Regenerative endodontic treatment options for immature permanent teeth: a case report with 21-month follow-up

Submitted: 29 January 2020
Accepted: 10 March 2020
Published: 4 June 2020
Abstract Views: 1186
PDF: 567
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The treatment of choice for necrotic teeth with incompletely formed roots is apexification with calcium hydroxide, which induces the formation of a hard tissue barrier at the apex, however, in the long term, this medicament may increase the brittleness of dentin walls because of its hygroscopic and proteolytic properties, in addition to the disadvantage of requiring multiple appointments. A treatment option for young permanent teeth with necrotic pulps is pulp regeneration, whose advantage lies in the stimulation of new tissue formation within the root canal. Pulp revascularization is based on the disinfection of the root canal system, often performed with irrigating solutions and intracanal medicaments, accompanied by induction of periapical bleeding and formation of a blood clot that will fill the root canal. The aim of this study was to present a case of avulsion of teeth 11 and 21, both with open apices, treated with replantation associated with regenerative endodontic therapy, but varying the intracanal medicaments used: calcium hydroxide in tooth 11 and double antibiotic paste in tooth 21. Pulp revascularization proved to be effective with both intracanal medicaments used, promoting symptom resolution and complete root development, including apical closure, even in the absence of a well-defined clinical

Hachmeister DR, Schindler W., Walker WA, Thomas DD. The sealing ability and retention characteristics of mineral trioxide aggregate in a model of apexification. Journal of Endodontics. 2002. 28(5):386-390.

Pace R, Giuliani V, Pini Prato L, Bacetti T, Pagavino G. Apical plug technique using mineral trioxide aggregate: results from a case series. Int Endod J. 2007. 40(6):478-484.

Rafter M. Apexification: a review. 2005 Dental Traumatol. 21(1):1-8.

Andreasen J, Farik B, Munksgaards E. Long term calcium hydroxide as a root canal dressing may increase risk of root fracture. Dental Traumatol. 2002. 18(3):134-137.

Wintherspoon D, Small J, Regan J, Numn M. Retrospective analysis of open apex teeth obturated with mineral trioxide aggregate. Journal of Endodontics. 2008. 34(10):1171-1176.

Norsat A, Seifi A, Asgary, S. Regenerative endodontic treatment (revascularization) for necrotic immature permanent molars: a review and report of two cases with a new biomaterial. Journal of Endodontics. 2011. 37(4):562-567.

Prirokh M, Torabinejad M. Mineral trioxide aggregate: a comprehensive literature review - Part III: Clinical applications, drawbacks, and mechanism of action. Journal of Endodontics. 2010. 36(3):400-13.

Lovelace TW, Henry MA, Hargreaves KM, Diogenes A. Evaluation of the delivery of mesenchymal stem cells into the root canal space of necrotic immature teeth after clinical regenerative endodontic procedure. J Endod. 2011. 37(2):133-8.

Fouad AF. The microbial challenge to pulp regeneration. Advances in Dental Research, v. 23, n. 3, p. 285-289, july 2011.

Verma P. et al. Effect of Residual Bacteria on the Outcome of Pulp Regeneration In Vivo. Journal of Dental Research. 2017, v. 96, n. 1, p. 100-106.

Jacobs, JC et al. Antibacterial Effects of Antimicrobials Used in Regenerative Endodontics against Biofilm Bacteria Obtained from Mature and Immature Teeth with Necrotic Pulps. Journal of Endodontics. 2017, v. 43, n. 4, p. 575-579.

Law AS. Consideration for Regenerative Procedures. Journal of Endodontics. 2016, v. 39, n. 3, p. 44-56.

Bystrom A, Claesson R, Sundqvist G. The antibacterial effect of camphorated paramonochlorophenol, camphorated phenol and calcium hydroxide in the treatment of infected root canals. Endodontics & Dental Traumatology. 1985, v. 1. n. 5, p. 170-175.

Kantaoutra PN. BCOR mutations and unstoppable root growth: a commentary on oculofaciocardiodental syndrome: novel BCOR mutations and expression in dental cells. Journal of Human Genetics. 2014, v. 59, n. 6, p. 297-299.

Hoshino E. et al. In-vitro antibacterial susceptibility of bacteria taken from infected root dentine to a mixture of ciprofloxacin, metronidazole and minocycline. International Endodontic Journal. 1996, 29, n. 2, p. 125-130.

Ruparel NB. et al. Direct effect of intracanal medicaments on survival of stem cells of the apical papilla. Journal of Endodontics. 2012, v. 38, n. 10, p. 1372-1375.

Kim JH et al. Tooth discoloration of immature permanent incisor associated with triple antibiotic therapy: a case report. Journal of Endodontics. 2010, v. 36, n. 6, p. 1086- 1091.

Petrino JA et al. Challenges in regenerative endodontics: a case series. Journal of Endodontics. 2010, v. 36, n. 3, p. 536-541.

Dabbagh B. et al. Clinical complications in the revascularization of immature necrotic permanent teeth. Pediatric Dentistry. 2012, v. 34, n. 5, p. 414-417.

Grottkau BE, Purudappa PP, Lin YF. Multilineage differentiation of dental pulp stem cells from green fluorescent protein transgenic mice. International Journal of Oral Science. 2010, v. 2, n. 1, p. 21-27.

Jung LY, Lee SJ, Hargreaves KM. Biologically base treatment of immature teeth with pulpal necrosis: a case series. Journal of Endodontics. 2008. 34(7):876-887.

Alcade MP, Guimaraes BM, Fernandes SL, Silva PAA, Bramante CM, Vivan RR. et al. Revascularização pulpar: considerações técnicas e implicações clínicas. Salusvita. 2014. 33(3):415-432.

Maniglia-Ferreira C, Gomes FA, Vitoriano MM. Intentional Replantation of an Avulsed Immature Permanent Incisor: A Case Report. Journal of Endodontics. 2017. 43(8):1383-1386.

Nagata JY, Gomes BP, Rocha Lima TF, Murakami LS, De Farias DE, Campos GR. et al. Traumatized immature teeth treated with 2 protocols of pulp revascularization. Journal of Endodontics. 2014. 40(5):606-612.

Reynolds K, Johnson J, Cohenca N. Pulp revascularization of necrotic bilateral bicuspids using a modified novel technique to eliminate potential coronal discolouration: a case report. International Endodontic Journal. 2009. 42(1):84-92.

Shin SY, Albert JS, Mortan RE. One step pulp revascularization treatment of a immature permanent tooth with chronic apical abscess: a case report. Int Endod J. 2009. 42(12):1118-1126.

Galler KM, D’Souza RN, Federlin M, Cavander A., Hartgerink JD, Hecker S. Dentin conditioning codetermines cell fate in regenerative endodontics. Journal of Endodontics. 2011. 37(11):1536-1541.

Trevino EG, Patwarhand AN, Henry MA. Effect of irrigants on the survival of human stem cells of the apical papilla in a platelet-rich plasma scaffold in human roots tips. Journal of Endodontics. 2011. 37(8):1109-1115.

Soares AJ, Lins FF, Nagat JY, Gomes BPFA, Zaia AA, Ferraz CC, Almeida JFA, DE Souza-Filho FJ. Pulp revascularization after root canal decontamination with calcium hydroxide and 2% chlorhexidine gel. J Endod 2013;39:417-420.

Dhillon H, Kaushik M, Sharma R. Regenerative endodontics - Creating new horizons. J Biomed Mater Res B Appl Biomater. 2016. 104(4):676-685.

Ding R, Cheung J, Yin X, Wang Q, Zhang C. Pulp revascularization of immature teeth with apical periodontitis: a clinical study. Journal of Endodontics. 2009. 35(5):745-749.

Bansal R. Regenerative endodontics: a state of the art. Indian J Dent Res. 2011. 22(1):122-131.

Souza-Filho FJ. Tratamento dos dentes com rizogênese incomplete: revitalização ou apicificação. Endodontia passo a passo: evidências clínicas. São Paulo Artes Médicas; 2015, p.166-175.

Chen MY, Chen KL, Chen CA, Tayebaty F, Rosenberg PA, Lin LM. Responses of immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscess to revascularization procedures. Int Endod J. 2012. 45(3):294-305.

Chueh LH, Ho YC, Kuo TC, Lai WH, Chen YH, Chiang CP. Regenerative endodontic treatment for necrotic immature permanent teeth. Journal of Endodontics. 2009. 35(2):160-164.

Carvalho Furtado Leite, M. ., Maniglia Ferreira, C. ., de Almeida Gomes, F., Pappen, F. G. ., Kerber Tedesco, T. ., Bissoto Calvo, A. F. ., & Pettorossi Imparato, J. C. . (2020). Regenerative endodontic treatment options for immature permanent teeth: a case report with 21-month follow-up. Giornale Italiano Di Endodonzia, 34(1).


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