Radiographic and Clinical Outcomes of the Treatment of Immature Permanent Teeth by Revascularization or Apexification: A Pilot Retrospective Cohort Study

Abstract

Introduction This retrospective cohort study compared clinical and radiographic outcomes of endodontic treatment performed in immature non-vital permanent teeth, by apexification (calcium hydroxide or apical barrier with Mineral Trioxide Aggregate (MTA)), versus revascularization. Methods A comprehensive chart review was performed to obtain a cohort of sequential previously completed cases with recalls. Clinical and radiographic data were collected for 31 treated teeth (19 revascularization and 12 apexification) with an average follow up time of 17 months and a recall rate of 63%. Tooth survival, success rate, and adverse events were analyzed. Changes in radiographic root length, width and area were quantified. Results The majority of treated teeth survived throughout the study period with 30/31 (97%) teeth surviving (18/19 (95%) revascularization, 12/12 apexification). Most cases were also clinically successful with 27/31 (87%) meeting criteria for success, (15/19 (78%) revascularization and 12/12 apexification; non-significant difference). A greater incidence of adverse events was observed in the revascularization group (8/19 (42%) versus 1/12 (11%) in apexification (Risk Ratio= 5.1, p=0.04, 95%CI (0.719, 35.48)). Although more revascularization cases than apexification cases demonstrated an increase in radiographic root area and width, the effect was not statistically significant. Conclusion In this study, revascularization was not superior to other apexification techniques in either clinical or radiographic outcomes. Studies with large subject cohorts, and long follow up periods are needed to evaluate outcomes of revascularization and apexification, while accounting for important co-variants relevant to clinical success.

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

“…At 12 months, the average within-case percent change from the pre-operative radiograph was 20%. This is comparable to what was observed in other cohort studies including Jeeruphan et al, who reported an average 27% increase with an average of 21 months follow up, and Alobaid et al, who saw a 10% increase with an average of 15 months follow up (4, 18). Differences in within- case radiographic changes could be due to non-standardized radiographs being used in the retrospective cohort studies, which often can reduce the accuracy in measuring the actual radiographic change.…”

“…This was the most robust and consistent radiographic change observed in the population treated in this study. Radiographic evidence of apical closure of revascularized teeth has been observed in other studies at various follow up times (10, 18–20), however, the frequency and time course of the occurrence of apical closure after revasc/revit treatment was not appreciated before this study.…”

“…Rather, cohort studies are needed with well defined inclusion/exclusion criteria, and which take into account subjects lost during the follow up period. Two retrospective cohort studies including about 20 revasc/revit studies have also reported fairly high rates of clinical success (78 and 100%) and radiographic healing of periapical lesions subsequent to treatment (93 and100%) (4, 18). Taken together, regenerative endodontic therapy appears to have a high clinical success rate, in the initial 1–2 years after treatment completion.…”

Management of Teeth with Persistent Apical Periodontitis after Root Canal Treatment Using Regenerative Endodontic Therapy

“…The treatment can result in regression of clinical signs/ symptoms as well as resolution of apical periodontitis. In addition, thickening of the canal walls and/or continued root development may occur in some cases (3)(4)(5). According to the American Association of Endodontists guidelines, the primary goals of RET are resolution of apical periodontitis and elimination of clinical signs/symptoms (6).…”

Growth Factors and Cell Homing in Dental Tissue Regeneration

“…Immature pulpless teeth are also more vulnerable to injury, losing the ability to sense environmental change and are more prone to root fracture [3, 4]. Traditional treatment of immature teeth is apexification, which involves placing a tri-calcium silicate matrix at the apex [5], or inducing a barrier using calcium hydroxide; however, these techniques are not designed to induce extension of root length or width [6, 7] and generally have poor long-term prognosis [8]. Therefore, strategies to either maintain pulpal health or stimulate the development of new biological tissue are paramount, not only to promote minimally invasive solutions but also to retain or reinstate the capacity of the pulp to generate tertiary dentin and respond to injurious stimuli [9•].…”