Management of permanent teeth with necrotic pulps and open apices according to the stage of root development

Plascencia, Hugo; Díaz, Mariana; Gascón, Gerardo; Garduño, Susana; Guerrero-Bobadilla, Carlos; Alba, Salvador Márquez-de; González-Barba, Geovani

doi:10.4317/jced.54287

Cited by 9 publications

(5 citation statements)

References 32 publications

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“…Journal of endodontics. 2008; 34(10):1171–6 Follow up periods not stated Plascencia et al ( 2017 ) Management of permanent teeth with necrotic pulps and open apices according to the stage of root development. Journal of clinical and experimental dentistry.…”

Section: Resultsmentioning

confidence: 99%

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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Section: Resultsmentioning

confidence: 99%

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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show abstract

“…Currently, apexification is regarded as the most classical treatment; however, long-term intracanal medication may decrease root strength due to the hygroscopic and proteolytic properties of calcium hydroxide[ 9 , 10 ]. The key to the apical barrier technique is to seal the wide-open apex tightly with bioceramic materials, such as iRoot BP plus or mineral trioxide aggregate[ 11 ], to prevent further infections. It is often a substantial technical challenge for dentists, and if the treatment fails, it is difficult to address[ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Different endodontic treatments induced root development of two nonvital immature teeth in the same patient: A case report

Chai¹,

Yang²,

Zhang³

2023

World J Clin Cases

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BACKGROUND Pulp revascularization is a novel way to treat immature teeth with periapical disease, and the technique has become increasingly well established in recent years. By puncturing the periapical tissue, bleeding is induced, and a blood clot is formed in the root canal. The blood clot acts as a natural bioscaffold onto which mesenchymal stem cells from periapical tissue can be seeded and restore pulp vascularity, thus promoting root development as well as apical closure. Although the effect of pulp revascularization is ideal, there are certain requirements for the apical condition of the teeth. The apical barrier technique and apexification are still indispensable for teeth that cannot achieve ideal blood clot formation. In addition, a meta-analysis of several clinical studies concluded that pulp revascularization has no significant advantages over other treatments. CASE SUMMARY A 10-year-old girl complained of pain in the right upper and lower posterior teeth for 2 d. Clinical and radiological examinations revealed that both the right maxillary and mandibular second premolars were immature with periapical radiolucency. The right maxillary second premolar was treated by pulp revascularization, while the right mandibular second premolar was treated by conventional apical barrier surgery after revascularization failed. The purpose of this report is to compare the different root maturation processes induced by the pulp revascularization and apical barrier techniques in the same patient in homonymous teeth from different jaws. Twelve months of follow-up showed that the apical foramen of both teeth presented a clear tendency to close; however, the tooth treated with pulp revascularization showed a significant increase in root length as well as root canal wall thickness. CONCLUSION For the treatment of nonvital immature teeth, pulp revascularization showed a superior therapeutic effect in comparison with the apical barrier technique.

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“…In a study by Vaessen et al evaluating IPI scores for the detection of respiratory events in patients undergoing UGE under sedation, it was reported that the use of IPI cannot be recommended in UGE, especially when CO2 was used (24). In another study by Berkenstadt et al, a limited agreement was found between respiratory physiological parameters and IPI scores (16).…”

Section: Discussionmentioning

confidence: 99%

“…The correlation between IPI respiratory physiological parameters in patients undergoing surgery and colonoscopy has been reported (15,16). However, there is only limited evidence on its role and usefulness in other clinical situations, including upper GI endoscopy.…”

Section: Introductionmentioning

confidence: 99%

The Role of the Integrated Pulmonary Index in Determining Respiratory Complications in Patients Undergoing Upper Gastrointestinal Endoscopy Under Sedation

Kazancıoğlu

Batçık

2021

Middle Black Sea Journal of Health Science

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Objective: In this study, we aimed to evaluate the respiratory complications defined by the Integrated Pulmonary Index (IPI) in patients with comorbid risk factors who underwent Upper gastrointestinal endoscopy (UGE) under sedation. Methods: This cross-sectional, prospective study was conducted with 157 patients, aged over 18 years, in our endoscopy unit between July 2020 and December 2020. Patients' demographic data, body mass index (BMI), ASA class and comorbidities were recorded. The mean arterial pressure (MAP), and HR, RR, SpO2, EtCO2 for the IPI were measured as baseline values and 5 minutes of the procedure and compared between two groups as the patients who developed (Group I) and did not develop (Group II) complications. Results: The mean BMI value was statistically significantly higher in Group I compared to Group II (p<0.001). The mean HR was statistically significantly higher and IPI score significantly lower in Group I than in Group II before the procedure (p=0.013, p=0.01; respectively). The mean SpO2, EtCO2 and IPI values were statistically significantly lower in Group I compared to Group II at 5 minutes of the procedure (p=0.001, p=0.004, p=0.010; respectively). The frequency of comorbidities was statistically significantly higher in Group I. In the logistic regression analysis, BMI value was found as an independent factor affecting the development of respiratory complications. Conclusion:The mean IPI scores dropped significantly in patients who developed complications, mainly due to the decreases in EtCO2 and SpO2 values at 5 minutes of the procedure. BMI was determined as a risk factor for the development of respiratory complications. IPI monitoring can provide guidance during sedation of patients with comorbid diseases undergoing UGE.

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Management of permanent teeth with necrotic pulps and open apices according to the stage of root development

Cited by 9 publications

References 32 publications

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

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

Different endodontic treatments induced root development of two nonvital immature teeth in the same patient: A case report

The Role of the Integrated Pulmonary Index in Determining Respiratory Complications in Patients Undergoing Upper Gastrointestinal Endoscopy Under Sedation

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