European Society of Endodontology position statement: Revitalization procedures

Abstract

This position statement represents a consensus of an expert committee convened by the European Society of Endodontology (ESE) on revitalization procedures. The statement is based on current clinical and scientific evidence as well as the expertise of the committee. The goal is to provide suitably trained dentists with a protocol including procedural details for the treatment of immature teeth with pulp necrosis as well as a patient consent form. Revitalization is a biologically based treatment as an alternative to apexification in properly selected cases. Previously published review articles provide more detailed background information and the basis for this position statement (Journal of Endodontics, 39, 2013, S30; Journal of Endodontics, 39, 2013, 319; Journal of Endodontics, 40, 2014, 1045; Dental Traumatology, 31, 2015, 267; International Endodontic Journal, 2015, doi: ). As controlled clinical trials are lacking and new evidence is still emerging, this position statement will be updated at appropriate intervals. This might lead to changes to the protocol provided here.

Continued root maturation despite persistent apical periodontitis of immature permanent teeth after failed regenerative endodontic therapy

“…In RET, an increase in root thickness and length of immature permanent teeth with necrotic pulp is considered a successful outcome . However, in the cases presented here, apical closure was observed in immature permanent teeth as adventitious findings of failed RET accompanied by persistent apical periodontitis.…”

“…However, it has been shown that the arrested physiological development of roots of immature permanent teeth with necrotic pulp and/or apical periodontitis could resume normal development after successful regenerative endodontic therapy (RET) evidenced by radiographic findings of thickening of the canal walls and/or continued root development . Increased thickness of the root canal walls and root length of immature permanent teeth with necrotic pulp and/or apical periodontitis after RET is considered a criteria of success by the American Association of Endodontists and the European Society of Endodontology (ESE) . Control of root canal infection of immature permanent teeth with necrotic pulp and/or apical periodontitis after RET is necessary for root maturation to occur .…”

Outcome of Regenerative Endodontic Treatment for an Avulsed Immature Permanent Tooth: A Case Report

“…In this case, there was no mechanical instrumentation of the root canal walls during procedures and antibiotic paste containing equal powdered proportions of ciprofloxacin, metronidazole, and cefaclor was used as protocols by AAE [6] and European Society of Endodontology [7]. But only sodium hypochlorite and sterile normal saline were used as irrigants, which is different from the protocols using EDTA in addition to them.…”

“…Recently, evidence for pulp regeneration, even in infected immature teeth, was presented [4]. Clinical guidelines for regenerative endodontic treatment (RET) published by the American Association of Endodontics (AAE) [6] and the European Society of Endodontology [7] proposed a two-step protocol as follows. At the first visit, the clinician performs chemical debridement and places intracanal medicaments comprising calcium hydroxide or antibiotic pastes.…”

Microbiological aspects of traumatic injuries

“…Contemporary regenerative protocols for immature teeth with pulp necrosis involve the use of intracanal antibiotics or calcium hydroxide. 75 With respect to antibiotics, triple antibiotic paste (com- (Table 3). 76 The susceptibility of endodontic pathogens to various antibiotics in hydrogel vehicles or other scaffold materials is currently being explored 28 ( Figure 5).…”