A Prospective Study of Long-Term Regenerative Endodontics Outcomes of Necrotic Immature Permanent Teeth: An 8-Year Follow-Up

Abstract

For the management of necrotic immature teeth, regenerative endodontics offers the advantage of further root lengthening, thickening of dentin wall, and apical closure. This prospective study aimed to evaluate the long-term outcome of regenerative endodontics in immature necrotic permanent teeth. A total of 23 immature roots were medicated by triple antibiotic paste. After 21 days, bleeding was induced by over-instrumentation, and then mineral trioxide aggregate and coronal restoration were applied. Patients were scheduled for clinical and radiographic follow-up for 8 years. The radiographic changes of root dimensions were assessed using the ImageJ Plugin and statistically analyzed by Kruskal–Wallis test at a 95% confidence level. For qualitative evaluation, images were overlapped and analyzed using Photoshop software. All teeth were asymptomatic one month after the treatment. All teeth (n = 18) with preoperative periapical radiolucency showed complete resolution within 6–9 months. Recall rate at two, three, and eight years was 69.6%, 56.5%, and 34.8%, respectively. Continuous root development with a significant increase in root length and thickening of dentin wall accompanied by a significant decrease in apical canal diameter was seen at the end of the observation period (p < 0.001). In conclusion, the long-term outcome of regenerative endodontics revealed successful clinical and radiographic results with appropriate case selection.

Regenerative Endodontic Procedure on an Immature Necrotic Molar: A Case Report with a 5-Year Review

“…In the presented case, radiographic evidence confirmed the positive effect of the REP since root length and dentin thickness increased and the root apices were closed compared to their presentation at the initial visit and the counterpart tooth at the followup visit. A prospective study reported similar findings based on the Banchs and Trope treatment protocol, observing at follow-up after 8 years that root length and dentinal wall thickness showed a progressive increase, while a decrease in apical diameter was evident throughout the follow-up period [32]. However, the study involved only 2 molar teeth that were followed up for only 2 years.…”

Expert consensus on regenerative endodontic procedures

“…Blood clot has been induced as a scaffold in most of the REPs cases, 43,[46][47][48] which is a relatively straightforward and simple approach. It allows integrators on cell surfaces to adhere to fibrous components and selectively adsorb cells, supplying growth factors to promote tissue regeneration.…”

Revascularization Induced Maturogenesis of Non-Vital Immature Teeth Using Different Scaffolds and Intra Canal Medications

“…It is the least expensive technique to induce a calcified apical barrier. However, this long term procedure does not increase the thickness or length of the root and causes the tooth to be susceptible to future fractures [1] .…”