices is not exclusive to young patients with an open apex. Moreover, teeth with fragile, irregular and divergent apical morphologies, such as Cvek's sta-ges´I and II, were not common and may be considered to be unusual findings. The diverse endodontic procedures were reliable regardless of the stage of root development.
The journal of contemporary dental practice, 2024
Aim: This report addresses the management of a large persistent discharging lesion in an 11-year-old boy. The report describes the use of aspiration-irrigation technique for the management of immature necrotic tooth with persistent discharge after a failed regenerative procedure. Background: Regenerative endodontics aim to provide an increase in root canal width, length, and in apical closure. Alternative procedures, such as apexification, should be attempted when regeneration fails. If the canal cannot be dried to persistent discharge, the aspiration-irrigation technique can be used. The technique relies on using aspiration along with irrigation to remove pus from the periapical area. Case description: This is a case for an 11-year-old patient who had trauma to tooth #11, which resulted in the complicated crown fracture. He had an emergency management that included pulpectomy and intracanal medication at another clinic. Two years later, the patient was presented to our clinic. Upon examination, the diagnosis was previously initiated therapy with asymptomatic apical periodontitis in immature tooth #11. Regeneration was attempted first but failed. The mineral trioxide aggregate (MTA) plug was removed, and the canal had persistent pus discharge. The canal was filled with intracanal medication, and then 2 weeks later, the canal was filled with triple antibiotic paste (TAP). Next visit, and due to continuous discharge, tooth #11 was treated conservatively with an intracanal aspiration-irrigation technique. An IrriFlex needle attached to a high-volume suction was used to aspirate the cystic fluid. Mineral trioxide aggregate plug apexification was performed in a later visit and the tooth was restored. Conclusion: During the 3-month and 16-month follow-up, there was resolution of the symptoms, a decrease in the periapical lesion size, and soft tissues appeared within normal limits. Clinical significance: Regenerative procedures are a good option for immature necrotic teeth. These procedures may fail due to persistent pus discharge from the root canals. The aspiration-irrigation technique is a good treatment option in cases of consciously discharging canals.
External Root Resorption Management of an Avulsed and Reimplanted Central Incisor: A Case Report
Dentistry Journal
Background: Avulsion and reimplantation of permanent teeth represent a major challenge in terms of treatment and long-term prognosis. The present study reported clinical management of external root resorption of an avulsed and reimplanted maxillary central incisor. Case report: A 9-year-old boy reported an uncomplicated crown fracture and avulsion of tooth 11 and complicated crown fracture of tooth 21 due to trauma. Reimplantation of element 11 was obtained within 30 min post-trauma and 3 days after both elements were diagnosed with necrotic pulp. In addition, tooth 11 showed early external root resorption. Both elements underwent endodontic treatment and root closure with apical plug using calcium-silicate-based cement. At 6-month follow-up root resorption appeared to be arrested. Twenty-four months after trauma the clinical results were stable, although signs and symptoms of ankylosis were observed. Conclusions: An immediate endodontic approach and use of calcium-silicate-based ce...
Journal of Endodontics, 2019
Introduction: The goal of regenerative endodontic treatment (RET) is to regenerate the pulpdentin complex in immature teeth with pulp necrosis. There is no consensus in using RET in previously treated teeth. This article reports on long-term outcomes of RET in previously treated immature teeth. Methods: Previously treated immature teeth with signs/symptoms of failure were included. After local anesthesia and rubber dam isolation, the root canal filling material was removed without the use of chemical solvents. The root canals were irrigated with 6% sodium hypochlorite using an EndoVac (Kerr Endodontics, Culver City, CA), and a creamy mix of metronidazole and ciprofloxacin was placed in the canals for 4 weeks. At the second visit, the antibiotic dressing was removed using 17% EDTA. Bleeding was induced into the root canal space, and SynOss Putty (Collagen Matrix Inc, Oakland, NJ) was placed. Bioceramic putty was placed over the SynOss Putty, and the teeth were restored at a subsequent visit. Results: Five teeth in 4 patients were included. The patients' ages ranged from 14-46 years. Recall examinations were performed from 20 to 72 months with an average of 54.4 months. The apical openings of the teeth ranged from 1-3.7 mm. All teeth were functional and asymptomatic at the recall visits. All periapical lesions resolved with partial or complete mineralization of the root canals, and all teeth showed partial to complete apical closure at the follow-up visits. Conclusions: RET can be a viable option for nonsurgical retreatment of immature teeth. This article adds a new perspective to the field of regenerative endodontics.