Keep Me Alive: Revascularization in Immature Permanent Molar (original) (raw)
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Revascularization: A New Hope for Necrotic Permanent Teeth with Immature Apex-A Review
2018
Root development commences after the completion of enamel formation. Irritation of pulp tissue results in major changes in pulp microcirculation that can lead to pulp necrosis and arrest root formation. The treatment of necrotic young permanent tooth with an immature open apex still presents multiple challenges in pediatric and endodontic dentistry. Conventionally, tooth that has lost its vitality is being treated by apexification. Through this technique, the formation of an apical barrier to close the open apex is promoted so that the filling materials can be confined to the root canal but it involves long-term periodic exchanges of calcium hydroxide paste into canal which may lead to weakening of the canal and tooth fracture. Furthermore, tissue regeneration cannot be achieved with apexification. Recently, revascularization is introduced as a new treatment modality for immature non-vital teeth. Revascularization not only provides apical closure but also increases the dentine wall ...
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.
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
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.
Pulp Revascularisation of Necrotic Immature Permanent Teeth: A Review
2021
As the importance attributed to conservative endodontic treatment increases manifold, pulp revascularization represents a recent and promising therapy for immature teeth, highly recommended as an alternative to apexification in cases of endodontic treatment of irreversible pulpitis and pulp necrosis, whether or not associated with periapical lesion. This review is an attempt towards the recommendation of revascularization as an alternative to apexification.
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...
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.
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)