Rate and predictability of pulp revascularization in therapeutically reimplanted permanent incisors

Kling, Margareta; Cvek, Miomir; Mejàre, Ingegerd

doi:10.1111/j.1600-9657.1986.tb00132.x

Cited by 236 publications

(222 citation statements)

References 15 publications

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“…Andreasen et al (31,32) and Kling et al (33) showed excellent radiographic images of the ingrowth of bone and periodontal ligament (PDL) (next to the inner dentinal wall) into the canal space with arrested root formation after the replantation of avulsed maxillary incisors, suggesting a complete loss of the viability of pulp, apical papilla, and/or HERS. Some cases showed partial formation of the root accompanied with ingrowth of bone and PDL into the canal space, and in some cases the teeth continued to develop roots to their completion, suggesting that there was partial or total pulp survival after the replantation.…”

Section: The Potential Role Of Scap In Replantation and Transplantationmentioning

confidence: 99%

The Hidden Treasure in Apical Papilla: The Potential Role in Pulp/Dentin Regeneration and BioRoot Engineering

Huang

Sonoyama

Liu

et al. 2008

Journal of Endodontics

652

543

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Some clinical case reports have shown that immature permanent teeth with periradicular periodontitis or abscess can undergo apexogenesis after conservative endodontic treatment. A call for a paradigm shift and new protocol for the clinical management of these cases has been brought to attention. Concomitantly, a new population of mesenchymal stem cells residing in the apical papilla of permanent immature teeth recently has been discovered and was termed stem cells from the apical papilla (SCAP). These stem cells appear to be the source of odontoblasts that are responsible for the formation of root dentin. Conservation of these stem cells when treating immature teeth may allow continuous formation of the root to completion. This article reviews current findings on the isolation and characterization of these stem cells. The potential role of these stem cells in the following respects will be discussed: (1) their contribution in continued root maturation in endodontically treated immature teeth with periradicular periodontitis or abscess and (2) their potential utilization for pulp/ dentin regeneration and bioroot engineering. KeywordsApexogenesis; apical papilla; bioroot engineering; dental pulp stem cells; immature teeth; periodontal ligament stem cells; pulp regeneration; stem cells from human exfoliated deciduous teeth; stem cells from the apical papilla A number of recent clinical case reports have revealed the possibilities that many teeth that traditionally would receive apexification may be treated for apexogenesis. A call for a paradigm shift and new protocol for the clinical management of these cases has been made by the authors (1-3). A recent scientific finding, which may explain in part why apexogenesis can occur in these infected immature permanent teeth, is the discovery and isolation of a new population of mesenchymal stem cells (MSCs) residing in the apical papilla of incompletely developed teeth (4,5). These cells are termed stem cells from the apical papilla (SCAP), and they differentiate

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Section: The Potential Role Of Scap In Replantation and Transplantationmentioning

confidence: 99%

The Hidden Treasure in Apical Papilla: The Potential Role in Pulp/Dentin Regeneration and BioRoot Engineering

Huang

Sonoyama

Liu

et al. 2008

Journal of Endodontics

652

543

View full text Add to dashboard Cite

show abstract

“…Additionally, the overall rate of periodontal healing was related to the stage of root development and was better for teeth with incomplete apical closure (23). sonable prognosis for the retention (25)(26)(27)(28). In an assessment of 154 replanted avulsed permanent incisors that correlated pulp revascularization with respect to the width of the apical foramen, the rate of revascularization in the entire sample studied was 8% with a difference between immature teeth (which was 18%) and mature teeth (which was 0%).…”

Section: Discussionmentioning

confidence: 99%

“…In light of these clinical studies (25)(26)(27)(28), it is clear that pulp revascularization and periodontal reattachment can be considered viable outcomes with favourable prognoses for replanted avulsed immature permanent teeth among children, within the parameters of current guidelines for the management of tooth avulsions (16,17).…”

Section: Discussionmentioning

confidence: 99%

“…In an assessment of 154 replanted avulsed permanent incisors that correlated pulp revascularization with respect to the width of the apical foramen, the rate of revascularization in the entire sample studied was 8% with a difference between immature teeth (which was 18%) and mature teeth (which was 0%). However, the rate of revascularization was highest at 25% among the group of immature teeth with an apical foramen width of 2 to 3 mm (25). A clinical and radiographic retrospective study of 33 teeth with fully formed root lengths but with open apices at Moorrees (24) stages 5 and 6, replanted within 1 to 3 hours or more after avulsion and followed for up to 5 years, found that only 24% were diagnosed with pulp necrosis and endodontically treated.…”

Section: Discussionmentioning

confidence: 99%

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Dental Pulp Revascularization in a Replanted Avulsed Immature Maxillary Permanent Central Incisor

Fiore¹,

Hartwell²

2017

Eur Endod J

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An 8-year-old girl sustained an accidental traumatic avulsion of her right maxillary permanent central incisor. She arrived with her mother at a hospital dental clinic with the right maxillary central incisor tooth wrapped in a wet paper towel over 1 hour after the injury. Replantation was accomplished without root surface alteration or root canal intervention. Clinical and radiographic follow-up examinations for over 1 year revealed continued root growth and apical development of the replanted avulsed immature maxillary central incisor with no signs or symptoms of pulpal or periapical pathosis. Excellent outcomes were achieved for periodontal ligament reattachment without removal of the periodontal membrane and pulp revascularization without endodontic intervention.

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“…Optimal replantation techniques, prompt replantation to minimize the risk of infection, and an open apex greater than 1.1 mm increases the chances of revasularization. 2 Recently, a number of case series and case reports have described continued root development and even responses to pulp sensibility testing in treated necrotic immature teeth with infected root canal systems, including those with draining sinus tracts. [3][4][5][6][7][8][9] These regenerative endodontic procedures and revasularization of the root canal in teeth with infected root canal systems have been termed 'a paradigm shift' in the treatment protocol for endodontic management.…”

Section: Introductionmentioning

confidence: 99%

Regenerative endodontics – biologically‐based treatment for immature permanent teeth: a case report and review of the literature

Thomson

Kahler

2010

Australian Dental Journal

114

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Background: A paradigm shift in the treatment of immature, necrotic teeth has occurred with biologically-based principles and regenerative endodontic protocols replacing traditional 'apexification' procedures. Preliminary research suggests that stem and progenitor cells from the pulp and ⁄ or periodontium contribute to continued root development when regenerative procedures are followed. Methods: A mandibular premolar tooth with a chronic periapical abscess was irrigated with sodium hypochlorite with minimal instrumentation and then dressed with tri-antibiotic paste consisting of ciprofloxacin, metronidazole and amoxicillin. At a subsequent visit a blood clot was evoked in the canal by irritating periapical tissues and the canal sealed with mineral trioxide aggregate, glass ionomer cement and composite resin. Results: Resolution of apical periodontitis and the draining sinus, continued root maturation and apical closure occurred over an 18-month period. The tooth became responsive to pulp sensibility testing. Conclusions: It is important that dentists recognize the potential of regenerative endodontics in the treatment of necrotic, immature teeth. Initial management should involve irrigation with sodium hypochlorite only. Intra-canal medicaments, such as calcium hydroxide, are contraindicated as they inhibit further root growth. This report uses a variation of the triantibiotic paste currently recommended for regenerative procedures that avoided the discolouration of the crown associated with current protocols. Regenerative endodontics with continued root growth may reduce the risk of fracture and premature tooth loss associated with traditional 'apexification' procedures where the root remains thin and weak.

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Rate and predictability of pulp revascularization in therapeutically reimplanted permanent incisors

Cited by 236 publications

References 15 publications

The Hidden Treasure in Apical Papilla: The Potential Role in Pulp/Dentin Regeneration and BioRoot Engineering

The Hidden Treasure in Apical Papilla: The Potential Role in Pulp/Dentin Regeneration and BioRoot Engineering

Dental Pulp Revascularization in a Replanted Avulsed Immature Maxillary Permanent Central Incisor

Regenerative endodontics – biologically‐based treatment for immature permanent teeth: a case report and review of the literature

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