Dental Pulp Revascularization of Necrotic Permanent Teeth with Immature Apices

Ashiry, Eman A El; Farsi, Najat; Zeid, Sawsan Abu Abu T.; Ashiry, Mohamed M El; Bahammam, Hammam Ahmed

doi:10.17796/1053-4628-40.5.361

Cited by 22 publications

(16 citation statements)

References 5 publications

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“…In the aforementioned cases, great damage to periodontal ligament, which was shown to be a reason for root resorption, is very unlikely, which explains our high rate of resorption compared to other case reports. Moreover, re-implanted teeth have a higher risk of Hertwig's epithelial root sheath (HERS) or apical papilla injury [13,52], which are described as the most important elements to determine the continuing of root development after a severe trauma [14,52,53]. Thus, traumatized teeth, especially avulsed teeth, are less likely to complete root development after revascularization than teeth with necrotic pulp caused by caries [13].…”

Section: Discussionmentioning

confidence: 99%

“…Hitherto, many case reports and case series viewed revascularization very positively, as the studies observed an increase in root length and dentin wall thickness [ 9 , 12 – 14 , 16 , 19 ]. The discrepancies in our study can be explained based on the following issues.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have a lower number of cases [ 12 , 16 – 19 ], a shorter period of follow-up [ 13 , 18 , 19 ] or no standardized and/or blinded radiographic evaluation [ 14 , 24 ]. Moreover, most analyses include teeth with diverse etiologies of necrotic pulp [ 14 , 15 , 24 ]. For instance, caries can lead to pulp infection and may result in an interruption of root development, which represents an indication for revascularization therapy as well [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…From 2001 lots of case reports, case series and review papers were published [10,11]. They observed not only the healing of periapical lesion, but also an increase in root length and thickness [12][13][14][15][16]. Some studies even described a restoring of pulp vitality [16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

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Outcome of revascularization therapy in traumatized immature incisors

et al. 2020

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Background: The aim of this retrospective analysis was to evaluate the clinical and radiological outcome of revascularization therapy in traumatized permanent incisors to determine whether this approach could be implemented into clinical routine. Methods: A total of 16 traumatized incisors (either avulsion or severe luxation/intrusion) with open apices (> 1 mm) that underwent revascularization following a standardized protocol were analyzed with a mean follow-up of 22 months. Radiographs and clinical parameters (such as root length, pulp space, dentin wall width, apical foramen, alveolar bone loss, ankylosis/mobility, supra−/infraposition, discoloration, probing depth) were compared pre-and postoperatively and statistically analyzed. Results: Over the follow-up period, 81.3% of the teeth survived revascularization and regained sensitivity, while 18.7% failed, as they had to be extracted due to serious root resorption. Regarding radiographic outcomes a significant difference could only be found in the decrease of apical foramina (p = 0.04). The other parameters showed no significant difference between pre-and postoperative measurements. More than half of the teeth (56.3%) developed root resorptions and 31.3% displayed signs of ankylosis and 92.9% developed discolorations during follow-up. However, 85.7% of the teeth maintained the bone level and outcomes of mobility showed a significant solidification. Conclusions: Revascularization is a promising approach for the treatment of immature incisors to regain sensitivity and to enhance apical closure and at least to maintain alveolar bone in terms of a socket preservation. Further studies have to be performed to determine ideal conditions (type of trauma, age, width of apical foramen) for a revascularization.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcome of revascularization therapy in traumatized immature incisors

et al. 2020

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“…In addition, obtaining fresh blood clot is not always possible and there is enough evidence to support this drawback. 11,12 Although various biologically based scaffold materials like platelet-rich plasma or platelet-rich fibrin, and collagen have been used with successful results, each one documented with their own disadvantages. Therefore, there is a quest for the best approach which leads to the development of the amniotic membrane in the arena of tooth tissue engineering.…”

Section: Discussionmentioning

confidence: 99%

Revascularization of a Nonvital, Immature Permanent Tooth Using Amniotic Membrane: A Novel Approach

Nagaveni

Poornima

Bajaj³

et al. 2019

International Journal of Clinical Pediatric Dentistry

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AimTo evaluate the clinical and radiological results of a revascularization treatment done in a nonvital, immature permanent tooth using the amniotic membrane.Case descriptionA 12-year-old boy reported with a complaint of pain in the lower left back tooth since 1 month due to dental caries. On clinical examination, the mandibular left second premolar was tender on percussion and discolored due to dental caries. Radiographic examination of the same tooth revealed open apex, thin root dentinal walls, and periodontal ligament widening. An access opening was prepared, necrotic pulp extirpated completely followed by thorough irrigation. After drying the canal, closed dressing with the 3-mix antibacterial paste was given for 15 days. After 15 days, the paste was removed and the amniotic membrane was placed inside the canal extending 1 mm beyond the apex and mineral tri-oxide aggregate was placed over this followed by sealing of the cavity. The patient was followed up at 1, 3, and 6 months for clinical and radiographic evaluation.ConclusionAfter 6 months, clinically the tooth found asymptomatic. Radiographic examination showed continued root elongation, closure in the periapical opening, thick root dentinal walls with narrowing of the canal space, and normal periradicular architecture.Clinical significanceAmniotic membrane can be used as a scaffold for revascularization in nonvital immature teeth.How to cite this articleNB Nagaveni, P Poornima, et al. Revascularization of a Nonvital, Immature Permanent Tooth Using Amniotic Membrane: A Novel Approach. Int J Clin Pediatr Dent 2019;12(2):150–152.

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What is the best long-term treatment modality for immature permanent teeth with pulp necrosis and apical periodontitis?

Wikström

Brundin

Lopes

et al. 2021

Eur Arch Paediatr Dent

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Purpose To evaluate and assess the current knowledge about apexification and regenerative techniques as a meaningful treatment modality and to map the scientific evidence for the efficacy of both methods for the management of traumatised immature teeth with pulp necrosis and apical periodontitis. Methods This systematic review searched five databases: PubMed, Web of Science, Cochrane Library, Ovid (Medline), and Embase. Published articles written in English were considered for inclusion. The following keywords were used: Regenerative endodontic treatment OR regenerat* OR revital* OR endodontic regeneration OR regenerative endodontics OR pulp revascularization OR revasculari* OR ‘traumatized immature teeth’. Only peer-reviewed studies with a study size of at least 20 cases followed up for 24 months were included. Eligibility assessment was performed independently in a blinded manner by three reviewers and disagreements were resolved by consensus. Subgroup analyses were performed on three clinical outcomes: survival, success, and continued root development. Results Seven full texts out of 1359 citations were included and conventional content analysis was performed. Most of the identified citations were case reports and case series. Conclusions In the present systematic review, the qualitative analysis revealed that both regenerative and apexification techniques had equal rates of success and survival and proved to be effective in the treatment of immature necrotic permanent teeth. Endodontic regenerative techniques appear to be superior to apexification techniques in terms of stimulation of root maturation, i.e. root wall thickening and root lengthening. Knowledge gaps were identified regarding the treatment and follow-up protocols for both techniques.

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Dental Pulp Revascularization of Necrotic Permanent Teeth with Immature Apices

Cited by 22 publications

References 5 publications

Outcome of revascularization therapy in traumatized immature incisors

Outcome of revascularization therapy in traumatized immature incisors

Revascularization of a Nonvital, Immature Permanent Tooth Using Amniotic Membrane: A Novel Approach

What is the best long-term treatment modality for immature permanent teeth with pulp necrosis and apical periodontitis?

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