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Nogueira APA, Grazziotin-Soares R, Leal AMM, Freitas Júnior SAG, Gonçalves BLL, Bauer J, Ferreira MC, Carvalho CN. Root Canal Dentin Microhardness after Contact with Antibiotic Medications: An In Vitro Study. Dent J (Basel) 2024; 12:201. [PMID: 39056988 PMCID: PMC11276266 DOI: 10.3390/dj12070201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/19/2024] [Accepted: 05/21/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Antibiotic pastes used as intracanal medication in cases of revascularization therapy might cause negative effects on tooth properties, such as a reduction in dentin microhardness. This in vitro study investigated dentin microhardness in three different locations distancing from the canal lumen after 20 days of treatment with a tri-antibiotic paste (ciprofloxacin, metronidazole, and minocycline), and with a double-antibiotic paste (ciprofloxacin and metronidazole), with calcium hydroxide [Ca(OH)2] UltracalTM XS-treated dentin as comparison. Material and Methods: Human mandibular premolars (n = 48) had the root canals cleaned and shaped and were used to produce dentin slices. Dentin slices remained immersed in the medications for 20 days. The Knoop microhardness (KHN) test was performed before (baseline/Day-0) and after treatment (Day-20) with the medications. Indentations were made at 25 µm, 50 µm, and 100 µm distances from the root canal lumen. The KHN was compared intra-group using Wilcoxon's test. Independent groups were compared using Mann-Whitney's and Kruskal-Wallis' tests, at α = 5%. Results: The microhardness in all the tested groups was reduced at Day-20 in comparison with Day-0 (p < 0.001) (intra-group comparison/same distances). The Day-0 values were similar, and the Day-20 values were higher for the Ca(OH)2 group (p < 0.05) (comparison between groups/same distances). Conclusions: Calcium hydroxide for 20 days would be preferred rather than antibiotic pastes to minimize the expected reduction in dentin microhardness during regenerative procedures.
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Affiliation(s)
- Amanda Palmeira Arruda Nogueira
- School of Dentistry, CEUMA University, São Luís 65075-120, MA, Brazil; (A.P.A.N.); (A.M.M.L.); (S.A.G.F.J.); (B.L.L.G.); (M.C.F.)
| | - Renata Grazziotin-Soares
- Department of Oral Biological Medical Sciences, Faculty of Dentistry, University of British Columbia UBC, Vancouver, BC V6T 1Z4, Canada;
| | - Adriana Marques Mesquita Leal
- School of Dentistry, CEUMA University, São Luís 65075-120, MA, Brazil; (A.P.A.N.); (A.M.M.L.); (S.A.G.F.J.); (B.L.L.G.); (M.C.F.)
| | | | - Bruna Laís Lins Gonçalves
- School of Dentistry, CEUMA University, São Luís 65075-120, MA, Brazil; (A.P.A.N.); (A.M.M.L.); (S.A.G.F.J.); (B.L.L.G.); (M.C.F.)
| | - José Bauer
- Dental Materials Laboratory, School of Dentistry, University Federal of Maranhão (UFMA), São Luís 5085-582, MA, Brazil;
| | - Meire Coelho Ferreira
- School of Dentistry, CEUMA University, São Luís 65075-120, MA, Brazil; (A.P.A.N.); (A.M.M.L.); (S.A.G.F.J.); (B.L.L.G.); (M.C.F.)
| | - Ceci Nunes Carvalho
- School of Dentistry, CEUMA University, São Luís 65075-120, MA, Brazil; (A.P.A.N.); (A.M.M.L.); (S.A.G.F.J.); (B.L.L.G.); (M.C.F.)
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Bartaw RT, Eid MH, Gawad RYAA, Samad AMA. Discoloration after revascularization using calcium phosphosilicate-based bioceramic versus mineral trioxide aggregate in necrotic immature permanent anterior teeth: A Randomized clinical trial. JOURNAL OF CONSERVATIVE DENTISTRY AND ENDODONTICS 2024; 27:293-304. [PMID: 38634024 PMCID: PMC11019812 DOI: 10.4103/jcde.jcde_337_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 04/19/2024]
Abstract
Aim The aim of the current study is to evaluate the effect of calcium phophosilicate-based bioceramic "Totalfill bioceramic putty" and white mineral trioxide aggregate (WMTA) as the coronal plug on discoloration after revascularization of necrotic immature permanent anterior teeth. Materials and Methods This study was conducted on (48) necrotic young permanent central incisors in children ranging from 8 to 14 years old, that were randomly allocated to either Totalfill bioceramic (Group I = 24) or WMTA (Group II = 24) as the coronal plug. Two visits revascularization protocol was adopted in this study using 1.5% sodium hypochlorite, followed by 17% ethylenediaminetetraacetic acid, and ending with a saline flush as irrigation solution. The double antibiotic paste was used as intracanal medication. The blood clot was used as scaffold followed by the application of collagen membrane followed by coronal plud malterial. Finally, the access was sealed using resin composite restoration and composite restoration. Clinical assessment was conducted at 1, 3, 6, 9, and 12 months, while radiographic assessment was conducted at 6 and 12 months. Data were statistically analyzed using the Chi-squared test for intergroup comparisons and Cochran's Q test for intragroup comparison. Results Clinically, Group I exhibited a success rate of 100%, whereas Group II exhibited a success rate of 85.7%. Radiographically, both materials showed a 90.5% success rate. There was no statistically significant difference between both materials for all assessed clinical and radiographic parameters at different follow-up periods. Conclusions Both Totalfill bioceramic putty and WMTA can be used successfully as coronal plug in esthetic areas.
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Affiliation(s)
- Rana Tarek Bartaw
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Cairo University, Giza, Egypt
| | - Mahmoud Hamdy Eid
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Cairo University, Giza, Egypt
| | - Randa Youssef Abd Al Gawad
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Cairo University, Giza, Egypt
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Alsofi L, Almarzouki S. Failed Regenerative Endodontic Case Treated by Modified Aspiration-irrigation Technique and Apexification. J Contemp Dent Pract 2024; 25:92-97. [PMID: 38514438 DOI: 10.5005/jp-journals-10024-3601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
AIM This report addresses the management of a large persistent discharging lesion in an 11-year-old boy. The report describes the use of aspiration-irrigation technique for the management of immature necrotic tooth with persistent discharge after a failed regenerative procedure. BACKGROUND Regenerative endodontics aim to provide an increase in root canal width, length, and in apical closure. Alternative procedures, such as apexification, should be attempted when regeneration fails. If the canal cannot be dried to persistent discharge, the aspiration-irrigation technique can be used. The technique relies on using aspiration along with irrigation to remove pus from the periapical area. CASE DESCRIPTION This is a case for an 11-year-old patient who had trauma to tooth #11, which resulted in the complicated crown fracture. He had an emergency management that included pulpectomy and intracanal medication at another clinic. Two years later, the patient was presented to our clinic. Upon examination, the diagnosis was previously initiated therapy with asymptomatic apical periodontitis in immature tooth #11. Regeneration was attempted first but failed. The mineral trioxide aggregate (MTA) plug was removed, and the canal had persistent pus discharge. The canal was filled with intracanal medication, and then 2 weeks later, the canal was filled with triple antibiotic paste (TAP). Next visit, and due to continuous discharge, tooth #11 was treated conservatively with an intracanal aspiration-irrigation technique. An IrriFlex needle attached to a high-volume suction was used to aspirate the cystic fluid. Mineral trioxide aggregate plug apexification was performed in a later visit and the tooth was restored. CONCLUSION During the 3-month and 16-month follow-up, there was resolution of the symptoms, a decrease in the periapical lesion size, and soft tissues appeared within normal limits. CLINICAL SIGNIFICANCE Regenerative procedures are a good option for immature necrotic teeth. These procedures may fail due to persistent pus discharge from the root canals. The aspiration-irrigation technique is a good treatment option in cases of consciously discharging canals. How to cite this article: Alsofi L, Almarzouki S. Failed Regenerative Endodontic Case Treated by Modified Aspiration-irrigation Technique and Apexification. J Contemp Dent Pract 2024;25(1):92-97.
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Affiliation(s)
- Loai Alsofi
- Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia, Phone: +966 555318481, e-mail:
| | - Sara Almarzouki
- Department of Endodontics, University Dental Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
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Lu J, Kahler B, Jiang X, Lu Z, Lu Y. Treatment outcomes of regenerative endodontic procedures in nonvital mature permanent teeth: a retrospective study. Clin Oral Investig 2023; 27:7531-7543. [PMID: 37875745 DOI: 10.1007/s00784-023-05343-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/14/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVES This retrospective study was undertaken to clinically and radiographically evaluate the long-term outcomes of regenerative endodontic procedures (REPs) for nonvital mature permanent teeth, to analyze predictors influencing treatment outcomes. METHODS Nonvital mature permanent teeth treated by REPs with a minimum follow-up period of 6 months were included from 2015 to 2017. Treatment outcomes were categorized as success and failure. The periapical status and lesion healing were assessed in terms of the periapical index (PAI) and the percentage changes in periapical radiolucency (PARL) area. The clinical and radiographic outcomes of REPs were assessed by Mann-Whitney test at different follow-up period. Kaplan-Meier curves and Univariate Cox regression analysis were conducted to assess the success and identify potential predictors affecting outcomes, respectively. RESULTS A total of 37 mature teeth with an average follow-up of 4.3 years satisfied the criteria, and 89.2% of the teeth had a successful outcome. Significant differences in PAI scores were found between each period with respect to the baseline (p < .05). Among different periods, there was a significant difference between intervals of 3-6 months and 7-12 months (p = .039) and no significant difference between each interval of more than 12 months (p > .05). Eighty-seven percent of teeth with preoperative PARL presented completely healed. REPs significantly decreased the PARL area at the interval of 7-12 months compared to 3-6 months (p = .025), with no significant difference between each interval of more than 12 months (p > .05). No significant predictor was found for the success of outcome (p > .05). Thirteen teeth (35.1%) regained pulp sensibility, and 40.5% of the teeth exhibited intracanal calcification. CONCLUSIONS Within the limitations of this study, REPs provided a high long-term success rate and promoted the resolution of PARL as a biologically-based alternative treatment option for nonvital mature teeth. CLINICAL RELEVANCE REPs provide a high long-term success rate and promoted healing of apical periodontitis comparable with reported outcomes for root canal therapy of mature teeth.
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Affiliation(s)
- Jing Lu
- Fujian Key Laboratory of Oral Diseases, School and Hospital of Stomatology, Fujian Medical University, 246 Yangqiao Zhong Road, Fuzhou, 350002, Fujian, China
| | - Bill Kahler
- School of Dentistry, University of Sydney, Camperdown, Australia
| | - Xing Jiang
- Fujian Key Laboratory of Oral Diseases, School and Hospital of Stomatology, Fujian Medical University, 246 Yangqiao Zhong Road, Fuzhou, 350002, Fujian, China
| | - Zhaojie Lu
- Fujian Key Laboratory of Oral Diseases, School and Hospital of Stomatology, Fujian Medical University, 246 Yangqiao Zhong Road, Fuzhou, 350002, Fujian, China
| | - Youguang Lu
- Fujian Key Laboratory of Oral Diseases, School and Hospital of Stomatology, Fujian Medical University, 246 Yangqiao Zhong Road, Fuzhou, 350002, Fujian, China.
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Hristov K, Doitchinova L, Gateva N. Regenerative endodontic treatment of immature permanent teeth after mechanical instrumentation with XP-Endo Finisher. Folia Med (Plovdiv) 2023; 65:460-467. [PMID: 38351823 DOI: 10.3897/folmed.65.e80063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/18/2022] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION The traditional treatment of immature permanent teeth with necrotic pulp involves creating an apical barrier by using calcium hydroxide or an MTA plug for an extended period of time. A novel therapeutic approach called regenerative endodontic procedures (REP) is used to allow root development to continue.
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Küçükkaya Eren S. Clinical applications of calcium silicate-based materials: a narrative review. Aust Dent J 2023; 68 Suppl 1:S96-S109. [PMID: 37885314 DOI: 10.1111/adj.12986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 10/28/2023]
Abstract
Calcium silicate-based materials are hydrophilic materials with biocompatibility and bioactivity properties. Despite many advantages, they might present some problems related to discolouration, setting time, manipulation and solubility depending on the composition of the product and the type of clinical application. Calcium silicate-based materials can be evaluated under two types according to their intended use: calcium silicate-based cements (CSCs) and calcium silicate-based sealers (CSSs). CSCs can be used in many endodontic procedures including perforation repair, resorption repair, apical barriers, guided endodontic repair, vital pulp treatment, endodontic surgery, root fractures and root canal filling as a core obturation material. CSSs are available for use with gutta-percha to obturate root canals using cold and warm techniques, including the sealer-based obturation technique. The purpose of this review is to evaluate the available literature on CSCs and CSSs and to provide up-to-date information and recommendations for their clinical applications.
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Affiliation(s)
- S Küçükkaya Eren
- Faculty of Dentistry, Department of Endodontics, Hacettepe University, Ankara, Turkey
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Dong X, Xu X. Bioceramics in Endodontics: Updates and Future Perspectives. Bioengineering (Basel) 2023; 10:bioengineering10030354. [PMID: 36978746 PMCID: PMC10045528 DOI: 10.3390/bioengineering10030354] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
Bioceramics, with excellent bioactivity and biocompatibility, have been widely used in dentistry, particularly in endodontics. Mineral trioxide aggregate (MTA) is the most widely used bioceramic in endodontics. Recently, many new bioceramics have been developed, showing good potential for the treatment of endodontic diseases. This paper reviews the characteristics of bioceramics and their applications in various clinical endodontic situations, including root-end filling, root canal therapy, vital pulp therapy, apexification/regenerative endodontic treatment, perforation repair, and root defect repair. Relevant literature published from 1993 to 2023 was searched by keywords in PubMed and Web of Science. Current evidence supports the predictable outcome of MTA in the treatment of endodontic diseases. Although novel bioceramics such as Biodentine, EndoSequence, and calcium-enriched mixtures have shown promising clinical outcomes, more well-controlled clinical trials are still needed to provide high-level evidence for their application in endodontics. In addition, to better tackle the clinical challenges in endodontics, efforts are needed to improve the bioactivity of bioceramics, particularly to enhance their antimicrobial activity and mechanical properties and reduce their setting time and solubility.
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Affiliation(s)
- Xu Dong
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China;
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Xin Xu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China;
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Correspondence: ; Tel.: +86-028-85503494
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Minic S, Vital S, Chaussain C, Boukpessi T, Mangione F. Tissue Characteristics in Endodontic Regeneration: A Systematic Review. Int J Mol Sci 2022; 23:ijms231810534. [PMID: 36142446 PMCID: PMC9504778 DOI: 10.3390/ijms231810534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 12/01/2022] Open
Abstract
The regenerative endodontic procedure (REP) represents a treatment option for immature necrotic teeth with a periapical lesion. Currently, this therapy has a wide field of pre-clinical and clinical applications, but no standardization exists regarding successful criteria. Thus, by analysis of animal and human studies, the aim of this systematic review was to highlight the main characteristics of the tissue generated by REP. A customized search of PubMed, EMBASE, Scopus, and Web of Science databases from January 2000 to January 2022 was conducted. Seventy-five human and forty-nine animal studies were selected. In humans, the evaluation criteria were clinical 2D and 3D radiographic examinations. Most of the studies identified a successful REP with an asymptomatic tooth, apical lesion healing, and increased root thickness and length. In animals, histological and radiological criteria were considered. Newly formed tissues in the canals were fibrous, cementum, or bone-like tissues along the dentine walls depending on the area of the root. REP assured tooth development and viability. However, further studies are needed to identify procedures to successfully reproduce the physiological structure and function of the dentin–pulp complex.
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Affiliation(s)
- Sandra Minic
- URP 2496 Laboratory of Orofacial Pathologies, Imaging and Biotherapies, Life Imaging Platform (PIV), Laboratoire d’excellence INFLAMEX, UFR Odontology, Université Paris Cité, 92120 Montrouge, France
| | - Sibylle Vital
- URP 2496 Laboratory of Orofacial Pathologies, Imaging and Biotherapies, Life Imaging Platform (PIV), Laboratoire d’excellence INFLAMEX, UFR Odontology, Université Paris Cité, 92120 Montrouge, France
- Louis Mourier Hospital, AP-HP, DMU ESPRIT, 92700 Colombes, France
| | - Catherine Chaussain
- URP 2496 Laboratory of Orofacial Pathologies, Imaging and Biotherapies, Life Imaging Platform (PIV), Laboratoire d’excellence INFLAMEX, UFR Odontology, Université Paris Cité, 92120 Montrouge, France
- Bretonneau Hospital Dental Department and Reference Center for Rare Diseases of Calcium and Phosphorus Metabolism, AP-HP, 75018 Paris, France
| | - Tchilalo Boukpessi
- URP 2496 Laboratory of Orofacial Pathologies, Imaging and Biotherapies, Life Imaging Platform (PIV), Laboratoire d’excellence INFLAMEX, UFR Odontology, Université Paris Cité, 92120 Montrouge, France
- Pitié Salpétrière Hospital, DMU CHIR, AP-HP, 75013 Paris, France
| | - Francesca Mangione
- URP 2496 Laboratory of Orofacial Pathologies, Imaging and Biotherapies, Life Imaging Platform (PIV), Laboratoire d’excellence INFLAMEX, UFR Odontology, Université Paris Cité, 92120 Montrouge, France
- Henri Mondor Hospital, AP-HP, 94000 Créteil, France
- Correspondence:
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Zeng Q, Zhang J, Guo J, Liu S, Yang M, Lin J. Preoperative factors analysis on root development after regenerative endodontic procedures: a retrospective study. BMC Oral Health 2022; 22:374. [PMID: 36058906 PMCID: PMC9442966 DOI: 10.1186/s12903-022-02412-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/26/2022] [Indexed: 12/22/2022] Open
Abstract
Background Regenerative endodontic procedures (REPs) have achieved clinical success on the immature permanent teeth with pulp necrosis, and can promote root development. However, preoperative factors and their effects on root development of REPs have not been definitely concluded. The aim of this study was to investigate the preoperative factors that may influence the root development of REPs. Methods A total of 116 teeth in 110 patients treated with REPs in the Paediatric Dentistry Department and Endodontics Department from 2013 to 2017 were included in this study. Preoperative factors including aetiology, age, diagnosis and initial root morphology were collected retrospectively, and the associations between these factors and root development after REPs were analysed by Fisher's exact test and multivariate logistic regression model. Results The overall rate of root development after REPs was 89.7%. The dens evaginatus group showed a higher rate (98.8%) in root development than the trauma group (67.6%) (P < 0.01). There was no significant difference among the different age groups (7–13 years old) or among different diagnoses groups (P > 0.05). And it showed in the trauma group that the teeth with apical foramen sizes larger than 3 mm significantly promoted root development than those smaller than 3 mm (P < 0.01). Multivariate logistic regression indicated that aetiology was significantly correlated with root development of REPs (OR: 0.07, 95% CI 0.007, 0.627, P < 0.05). Conclusions The REPs promoted more root developments in the dens evaginatus group than the trauma group, indicating that aetiology may be correlated with the root development of REPs. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02412-x.
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Affiliation(s)
- Qian Zeng
- Hospital of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, 510055, China
| | - Jianying Zhang
- Xiangya Stomatological Hospital, Xiangya School of Stomatology, Central South University, Hunan Key Laboratory of Oral Health Research, Changsha, Hunan, China
| | - Jiang Guo
- Hospital of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, 510055, China
| | - Shuya Liu
- Hospital of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, 510055, China
| | - Maobin Yang
- Department of Endodontology, Kornberg School of Dentistry, Temple University, Philadelphia, PA, USA.
| | - Jiacheng Lin
- Hospital of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, 510055, China.
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Panda P, Mishra L, Govind S, Panda S, Lapinska B. Clinical Outcome and Comparison of Regenerative and Apexification Intervention in Young Immature Necrotic Teeth-A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11133909. [PMID: 35807193 PMCID: PMC9267570 DOI: 10.3390/jcm11133909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 12/12/2022] Open
Abstract
This systematic review aimed to evaluate interventions individually and compare the clinical outcome of young, immature teeth treated with regenerative endodontic therapy (RET) and apexification procedure. The protocol was registered with PROSPERO (International Prospective Register of Systematic Reviews), bearing the registration number CRD42021230284. A bibliographic search in the biomedical databases was conducted in four databases—PubMed, CENTRAL, EMBASE and ProQuest—using searching keywords and was limited to studies published between January 2000 and April 2022 in English. The search was supplemented by manual searching, citation screening and scanning of all reference lists of selected paper. The study selection criteria were randomized clinical trial, prospective clinical studies and observational studies. The search found 32 eligible articles, which were included in the study. The quality assessment of the studies was performed using the Cochrane risk of bias tool for randomized control trials and non-randomized clinical studies. The meta-analysis was performed using Review Manager software (REVMAN, version 5). The results indicated that a clinicians’ MTA apexification procedure was more successful compared to calcium hydroxide. In RET, apical closure and overall success rate is statistically same for both apical platelet concentrates (APCs) and blood clots (BC). Both interventions have similar survival rates; however, RET should be preferred in cases where the root development is severely deficient, there is insufficient dentine and the tooth’s prognosis is hopeless even with an apexification procedure.
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Affiliation(s)
- Pratima Panda
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, Odisha, India; (P.P.); (S.G.)
| | - Lora Mishra
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, Odisha, India; (P.P.); (S.G.)
- Correspondence: (L.M.); (B.L.); Tel.: +91-889-526-6363 (L.M.); +85-42-675-74-61 (B.L.)
| | - Shashirekha Govind
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, Odisha, India; (P.P.); (S.G.)
| | - Saurav Panda
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar 751003, Odisha, India;
| | - Barbara Lapinska
- Department of General Dentistry, Medical University of Lodz, 92-213 Lodz, Poland
- Correspondence: (L.M.); (B.L.); Tel.: +91-889-526-6363 (L.M.); +85-42-675-74-61 (B.L.)
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Lee C, Song M. Failure of regenerative endodontic procedures: case analysis and subsequent treatment options. J Endod 2022; 48:1137-1145. [PMID: 35714726 DOI: 10.1016/j.joen.2022.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/15/2022] [Accepted: 06/05/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Regenerative endodontic procedures (REPs) are considered effective treatments for immature necrotic permanent teeth, with favorable outcomes. However, failed cases require subsequent treatment. This study aimed to review and analyze failed cases after REPs and suggest a treatment algorithm to aid clinical decision making. METHODS A total of 111 REP cases were selected that conducted between 2015-2020. Clinical outcomes were assessed based on clinical and radiographic evaluations. The criteria for failure included persistence of clinical signs or symptoms and/or periapical radiolucency showing persistent apical periodontitis. Cases requiring any treatment intervention, including extraction, were also considered failures. RESULTS Sixteen cases were included as failures. The etiology of pulpal disease was stratified into dental trauma (56%), dens evaginatus (25%), and dental caries (12.5%), with the remaining one case having an undocumented cause. The primary reasons for treatment failure were persistent infection (81.3%) and root resorption (18.7%). The identification time of failure varied, with six cases (37.5%) detected in less than six months and ten cases (62.5%) later than six months after REPs. Sixteen failed cases received five different interventions: second REPs, apexification, conventional root canal treatment, surgical approach, and extraction. CONCLUSION Interventions for failed REPs are challenging. Consideration of the treatability of the tooth, accessibility to the canal, and the presence of an apical seat might be key factors in clinical decision making to obtain a successful outcome.
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Affiliation(s)
- Chaehwan Lee
- Department of Conservative Dentistry, College of Dentistry, Yonsei University, Seoul, Korea.
| | - Minju Song
- Department of Conservative Dentistry, College of Dentistry, Dankook University, Cheonan, Korea.
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Liu H, Lu J, Jiang Q, Haapasalo M, Qian J, Tay FR, Shen Y. Biomaterial scaffolds for clinical procedures in endodontic regeneration. Bioact Mater 2022; 12:257-277. [PMID: 35310382 PMCID: PMC8897058 DOI: 10.1016/j.bioactmat.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 12/14/2022] Open
Abstract
Regenerative endodontic procedures have been rapidly evolving over the past two decades and are employed extensively in clinical endodontics. These procedures have been perceived as valuable adjuvants to conventional strategies in the treatment of necrotic immature permanent teeth that were deemed to have poor prognosis. As a component biological triad of tissue engineering (i.e., stem cells, growth factors and scaffolds), biomaterial scaffolds have demonstrated clinical potential as an armamentarium in regenerative endodontic procedures and achieved remarkable advancements. The aim of the present review is to provide a broad overview of biomaterials employed for scaffolding in regenerative endodontics. The favorable properties and limitations of biomaterials organized in naturally derived, host-derived and synthetic material categories were discussed. Preclinical and clinical studies published over the past five years on the performance of biomaterial scaffolds, as well as current challenges and future perspectives for the application of biomaterials for scaffolding and clinical evaluation of biomaterial scaffolds in regenerative endodontic procedures were addressed in depth. Overview of biomaterials for scaffolding in regenerative endodontics are presented. Findings of preclinical and clinical studies on the performance of biomaterial scaffolds are summarized. Challenges and future prospects in biomaterial scaffolds are discussed.
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Wikström A, Brundin M, Romani Vestman N, Rakhimova O, Tsilingaridis G. Endodontic pulp revitalization in traumatized necrotic immature permanent incisors: Early failures and long-term outcomes-A longitudinal cohort study. Int Endod J 2022; 55:630-645. [PMID: 35332566 PMCID: PMC9325385 DOI: 10.1111/iej.13735] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 11/29/2022]
Abstract
AIM This prospective cohort study evaluates clinical and radiographical outcomes of endodontic pulp revitalization (PR) of traumatized necrotic incisors. METHODOLOGY Pulp revitalization was performed in 75 traumatized necrotic immature incisors from 71 patients. The radiographic outcome measures were continued root formation (width and length), root resorption, apex closure, periapical index, and root development stage. The clinical outcome measures were percussion pain, palpation pain, pathological tooth mobility, swelling, sinus tract, ankylosis, crown discolouration, response to pulp sensitivity test, and subjective pain. Treatment outcomes were categorized as a success based on the absence of clinical symptoms and when radiographic evidence was present for apical healing and continued root development. The performed statistical tests were repeated measures anova, pairwise comparisons of interactions (t-test), McNemar's test, and linear regression model. RESULTS In 45 of 75 teeth (60%), PR was successful with the resolution of clinical and radiographic signs and continued root development. PR failed due to the absence of bleeding (n = 19) and persistent infection (n = 11). PR showed statistically significant increases in root length (11%), and dentinal wall thickness (30%), root maturation (pre-operative 3.38 [CI 1.88; 4.88]; post-operative 4.04, [CI 2.56; 5.52]) apical closure (71.4%), healing of pre-operative apical periodontitis (100%), and healing of pre-operative inflammatory root resorptions (100%). Three predictive variables for continued root maturation were identified - root development stage at entry (p = .0001, β 0.649), [CI 0.431; 0.867], trauma to the soft tissues (p = .026, β -0.012), [CI -0.0225; -0.015], and pre-operative dentinal wall thickness (p = .009, β -0.001); [CI -0.001; 0.0001]. CONCLUSIONS Our findings indicate that PR provides satisfactory clinical and radiographical outcomes in traumatized necrotic incisors. The failed cases were related to lack of bleeding and persistent infections, indicating that new techniques are needed to improve the predictability of PR.
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Affiliation(s)
- Alina Wikström
- Division of Orthodontics and Paediatric DentistryDepartment of Dental MedicineKarolinska InstituteStockholmSweden
- Department of EndodonticsPublic Dental Health ServicesEastmaninstitutetStockholmSweden
- Centre of Paediatric Oral HealthHuddingeSweden
| | | | - Nelly Romani Vestman
- Department of EndodonticsCounty Council of VästerbottenUmeåSweden
- Wallenberg Centre for Molecular MedicineUmeå UniversityUmeåSweden
| | | | - Georgios Tsilingaridis
- Division of Orthodontics and Paediatric DentistryDepartment of Dental MedicineKarolinska InstituteStockholmSweden
- Centre of Paediatric Oral HealthHuddingeSweden
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Alfahadi HR, Al-Nazhan S, Alkazman FH, Al-Maflehi N, Al-Nazhan N. Clinical and radiographic outcomes of regenerative endodontic treatment performed by endodontic postgraduate students: a retrospective study. Restor Dent Endod 2022; 47:e24. [PMID: 35692225 PMCID: PMC9160761 DOI: 10.5395/rde.2022.47.e24] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/21/2021] [Accepted: 11/03/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives Regenerative endodontic treatment is a clinical procedure aimed at biologically regenerating damaged root canal tissue of immature permanent teeth. This study aimed to report the outcomes of regenerative endodontic treatment performed by endodontic postgraduate students. Materials and Methods Clinical and radiographic data of 27 patients, aged 10–22 years, who underwent regenerative treatment of immature permanent teeth from 2015 to 2019 were followed up, wherein clinical and radiographic examinations were performed for each patient. Postoperative success rate and tooth survival were analyzed, and the postoperative radiographic root area changes were quantified. Results A total of 23 patients attended the dental appointments, showing that all teeth survived and were asymptomatic. Specifically, 7 periapical pathosis cases were completely healed, 12 were incompletely healed, and 4 cases failed. Moreover, significant differences were found between discolored and non-discolored teeth, and between the presence or absence of periapical radiolucency. Additionally, 3 anterior teeth showed complete closure of the apical foramen, while the apical foramen width was reduced in 17 teeth and failed in 3 teeth. Root length was also found to have been increased in 7 anterior and 4 posterior teeth, and the average length ranged from 4.00–0.63 mm in the anterior teeth, 2.85–1.48 mm of the mesial root, and 2.73–2.16 mm of the molar teeth distal root. Furthermore, calcified tissue deposition was observed in 7 teeth. Conclusions A favorable outcome of regenerative endodontic treatment of immature permanent teeth with necrotic pulp was achieved with a high survival rate.
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Affiliation(s)
| | - Saad Al-Nazhan
- Department of Restorative Dentistry - Endodontics, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
| | | | - Nassr Al-Maflehi
- Department of Preventive Dental Sciences - Biostatistics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Nada Al-Nazhan
- College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
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Galler KM, Akamp T, Knüttel H, Widbiller M. A critical analysis of clinical research methods to study regenerative endodontics. Int Endod J 2022; 55 Suppl 2:456-470. [PMID: 35338660 DOI: 10.1111/iej.13734] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
Regenerative endodontic treatment such as revitalization provides a treatment option for immature teeth with pulp necrosis. The main difference to the alternative procedure, the apical plug, is the induction of a blood clot inside the canal as a scaffold for healing and new tissue formation. Due to the biology-based and minimally-invasive nature of the treatment, revitalization has raised considerable interest in recent years. Whereas the procedure is fairly new and recommendations from endodontic societies have been in place only for a few years, the treatment protocol has evolved over the past two decades. Evidence has been created, not only from laboratory and animal work, but also from clinical studies including case reports, cohort studies and eventually prospective randomized controlled clinical trials, systematic reviews and meta-analyses. However, the research methods and clinical studies with subsequent reports oftentimes present with methodical limitations, which makes it difficult to objectively assess the value of this treatment modality. Several open questions remain, including the need for a more differentiated indication of revitalization after different traumatic injuries, the long-term prognosis of treated teeth and the true benefits for the patient. Therefore, this review aims to identify and reflect on such limitations, scrutinizing study design, diagnostic tools, procedural details and outcome parameters. A core outcome set is also proposed in this context, which can be considered in future clinical investigations. These considerations may lead to a more detailed and stringent planning and execution of future studies in order to create high-quality evidence for the treatment modality of revitalization and thus provide more robust data, create a larger body of knowledge for clinicians and further specify current recommendations.
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Affiliation(s)
- K M Galler
- Department of Operative Dentistry and Periodontology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen
| | - T Akamp
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
| | - H Knüttel
- University Library, University of Regensburg, Germany
| | - M Widbiller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
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Jiang X, Liu H, Peng C. Continued root development of immature permanent teeth after regenerative endodontics with or without a collagen membrane: A randomized, controlled clinical trial. Int J Paediatr Dent 2022; 32:284-293. [PMID: 34138499 DOI: 10.1111/ipd.12853] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/17/2021] [Accepted: 06/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recent studies evaluated the efficacy of a collagen membrane (Bio-Gide) to promote root development in regenerative endodontics (REPs). However, the influence of etiology and tooth type on the results was not assessed. AIMS To evaluate the quantitative and qualitative effect of a collagen membrane (Bio-Gide), with and without the effect of etiology and tooth type, in promoting root development in immature teeth after REPs. DESIGN Eighty nonvital immature teeth were divided randomly into two groups (40 teeth in each group). REPs were performed with (experimental group) and without (control group) a collagen membrane. All teeth were subjected to regular clinical and radiographical follow-up. RESULTS Seventy-six teeth were included in the final analyses. The average follow-up periods were 33.1 ± 21.8 months for the control group and 28.1± 18.6 months for the experimental group. Quantitative analysis of root development in the experimental group showed a greater increase in dentin wall thickness in the middle one-third of the root compared to the control group, with or without the effect of etiology and tooth type. Six types of root development were observed. There was no significant difference in the type of tooth development between the two groups. CONCLUSION The use of a collagen membrane could promote an increase in dentin wall thickness in the middle one-third of the root, and it had no significant effect in terms of the type of subsequent root development.
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Affiliation(s)
- Xijun Jiang
- Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - He Liu
- Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Chufang Peng
- Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
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Báez V, Corcos L, Morgillo F, Imperatrice L, Gualtieri AF. "Meta-analysis of regenerative endodontics outcomes with antibiotics pastes and calcium hydroxide. The apex of the iceberg". J Oral Biol Craniofac Res 2022; 12:90-98. [PMID: 34815932 PMCID: PMC8593466 DOI: 10.1016/j.jobcr.2021.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/17/2021] [Accepted: 11/04/2021] [Indexed: 12/26/2022] Open
Abstract
PORPOSE The aim of this study was to evaluate, through a meta-analysis, the predictability of Regenerative Endodontic therapies with antibiotic pastes and calcium hydroxide [Ca(OH)2], related to four variables as follows: root dentin wall thickening, apical closure, apical repair and root lengthening. METHODS Literature electronic searches were performed in Pubmed - MEDLINE, Scopus and Lilacs-BVS platforms using appropriate search terms, Mesh (Medical Subject Headings), DeCS (Health Sciences Descriptors) and Boolean operators comprising articles published between 2009 and 2020. Thirty-two original indexed papers were included making a total of 758 regenerative endodontic procedures. A descriptive meta-analysis was performed. RESULTS Dentin wall thickening was present in 66% (CI95: 58%-73%) of the cases treated with antibiotic paste, while when Ca(OH)2 was used, a percentage of 53% (CI95: 26%-78%), was obtained. When antibiotic paste was used, apical closure was found in the 66% (CI95: 58%-73%) of the regenerative endodontic procedures, while when Ca(OH)2 was used, 88% (CI95: 80%-93%) of the cases were found to reach apical closure. Root lengthening and apical repair were found satisfactory for both disinfection protocols. CONCLUSIONS There could be differences between the two treatments since a higher percentage of root dentin wall thickening was found when using antibiotic pastes, while a higher percentage of apical closure was found when calcium hydroxide was used. Development of more clinical studies would be necessary in order to confirm the observed differences. The proposed approach could provide a useful contribution for endodontists when planning regenerative endodontic procedures, so as to guide decision-making to the best elective treatment and to select the appropriate disinfection method in accordance with preoperative radiographic diagnosis of root development stage, then increasing the predictability of regenerative endodontic treatment and reducing potential risk of root fractures.
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Affiliation(s)
- Viviana Báez
- Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Endodoncia. Buenos Aires, Argentina
- Centro de Educación Médica e Investigaciones Clínicas CEMIC, Departamento de Odontología. Buenos Aires, Argentina
| | - Lorena Corcos
- Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Endodoncia. Buenos Aires, Argentina
| | - Florencia Morgillo
- Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Endodoncia. Buenos Aires, Argentina
| | - Lorena Imperatrice
- Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Endodoncia. Buenos Aires, Argentina
| | - Ariel Félix Gualtieri
- Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Biofísica y Bioestadística. Buenos Aires, Argentina
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Alves FF, Lenzi R, Hernández S, Rôças I, Siqueira J. Regenerative endodontic therapy for management of an immature permanent tooth with recurrent post-treatment apical periodontitis: A case report. J Int Soc Prev Community Dent 2022; 12:468-473. [DOI: 10.4103/jispcd.jispcd_71_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/27/2022] [Accepted: 07/23/2022] [Indexed: 11/04/2022] Open
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Long-Term Follow-up for Immature Teeth Treated with Regenerative Endodontic Procedures That Underwent Orthodontic Treatment. Eur Endod J 2021; 6:242-246. [PMID: 34650020 PMCID: PMC8461485 DOI: 10.14744/eej.2020.29591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Although regenerative endodontic procedures (REPs) have become one of the widely accepted treatment modalities for necrotic immature teeth with apical periodontitis, little is known about the long-term outcomes and the effect of orthodontic tooth movement on this procedure. This report presents a case that underwent two REPs and orthodontic treatment over a period of seven years. A 9-year-old male was referred for evaluation of traumatized maxillary central incisors. Based on clinical and radiographic examinations, a diagnosis of pulp necrosis with acute apical abscess was established. REP was performed for both teeth, and the patient was brought in for follow-up annually. Orthodontic treatment was performed during the follow-up period. Annual follow-up visits demonstrated complete resolution of signs and symptoms of disease with the thickening of the roots. At the six-year follow-up visit, the patient presented with a sinus tract and periapical radiolucency. A second REP was performed for both teeth. The one-year recall visit after the second REP revealed complete resolution of clinical symptoms and radiographic signs of healing of apical pathology with further development of the roots. In conclusion, the effect of orthodontic treatment on teeth undergoing REP should be investigated and yearly follow-up visits should be recommended for patients undergoing REP as this case showed signs of deterioration six years after the treatment.
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Wu ZF, Lu LJ, Zheng HY, Tu Y, Shi Y, Zhou ZH, Fang LX, Fu BP. Separated root tip formation associated with a fractured tubercle of dens evaginatus: A case report. World J Clin Cases 2021; 9:2944-2950. [PMID: 33969081 PMCID: PMC8058674 DOI: 10.12998/wjcc.v9.i12.2944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/25/2021] [Accepted: 02/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Several previous studies have reported an unusual root formation in which a fractured apical fragment of an immature root continued to develop independent of the main root after trauma to an immature tooth. To date, there have been only rare reports of the continuing apical formation of the fractured root associated with dens evaginatus (DE). This paper presents a case of a separated root tip formation associated with a fractured tubercle of DE.
CASE SUMMARY An 11-year-old boy was referred for gingival sinus on the buccal side of the right mandibular second premolar (tooth # 45). Clinically, tooth # 45 was free of caries, but there was a sign of a fractured tubercle of DE on the occlusal surface. Radiography showed that the root canal of tooth # 45 was widely radiolucent. A separated root apex was found apically under the main root and was nearly completely formed with an apical orifice at the apical tip. Tooth # 45 was diagnosed as tubular fracture of DE with chronic apical periodontitis. A revascularization technique was recommended to treat the tooth. At 3-mo and 1-yr follow-up, the patient remained asymptomatic. Periapical radiography revealed that the separated root tip distally drifted with closure of the apex. However, the root length and thickness of the main root did not increased.
CONCLUSION Clinicians should be aware that even if tubercle of DE is fractured in an immature tooth, the root tip may be separated from the main root and completely formed.
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Affiliation(s)
- Zhi-Fang Wu
- Department of Pediatric Dentistry, The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou 310006, Zhejiang Province, China
| | - Ling-Jiao Lu
- Department of Prosthodontics, The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou 310006, Zhejiang Province, China
| | - Hai-Yan Zheng
- Department of Prosthodontics, The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou 310006, Zhejiang Province, China
| | - Yan Tu
- Department of Endodontics, The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou 310006, Zhejiang Province, China
| | - Ying Shi
- Department of Prosthodontics, The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou 310006, Zhejiang Province, China
| | - Zi-Huai Zhou
- Department of Prosthodontics, The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou 310006, Zhejiang Province, China
| | - Lin-Xian Fang
- Department of Pediatric Dentistry, The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou 310006, Zhejiang Province, China
| | - Bai-Ping Fu
- Department of Prosthodontics, The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou 310006, Zhejiang Province, China
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Clinical and Radiographic Outcomes of Immature Teeth Treated with Different Treatment Protocols of Regenerative Endodontic Procedures: A Retrospective Cohort Study. J Clin Med 2021; 10:jcm10081600. [PMID: 33918937 PMCID: PMC8069309 DOI: 10.3390/jcm10081600] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/27/2021] [Accepted: 04/07/2021] [Indexed: 12/18/2022] Open
Abstract
Regenerative endodontic procedure (REP) is a progressive treatment modality for immature permanent teeth with necrotic pulp. The ambiguousness about the predictability of REP outcome in relation to complete disinfection of the root canal system and the occurrence of discoloration still exists. The aim of this retrospective study was to analyze two treatment protocols on clinical success rate, radiographic root development and the occurrence of discoloration. Eighteen patients were treated by a single operator by either treatment protocol according to the American Association of Endodontists (AAEP, n = 9) or a modified protocol (MP, n = 9) with the use of 5% sodium hypochlorite and sandblasting. Patients were followed up after 3, 6, 9, 12, 18 and 24 months and clinical success, radiographic root development and the occurrence of discoloration were assessed. The clinical success of MP was significantly higher in two years follow-up (p = 0.015), but the change in radiographic root area was higher for AAEP (p = 0.017) and the occurrence of discoloration was higher in AAEP (p = 0.029). The use of 5% sodium hypochlorite for a longer period of time leads to a higher success rate. The sandblasting of the access cavity reduces the occurrence of discoloration.
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What is the best long-term treatment modality for immature permanent teeth with pulp necrosis and apical periodontitis? Eur Arch Paediatr Dent 2021; 22:311-340. [PMID: 33420674 PMCID: PMC8213569 DOI: 10.1007/s40368-020-00575-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/17/2020] [Indexed: 12/17/2022]
Abstract
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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Ong TK, Lim GS, Singh M, Fial AV. Quantitative Assessment of Root Development after Regenerative Endodontic Therapy: A Systematic Review and Meta-Analysis. J Endod 2020; 46:1856-1866.e2. [DOI: 10.1016/j.joen.2020.08.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/07/2020] [Accepted: 08/13/2020] [Indexed: 12/15/2022]
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Chen SJ, Karabucak B, Steffen JJ, Yu YH, Kohli MR. Spectrophotometric Analysis of Coronal Tooth Discoloration Induced by Tricalcium Silicate Cements in the Presence of Blood. J Endod 2020; 46:1913-1919. [PMID: 32949559 DOI: 10.1016/j.joen.2020.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/03/2020] [Accepted: 09/10/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION New tricalcium silicate cements have been shown to induce less coronal discoloration. The purpose of this in vitro study was to evaluate the degree of color change induced by various silicate materials in the presence and absence of blood. METHODS One hundred human extracted anterior single-canal teeth were sectioned to standardized root lengths, accessed, and instrumented. Eight random experimental groups and 2 control groups were created wherein specimens were filled with experimental materials below the buccal cementoenamel junction as follows: EndoSequence RRM putty (Brasseler USA, Savannah, GA), EndoSequence RRM fast set putty (Brasseler USA), Biodentine (Septodont, Saint-Maur-des-Fossés, France), and white mineral trioxide aggregate (Dentsply Sirona, York, PA) either with the presence or absence of blood. Blood-only and saline-only samples were used for the positive and negative controls. After incubation in 100% humidity at 37°C, color changes were evaluated with a spectrophotometer (Ocean Optics, Dunedin, FL) on days 0, 30, 60, and 180 after material placement. Data were transformed into Commission International de I'Eclairage's L∗a∗b color values, and corresponding ΔE values were calculated. The 1-way analysis of variance test was performed for statistical analysis. RESULTS Discoloration was observed in all specimens in the presence of blood. There was no statistical significance when comparing different materials in contact with blood. Intragroup observation at various time points, Biodentine, and EndoSequence RRM fast set putty showed significant difference between the presence and absence of blood at 180 days (P < .05). CONCLUSIONS Contamination with blood of tricalcium silicate materials has the potential to cause coronal tooth discoloration.
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Affiliation(s)
- Stephanie J Chen
- Department of Endodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
| | - Bekir Karabucak
- Department of Endodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania.
| | - Joshua John Steffen
- Department of Endodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
| | - Ya-Hsin Yu
- Department of Endodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
| | - Meetu R Kohli
- Department of Endodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
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Dentin Conditioning Protocol for Regenerative Endodontic Procedures. J Endod 2020; 46:1099-1104. [DOI: 10.1016/j.joen.2020.05.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/13/2020] [Accepted: 05/20/2020] [Indexed: 01/14/2023]
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26
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Lee S, Park YT, Setzer FC. Combined Regenerative and Vital Pulp Therapies in an Immature Mandibular Molar: A Case Report. J Endod 2020; 46:1085-1090. [PMID: 32553418 DOI: 10.1016/j.joen.2020.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/09/2020] [Accepted: 04/19/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This report describes the treatment of an immature mandibular molar by combining vital pulp therapy (VPT) and regenerative endodontic procedures (REPs). It details the use of REP to regain functionality and continued root development of an immature root with pulp necrosis and VPT for an immature root containing vital pulpal tissues. METHODS An 8-year old male presented for evaluation of a mandibular first right molar with mild buccal swelling and a nontraceable sinus tract. He recently had received a restoration. After intraoral and radiographic examination, a diagnosis of pulp necrosis and chronic apical abscess was made. After access, pulp necrosis was confirmed in the distal root; however, vital pulp tissues were present in the mesial canals. It was decided on pulpotomy (VPT) in the mesial and REP in the distal root. At the initial visit, pulpotomy was completed in the mesial root, and REP was initiated in the distal root. Three weeks later, the patient was asymptomatic and the sinus tract absent. REP was completed in the distal root, and the tooth was restored. RESULTS At the 6-, 12-, and 18-month follow-up, the patient presented without symptoms, and the tooth responded positively to pulp sensibility tests. Radiographic examinations showed resolution of the apical radiolucency and completed root development. CONCLUSIONS Combined treatment using both VPT and REP for immature molars with different pulpal status in individual roots may be a preferable treatment option because preservation of vital pulp tissues and regeneration of new vital tissues allow for continued root development and functionality.
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Affiliation(s)
- Sumin Lee
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Frank C Setzer
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Tzanetakis GN, Giannakoulas DG, Papanakou S, Gizani S, Lygidakis N. Regenerative endodontic therapy of immature permanent molars with pulp necrosis: a cases series and a literature review. Eur Arch Paediatr Dent 2020; 22:515-525. [PMID: 32677019 DOI: 10.1007/s40368-020-00550-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/30/2020] [Indexed: 02/08/2023]
Abstract
AIM To present the application and the outcome of the regenerative endodontic therapy (RET) in a series of symptomatic immature mandibular molars with pulp necrosis and apical periodontitis and to review the relevant literature for the documentation of the procedure as a potential treatment option. METHODS Three young male patients were referred with pain in the left mandibular region resulting from pulp necrosis and apical periodontitis of the first permanent molar. Regenerative endodontic approach was performed for the complete resolution of the lesions and the thickening of the apical root canal walls. The databases of Medline, Pubmed and Google Scholar were also searched for articles in which a regenerative approach has been undertaken for the endodontic management of immature permanent molars with pulp necrosis and apical periodontitis. RESULTS Follow-up examinations showed that the teeth remained functional without any signs or symptoms. Final radiographic examination at 12, 18 and 36 months, respectively, revealed complete resolution of the lesions and complete apical closure in the two out of three cases. The search of the literature revealed the existence of only 25 clinical articles in which necrotic immature molars were treated by the regenerative approach. The total number of the treated teeth were 46. CONCLUSIONS Regenerative endodontic approach may be applied in posterior non-vital molar teeth with a possible favorable outcome. However, the literature support for the documentation of the procedure as a predictable and reproducible treatment option in posterior immature molar teeth is at present limited.
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Affiliation(s)
- G N Tzanetakis
- Department of Endodontics, Dental School, University of Athens, Greece Private, 421B Mesogeion Ave., Agia Paraskevi, 15343, Athens, Greece.
| | - D G Giannakoulas
- Department of Endodontics, Dental School, University of Athens, Greece Private, 421B Mesogeion Ave., Agia Paraskevi, 15343, Athens, Greece
| | - S Papanakou
- Department of Paediatric Dentistry, Dental School, University of Athens, Greece Private, Athens, Greece
| | - S Gizani
- Department of Paediatric Dentistry, Dental School, University of Athens, Greece Private, Athens, Greece
| | - N Lygidakis
- Department of Paediatric Dentistry, Dental School, University of Athens, Greece Private, Athens, Greece
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Mittmann CW, Kostka E, Ballout H, Preus M, Preissner R, Karaman M, Preissner S. Outcome of revascularization therapy in traumatized immature incisors. BMC Oral Health 2020; 20:207. [PMID: 32664918 PMCID: PMC7362656 DOI: 10.1186/s12903-020-01193-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/09/2020] [Indexed: 11/25/2022] Open
Abstract
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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Affiliation(s)
- Carolina W Mittmann
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Assmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Eckehard Kostka
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Assmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Husam Ballout
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Assmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Mareike Preus
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Assmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Robert Preissner
- Institute of Physiology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Philippstrasse 12, 10115, Berlin, Germany
| | - Murat Karaman
- Institute of Physiology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Philippstrasse 12, 10115, Berlin, Germany
| | - Saskia Preissner
- Department Oral, Maxillary and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin. Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
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Chrepa V, Joon R, Austah O, Diogenes A, Hargreaves KM, Ezeldeen M, Ruparel NB. Clinical Outcomes of Immature Teeth Treated with Regenerative Endodontic Procedures-A San Antonio Study. J Endod 2020; 46:1074-1084. [PMID: 32560972 DOI: 10.1016/j.joen.2020.04.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/03/2020] [Accepted: 04/21/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Factors that influence clinical outcomes for regenerative endodontic procedures (REPs) are unknown. This retrospective study aimed to assess tooth healing, root development, pulp vitality, and esthetics post-REPs and categorize them into clinician- and patient-centered outcomes. Furthermore, this study identified significant predictors affecting such outcomes. METHODS Immature permanent teeth diagnosed with pulp necrosis treated with REPs between 2008 and 2018 with a minimum of 1-year follow-up were included. Outcomes included success and survival rates, changes in root development using 2-dimensional radiographic root area (RRA) and 3-dimensional measurements, pulp vitality, and tooth discoloration. Predictor variables of success included age, sex, etiology of pulp necrosis (PN), type of medicament, sodium hypochlorite (NaOCl) concentration, type of biomaterial used over the blood clot, and preoperative apical diagnosis. Statistical analyses included Cox proportional hazard analyses and generalized regression models. RESULTS Fifty-one teeth with an average of 2.1 years of follow-up satisfied the criteria. The survival rate was 92%. The success rate was 84.3% with age, etiology of PN, type of medicament, and NaOCl concentration being significant predictors of failure. Root development occurred in 91.4% of cases with age, sex, etiology of PN, type of medicament, NaOCl concentration, and apical diagnosis being significant predictors for RRA change. Positive pulp sensibility responses were associated with greater RRA change, and, finally, the type of biomaterial was a significant predictor for tooth discoloration after treatment. CONCLUSIONS REPs provide a high survival rate. Patient and clinical factors may affect outcomes, and this knowledge may help to define the criteria for optimal treatment planning of REPs.
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Affiliation(s)
- Vanessa Chrepa
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Ruchika Joon
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Obadah Austah
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Anibal Diogenes
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Kenneth M Hargreaves
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Mostafa Ezeldeen
- OMFS IMPATH Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial surgery, University Hospitals Leuven, Leuven, Belgium
| | - Nikita B Ruparel
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
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Cymerman JJ, Nosrat A. Regenerative Endodontic Treatment as a Biologically Based Approach for Non-Surgical Retreatment of Immature Teeth. J Endod 2020; 46:44-50. [DOI: 10.1016/j.joen.2019.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/07/2019] [Accepted: 10/09/2019] [Indexed: 12/16/2022]
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Rossi-Fedele G, Kahler B, Venkateshbabu N. Limited Evidence Suggests Benefits of Single Visit Revascularization Endodontic Procedures - A Systematic Review. Braz Dent J 2019; 30:527-535. [DOI: 10.1590/0103-6440201902670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/03/2019] [Indexed: 12/18/2022] Open
Abstract
Abstract Revascularization endodontic procedures commonly require multiple treatment sessions. However, single visit procedures may be advantageous from the clinical and patient management standpoints. The purpose of this review was to evaluate the outcomes of single-visit revascularization endodontic procedures for the management of immature permanent teeth with non-vital pulp. Two electronic databases (Scopus and PubMed) were searched, from their inception to July 2018, for studies that assessed clinical and/or radiographic and/or histologic outcomes of single-visit revascularization endodontic procedures performed in immature permanent teeth with non-vital pulp. Case reports, animal studies and clinical trials were included. The quality of case reports was appraised by Joanna Briggs Institute Critical Appraisal Checklist for Case Reports. The quality of randomized clinical trials was assessed by the revised Cochrane risk of bias tool for randomized trials. The risk of bias for animal studies was assessed using SYRCLE’s risk of bias tool. Tabulation followed by narrative synthesis was used to draw conclusions. Seven studies satisfied the selection criteria. Five were classified as case reports, one as a randomized clinical trial and one as animal study. The latter presented with a high risk of bias, whilst the remaining showed a low risk. The evidence supporting the potential use of single-visit revascularization endodontic procedures is scarce. Successful single-visit revascularization endodontic procedures commonly include the use of high concentrations of sodium hypochlorite and EDTA combined with the use of agitation systems. Further clinical trials with long term follow up are needed to confirm the results of the current review.
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Regenerative Endodontics: A Systematic Analysis of the Failed Cases. J Endod 2019; 45:567-577. [DOI: 10.1016/j.joen.2019.02.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/24/2019] [Accepted: 02/01/2019] [Indexed: 01/04/2023]
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Regenerative Endodontic Procedures Using Contemporary Endodontic Materials. MATERIALS 2019; 12:ma12060908. [PMID: 30893790 PMCID: PMC6471897 DOI: 10.3390/ma12060908] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 02/28/2019] [Accepted: 03/13/2019] [Indexed: 12/12/2022]
Abstract
Calcium hydroxide apexification and Mineral Trioxide Aggregate (MTA) apexification are classical treatments for necrotic immature permanent teeth. The first tend to fail for lack of compliance given the high number of sessions needed; the second has technical difficulties such as material manipulation and overfilling. With both techniques, the root development is interrupted leaving the tooth with a fragile root structure, a poor crown-to-root ratio, periodontal breakdown, and high risk of fracture, compromising long-term prognosis of the tooth. New scientific literature has described a procedure that allows complete root development of these specific teeth. This regenerative endodontic procedure (REP) proposes the use of a combination of antimicrobials and irrigants, no canal walls instrumentation, induced apical bleeding to form a blood clot and a tight seal into the root canal to promote healing. MTA is the most used material to perform this seal, but updated guidelines advise the use of other bioactive endodontic cements that incorporate calcium and silicate in their compositions. They share most of their characteristics with MTA but claim to have fewer drawbacks with regards to manipulation and aesthetics. The purpose of the present article is to review pertinent literature and to describe the clinical procedures protocol with its variations, and their clinical application.
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Shetty H, Shetty S, Kakade A, Desai R, Zhang CF, Neelakantan P. Cone-beam computed tomographic and histological investigation of regenerative endodontic procedure in an immature mandibular second premolar with chronic apical abscess. ACTA ACUST UNITED AC 2018; 9:e12352. [PMID: 29984903 DOI: 10.1111/jicd.12352] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 05/19/2018] [Indexed: 12/15/2022]
Abstract
AIM The aim of the present study was to investigate the tissue generated after regenerative endodontic procedure (REP) in the root canal space of an immature mandibular second premolar with pulp necrosis and chronic apical abscess using cone-beam computed tomographic (CBCT) and histological methods. METHODS REP was performed in an immature mandibular second premolar. At the 3-year follow up, CBCT scans were taken to evaluate the outcome of treatment. As the tooth was not restorable to function, it was extracted and processed for histological examination. RESULTS CBCT showed a reduction in size of the periradicular radiolucency, with a marginal increase in root length. Apical closure and thickening of the root canal walls were apparent. Histologically, the root canal space was filled with minimally-inflamed fibrous connective tissue. Some cementum-like mineralized connective tissue was evident on the internal canal walls. The apical third showed cementum-like deposits at the apex and the outer canal walls, without dentin formation. CONCLUSIONS The present study of a structurally-failed tooth with prior REP demonstrates that the tissue formed within the root canal space was fibrous connective tissue with cementum-like deposition in the canal space. No evidence of dentin- or pulp-like tissue was found.
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Affiliation(s)
- Heeresh Shetty
- Department of Conservative Dentistry and Endodontics, Nair Hospital Dental College, Mumbai, India
| | - Shishir Shetty
- Department of Conservative Dentistry and Endodontics, A.B. Shetty Memorial Institute of Dental Sciences, Mangalore, India
| | - Adesh Kakade
- Department of Pediatric Dentistry, Nair Hospital Dental College, Mumbai, India
| | - Rajiv Desai
- Department of Oral and Maxillofacial Pathology, Nair Hospital Dental College, Mumbai, India
| | - Cheng F Zhang
- Discipline of Endodontology, Faculty of Dentistry, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Prasanna Neelakantan
- Discipline of Endodontology, Faculty of Dentistry, The University of Hong Kong, Pok Fu Lam, Hong Kong
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Kim SG, Malek M, Sigurdsson A, Lin LM, Kahler B. Regenerative endodontics: a comprehensive review. Int Endod J 2018; 51:1367-1388. [PMID: 29777616 DOI: 10.1111/iej.12954] [Citation(s) in RCA: 197] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/14/2018] [Indexed: 12/13/2022]
Abstract
The European Society of Endodontology and the American Association for Endodontists have released position statements and clinical considerations for regenerative endodontics. There is increasing literature on this field since the initial reports of Iwaya et al. (Dental Traumatology, 17, 2001, 185) and Banchs & Trope (Journal of Endodontics, 30, 2004, 196). Endogenous stem cells from an induced periapical bleeding and scaffolds using blood clot, platelet rich plasma or platelet-rich fibrin have been utilized in regenerative endodontics. This approach has been described as a 'paradigm shift' and considered the first treatment option for immature teeth with pulp necrosis. There are three treatment outcomes of regenerative endodontics; (i) resolution of clinical signs and symptoms; (ii) further root maturation; and (iii) return of neurogenesis. It is known that results are variable for these objectives, and true regeneration of the pulp/dentine complex is not achieved. Repair derived primarily from the periodontal and osseous tissues has been shown histologically. It is hoped that with the concept of tissue engineering, namely stem cells, scaffolds and signalling molecules, that true pulp regeneration is an achievable goal. This review discusses current knowledge as well as future directions for regenerative endodontics. Patient-centred outcomes such as tooth discolouration and possibly more appointments with the potential for adverse effects needs to be discussed with patients and parents. Based on the classification of Cvek (Endodontics and Dental Traumatology, 8, 1992, 45), it is proposed that regenerative endodontics should be considered for teeth with incomplete root formation although teeth with near or complete root formation may be more suited for conventional endodontic therapy or MTA barrier techniques. However, much is still not known about clinical and biological aspects of regenerative endodontics.
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Affiliation(s)
- S G Kim
- Division of Endodontics, Columbia University College of Dental Medicine, New York, NY, USA
| | - M Malek
- Department of Endodontics, New York University College of Dentistry, New York, NY, USA
| | - A Sigurdsson
- Department of Endodontics, New York University College of Dentistry, New York, NY, USA
| | - L M Lin
- Department of Endodontics, New York University College of Dentistry, New York, NY, USA
| | - B Kahler
- The University of Queensland School of Dentistry, Brisbane, Australia
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Fonzar F, Forner L, Fabian-Fonzar R, Llena C. Induced post-traumatic apexification: 20 year follow-up and morphological study after new fracture. Ann Anat 2018; 216:120-124. [DOI: 10.1016/j.aanat.2017.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/26/2017] [Accepted: 12/12/2017] [Indexed: 12/29/2022]
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Influence of Apical Diameter on the Outcome of Regenerative Endodontic Treatment in Teeth with Pulp Necrosis: A Review. J Endod 2018; 44:414-431. [DOI: 10.1016/j.joen.2017.10.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 10/10/2017] [Accepted: 10/16/2017] [Indexed: 12/12/2022]
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Kahler B, Chugal N, Lin LM. Alkaline Materials and Regenerative Endodontics: A Review. MATERIALS 2017; 10:ma10121389. [PMID: 29206139 PMCID: PMC5744324 DOI: 10.3390/ma10121389] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/23/2017] [Accepted: 11/29/2017] [Indexed: 12/16/2022]
Abstract
Periapical health is the primary goal of endodontic treatment in mature and immature teeth. In addition, the goals of treatment of immature teeth with arrested root development include root growth to length and maturation of the apex, as well as thickening of the canal wall. These goals are valid for immature teeth that have been subjected to trauma and dental caries or that are the result of developmental anomalies that expose the tooth to the risk of pulp necrosis and consequently result in the cessation of root maturation. Regenerative endodontic procedures (REPs) have been described as a “paradigm shift” in the treatment of immature teeth with pulp necrosis and underdeveloped roots, as there is the potential for further root maturation and return of vitality. Treatment with REPs is advocated as the treatment of choice for immature teeth with pulp necrosis. REP protocols involve the use of alkaline biomaterials, primarily sodium hypochlorite, calcium hydroxide, mineral trioxide aggregates and Biodentine, and are the essential components of a successful treatment regimen.
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Affiliation(s)
- Bill Kahler
- The School of Dentistry, The University of Queensland, Brisbane 4072, Australia.
| | - Nadia Chugal
- School of Dentistry, UCLA, CHS A3-075, Los Angeles, CA 90095-1668, USA.
| | - Louis M Lin
- College of Dentistry, New York University, 345 East 24th Street, New York, NY 10010, USA.
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Regenerative Endodontic Treatment or Mineral Trioxide Aggregate Apical Plug in Teeth with Necrotic Pulps and Open Apices: A Systematic Review and Meta-analysis. J Endod 2017; 43:1806-1820. [DOI: 10.1016/j.joen.2017.06.029] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 06/12/2017] [Accepted: 06/16/2017] [Indexed: 12/29/2022]
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Torabinejad M, Parirokh M, Dummer PMH. Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part II: other clinical applications and complications. Int Endod J 2017; 51:284-317. [PMID: 28846134 DOI: 10.1111/iej.12843] [Citation(s) in RCA: 201] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 08/22/2017] [Indexed: 12/16/2022]
Abstract
Mineral trioxide aggregate (MTA) is a dental material used extensively for vital pulp therapies (VPT), protecting scaffolds during regenerative endodontic procedures, apical barriers in teeth with necrotic pulps and open apices, perforation repairs as well as root canal filling and root-end filling during surgical endodontics. A number of bioactive endodontic cements (BECs) have recently been introduced to the market. Most of these materials have calcium and silicate in their compositions; however, bioactivity is a common property of these cements. These materials include the following: BioAggregate, Biodentine, BioRoot RCS, calcium-enriched mixture cement, Endo-CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, Neo MTA Plus, Ortho MTA, Quick-Set, Retro MTA, Tech Biosealer, and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA but without the drawbacks. In Part I of this review, the available information on the chemical composition of the materials listed above was reviewed and their applications for VPT was discussed. In this article, the clinical applications of MTA and other BECs will be reviewed for apexification, regenerative endodontics, perforation repair, root canal filling, root-end filling, restorative procedures, periodontal defects and treatment of vertical and horizontal root fractures. In addition, the literature regarding the possible drawbacks of these materials following their clinical applications is reviewed. These drawbacks include their discolouration potential, systemic effects and retreatability following use as a root filling material. Based on selected keywords, all publications were searched regarding the use of MTA as well as BECs for the relevant clinical applications. Numerous publications were found regarding the use of BECs for various endodontic applications. The majority of these investigations compared BECs with MTA. Despite promising results for some materials, the number of publications using BECs for various clinical applications was limited. Furthermore, most studies had several methodological shortcomings and low levels of evidence.
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Affiliation(s)
- M Torabinejad
- Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, CA, USA
| | - M Parirokh
- Endodontology Research Center, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| | - P M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Revascularization-associated Intracanal Calcification: Assessment of Prevalence and Contributing Factors. J Endod 2017; 43:2025-2033. [PMID: 28965774 DOI: 10.1016/j.joen.2017.06.018] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 05/07/2017] [Accepted: 06/03/2017] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Intracanal calcifications have been reported in endodontic cases after revascularization. The purpose of the current study was to determine the incidence of intracanal calcification and potential contributing factors in retrospective revascularization cases. METHODS Among 37 patients who had undergone revascularization between 2010 and 2014, 29 cases were assessed with average follow-up period of 24.9 months. Clinical and radiographic examinations were performed to evaluate the treatment outcomes, eg, resolution of apical periodontitis (AP), root development, and occurrence of intracanal calcification. Radiographic assessment revealed varied calcification patterns, which were classified into calcific barrier or canal obliteration, collectively referred to as revascularization-associated intracanal calcification (RAIC). RESULTS All 29 cases demonstrated resolution of AP, whereas continued root development with apical closure occurred in 23 of 29 cases (79.3%). RAIC was noted in 18 of 29 cases (62.1%), among which 5 of 18 cases (27.8%) were classified as calcific barrier and 13 of 18 cases as canal obliteration (72.2%). Higher frequency of RAIC was noted in the cases with induced bleeding (16 of 23 cases, 69.6%), whereas the 6 cases without induced bleeding showed RAIC at 33.4%. Also, RAIC occurred more frequently in cases medicated with Ca(OH)2 (10 of 13 cases, 76.9%) than in those medicated with antibiotic pastes (6 of 13 cases, 46.2%). CONCLUSIONS This study indicated that RAIC is common (62.1%) among cases treated with revascularization. Multiple contributing factors may include the type of medicaments and induction of intracanal bleeding. Although RAIC does not interfere with resolution of AP, some cases may progress to complete obliteration of root canals and would impede normal function of dental pulp tissues.
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Altaii M, Richards L, Rossi-Fedele G. Histological assessment of regenerative endodontic treatment in animal studies with different scaffolds: A systematic review. Dent Traumatol 2017; 33:235-244. [PMID: 28342218 DOI: 10.1111/edt.12338] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIM The concept of regenerative endodontic procedures remains controversial. The aim of this study was to evaluate the histology of the tissues formed in immature animal teeth with necrotic and infected pulps after attempted endodontic regeneration procedures using different scaffolds. DESIGN A systematic electronic literature search was performed in PubMed, Web of Science, Scopus, EMBASE, DOSS, and Cochrane Library databases. The terms used were a combination of the following: "immature permanent necrotic tooth or teeth" or "open apex or apices" and "regeneration or revitalization or revascularization" and "histology." The inclusion criteria comprised animal studies with histological examination following regenerative endodontics in immature necrotic-infected permanent teeth. RESULTS From 123 screened studies, 13 met the inclusion criteria. Formation of dentin-like tissue on the dentinal walls was reported in only 4% of teeth treated with blood clot scaffold and 2% treated with blood clot with additional materials. Cementum-like hard tissue was found in 64% of teeth with blood clot, 80% treated with blood clot with additional materials, 50% treated with alternative scaffolds, and 5% that were left empty. Bone-like tissue was reported in 10% of teeth treated with blood clot, 2% treated with blood clot with additional materials, and 4% treated with alternative scaffolds. The tissues in the canal space were found to be connective tissue with infiltration of fibroblast-like cells and blood vessels. Forty-six percent of the studies reported formation of periodontal ligament-like tissues. CONCLUSIONS None of the regeneration protocols resulted in the predictable formation of a true pulp-dentin complex.
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Affiliation(s)
- Milad Altaii
- School of Dentistry, The University of Adelaide, Adelaide, SA, Australia.,Department of Restorative Dentistry, College of Dentistry, Babylon University, Babel, Iraq
| | - Lindsay Richards
- School of Dentistry, The University of Adelaide, Adelaide, SA, Australia
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