Regenerative Endodontic Treatment as a Retreatment Option for a Tooth with Open Apex - A Case Report

Abstract

Treatment of non-vital immature teeth with apical periodontitis has always been a challenge in Endodontics. Regenerative endodontic treatment (RET) has been successfully used for the management of these cases. The aim of this study is to present a case of RET used for the retreatment of a previously endodontically treated permanent tooth with an open apex. A 14-year-old boy with a poor endodontic treatment done on his maxillary right central incisor developed symptomatic apical periodontitis. Radiographically, incomplete root development with thin dentinal walls and an open apex were evident. After accessing and removing previous filling materials, the canal was copiously irrigated with 2.5% sodium hypochlorite. A triple antibiotic paste was placed inside the canal and left for 15 days. After removal of the antibiotic mixture, bleeding was induced into the canal by passing a hand file out of the apex. A collagen membrane barrier was placed over the blood clot, followed by sealing with mineral trioxide aggregate. Access was sealed with permanent filling materials. Clinical examination at 12, 24 and 36 months revealed no symptoms. Radiographic examination showed resolution of the periapical lesion and apical closure. Sensitivity tests with cold and an electric pulp test elicited a negative response at all recall periods. On the basis of long-term results, RET may be an effective option for the retreatment of an immature permanent tooth with a failed previous treatment and periapical periodontitis.

Bone, Periodontal and Dental Pulp Regeneration in Dentistry: A Systematic Scoping Review

“…Increase in length and width of root dentin walls and resolution of periapical lesion in immature permanent teeth with necrotic pulp were reported (23,(100)(101)(102)(103)(104)(105)(106)(107)(108)(109). Besides, tooth under revascularization could respond positively to thermal and electrical sensibility tests (110).…”

“…Tooth discoloration is unleashed by the contact of minocycline with the root walls during time needed for infection eradication (25). Thus, some studies have been investigating the substitution of minocycline by amoxicillin (100,145,146), cefaclor (23,(147)(148)(149)(150)(151)(152), clindamycin (153), tetracycline (154) and doxycycline (155)(156)(157) or utilization of Ca(OH) 2 (158)(159)(160)(161)(162)(163)(164)(165)(166)(167)(168). Besides, some studies did not use intracanal medication (169- Figure 2.…”

The Effects of Double Antibiotic Paste and Amoxicillin-Clavulanate Paste Used in Endodontic Regeneration on Microhardness of Radicular Dentine: An In vitro Study

“…[ 8 ] It was used initially as a component of triple antibiotic paste to substitute for minocycline. [ 9 10 ] Amoxicillin-clavulanate is an antibiotic found to be 100% effective against common endodontic pathogens. [ 11 12 ] The use of the amoxicillin-clavulanate paste is found to be effective in resolving periapical lesions and promoting apical closure of an immature tooth with necrotic pulp as an intracanal medicament.…”

An uncommon type of segmental root development after revitalization

“…It is a biologically based treatment aimed at the regeneration of the dentine-pulp complex (European Society of Endodontology 2016). In contrast to traditional apexification or the use of apical barriers, revitalization may result in increased thickening of the canal walls and continued root maturation, which reduces the risk of root fracture as it is strengthened by the deposition of new mineralized tissue in the root canal and continued development of the root (Banchs & Trope 2004, Thibodeau & Trope 2007, Cotti et al 2008, Jung et al 2008, Petrino et al 2010, Geisler 2012, Kim et al 2012, Schmalz & Smith 2014, Miltiadous & Floratos 2015.…”