Treatment outcomes of pulp revascularization in traumatized immature teeth using calcium hydroxide and 2% chlorhexidine gel as intracanal medication

Abstract

Treatment outcomes of pulp revascularization in traumatized immature teeth using calcium hydroxide and 2% chlorhexidine gel as intracanal medication Objective: Pulp revascularization is an effective treatment for immature necrotic teeth. Calcium hydroxide has been used in pulp revascularization as an intracanal medication due to its antimicrobial action and the nonexhibition of crown discoloration and cytotoxicity for stem cells from the apical papilla. Our study aimed to investigate the clinical success and quantitative radiographic changes of root development in immature traumatized teeth using calcium hydroxide plus 2% chlorhexidine gel as intracanal medication. Methodology: In this retrospective study, 16 patients were treated with a standardized pulp revascularization protocol. Calcium hydroxide and 2% chlorhexidine gel were manipulated in a 1:1 (v/v) ratio and inserted into root canals with Lentulo spirals (Dentsply Maillefer, Baillaigues, Switzerland). Patients were followed up for a period from 9 to 36 months for the evaluation of clinical and radiological data. Radiographic measurements of root length, root width, apical diameter, and MTA placement from the apex were quantified using software ImageJ. Wilcoxon test and t-test were used, according to nonparametric or parametric data, respectively, for changes over time in root length, root width, and apical diameter. Results: Fifteen teeth survived during the follow-up period (93.75%) and met the criteria for clinical success. Although the changes seem to be very small in many cases, significant increases in the average root length (14.28%, p<0.0001), root width (8.12%, p=0.0196), and decrease in apical diameter (48.37%, p=0.0007) were observed. MTA placement from the apex and age at the time of treatment was not significantly associated with the quantitative radiographic outcomes. Conclusions: Pulp revascularization in traumatized immature teeth treated with calcium hydroxide plus 2% chlorhexidine gel as intracanal medication had high success and survival rates, showing periodontal healing and resolution of signs and symptoms. However, concerning the continued root development, the outcomes can still be considered unpredictable.

Spectrophotometric analysis of internal bleaching of traumatized teeth with coronal discoloration following regenerative endodontic procedures

“…The REP is an effective therapy for the treatment of necrotic immature teeth, which combines decontamination techniques to eliminate microorganisms from the interior of the root canal and tissue stimulation techniques that will promote the continuation of root development 25 . Despite its clinical success 1,8 , the bond strength of restorative materials is influenced by the biomaterials used as a cervical barrier [26][27] , which can compromise the post-treatment sealing; in addition, some teeth show crown discoloration during the follow-up, often caused by intracanal medications and materials used in the procedure [7][8][9][10][11][12]19 .…”

“…The most accepted hypotheses that explain these findings are the possible interaction of minocycline with collagen, resulting in pigmented bioproducts, and the binding of minocycline to the calcium ion of dentin by chelation 6 . Thus, the use of calcium hydroxide associated with chlorhexidine 2% gel reduces the chances of coronary darkening after regenerative endodontic procedures 1 and may be an alternative to the use of TAP paste 4,8 .…”

“…Traumatic injuries in young patients are the major cause of pulp necrosis in immature permanent teeth 1 . The regenerative endodontic procedure (REP) is a technique based on principles of tissue engineering aimed at providing longitudinal development and strengthening of root walls with use of the inherent capacity of cell proliferation to fill gaps in the body 2 .…”

“…The regenerative endodontic procedure (REP) is a technique based on principles of tissue engineering aimed at providing longitudinal development and strengthening of root walls with use of the inherent capacity of cell proliferation to fill gaps in the body 2 . Ever since the first clinical report of the regenerative endodontic procedure 3 , several protocols have been proposed to promote bacterial decontamination 1,[4][5][6] and cervical sealing 7 , thus increasing the chances of clinical success.…”

“…Another factor related to coronary discoloration following REP is the use of calcium silicate-based cervical barriers 1,7,9,10,[12][13][14][15] and their interaction with the blood clot 16 , especially those that have bismuth oxide in their composition, which when in contact with collagen matrix result in a darkened precipitate 13 .…”