Clinical and Radiographic Outcomes of Traumatized Immature Permanent Necrotic Teeth after Revascularization/Revitalization Therapy

Abstract

Introduction Revascularization treatment is rapidly becoming an accepted alternative for the management of endodontic pathology in immature permanent teeth with necrotic dental pulps. However, the success and timing of clinical resolution of symptoms and of radiographic outcomes of interest, such as continued hard tissue deposition within the root, are largely unknown. Methods In this prospective cohort study, 20 teeth were treated with a standardized revascularization treatment protocol, and monitored for clinical and radiographic changes for one year. Standardized radiographs were collected at regular intervals and radiographic changes were quantified. Results All 20 treated teeth survived during the 12 month follow up period and all 20 also met the clinical criteria for success at 12 months. As a group, the treated teeth demonstrated a statistically significant increase in radiographic width and length, and a decrease in apical diameter, although the changes in many cases were quite small such that the clinical significance is unclear. The within-case percent change in apical diameter after 3 months was 16% and had increased to 79% by 12 months, with 55% (11/20) showing complete apical closure. The within-case percent change in root length averaged less than 1% at 3 months and increased to 5% at 12 months. The within-case percent change in root thickness averaged 3% at 3 months and 21% at 12 months. Conclusions Although clinical success was highly predictable with this procedure, clinically meaningful radiographic root thickening and lengthening is less predictable at one year of follow up. Apical closure is the most consistent radiographic finding.

Antibacterial efficacy of several intracanal medicaments for endodontic therapy

“…Regenerative endodontic therapy (RET) has become a viable alternative in the treatment of immature teeth with pulpal necrosis as long as an adequate disinfection of the root canal system is guaranteed 2) . Most of RET clinical reports have used either triple antibiotic paste (TAP) [3][4][5][6][7] or pure calcium hydroxide (Ca(OH)2) paste [8][9][10][11] , as intracanal medicaments for this purpose.…”

“…Moreover, it may induce an uncontrolled calcification of the canal space that would prevent the ingrowth of soft tissue with an odontogenic potential 9) . TAP consisting of metronidazole, ciprofloxacin and minocycline, has been successfully used to disinfect the canals in RET, achieving closure of the apex and thickening of the dentinal walls [3][4][5][6][7] . A potential disadvantage when using TAP is the possibility of tooth discoloration 4,12,13) due to minocycline 4,13) .…”

“…In contrast, TAP has shown to be effective against this bacteria [26][27][28] . However, there is a lack of consensus, not only referring to the medication used, but also to the length of the treatment, which ranges in literature from 7 days to several weeks [3][4][5][6][7][8][11][12][13][14] . To our knowledge, there are no microbiological studies comparing in situ the efficacy of TAP, DAP and Ca(OH) 2 paste alone or in combination with CHX and/ or CTR at different periods of time.…”

Histologic Outcomes of Uninfected Human Immature Teeth Treated with Regenerative Endodontics: 2 Case Reports

“…Several case reports and case series have shown clinically successful outcomes and further root development after regenerative endodontic treatment (5,6). Recent case reports and clinical studies have shown that root development as a possible indicator of pulp regeneration is not a predictable outcome (7)(8)(9). Among all aspects of root development (ie, increase in length, increase in root wall thickness, and apical closure), apical closure has been shown to be the most frequent finding (7), which could be unrelated to pulp regeneration (9).…”

“…Recent case reports and clinical studies have shown that root development as a possible indicator of pulp regeneration is not a predictable outcome (7)(8)(9). Among all aspects of root development (ie, increase in length, increase in root wall thickness, and apical closure), apical closure has been shown to be the most frequent finding (7), which could be unrelated to pulp regeneration (9). Hence, histologic analysis of tissues formed inside the root canal after regenerative treatment is important, especially regarding the differentiation of stem cells into odontoblasts.…”