Does Apical Papilla Survive and Develop in Apical Periodontitis Presence after Regenerative Endodontic Procedures?

Abstract

Regenerative endodontic procedures (REPs) have emerged as a treatment option for immature necrotic teeth to allow the reestablishment of a newly formed vital tissue and enable continued root development. The apical papilla stem cells (SCAPs) play an important role in physiologic root development and may also contribute to further root development during REPs. The goal of these case reports is to show evidence of the apical papilla survival and development, in human teeth with apical periodontitis, after REPs, with 5-year clinical and radiographic follow-up. In the first case, an 11-year-old girl with acute apical abscess of tooth 15 was referred for a REP. Treatment was performed with an intracanal medication followed by induction of a blood clot and a Mineral Trioxide Aggregate (MTA) cervical barrier. The 5-year follow-up showed an appreciable increase in root length as well as root canal thickness. In case 2, a 16-year-old girl was referred for endodontic treatment of tooth 21. The parents of the patient recalled a previous dental trauma (no specified on the patient records) on tooth 21 at age 7. The dental history reports a previous endodontic treatment failure and presence of a long-standing sinus tract. A mineralized tissue beyond the root apical portion could be seen at the preoperative X-ray. Nonsurgical root canal retreatment with an apical barrier was suggested as the treatment plan and accepted by the patient. After 2 weeks, the patient was recalled for a follow-up appointment presenting spontaneous pain, swelling, and sinus tract. Apical surgery was performed. Histopathological assessment of the apical root fragment collected showed the presence of dentin, cementum and pulp tissue, including odontoblasts. The 5-year follow-up depicted complete apical healing. The present case reports support survival and continued potential differentiation of the apical papilla after endodontic infection.

Regenerative Endodontic Management of an Immature Molar Using Calcium Hydroxide and Triple Antibiotic Paste: a Two-Year Follow-Up

“…These autogenous cells along with the blood clot will facilitate both pulp regeneration and continuing root tissue formation [16][17][18]. Also, another study revealed the survival and differentiation of the apical papilla and Hertwig's epithelial root sheath after endodontic infection, with clinical radiographic and histological evidence after REP [19].…”

Different Approaches to the Regeneration of Dental Tissues in Regenerative Endodontics

“…The positive result of the regenerative protocol depends on various circumstances, which are considered below. An infected immature permanent tooth with an open apex exhibits greater potential to achieve a positive result of endodontic treatment than mature teeth, due to rich vascularization, a significant supply of dental pulp stem cells (DPSC) [61], the reservoir of stem cells from apical papillae (SCAP), and their ability to produce the primary odontoblasts involved in apexogenesis [12,20,21,92]. However, one of the major problems of necrotic immature teeth is controlling the infection by obtaining a complete eradication of bacterial biofilm in the complex root canal system.…”

Evaluation of Root-End Preparation with Two Different Endodontic Microsurgery Ultrasonic Tips

“…Furthermore, although the present study focuses on a technical improvement of the root-end preparation, it is important to bear in mind that the success of endodontic microsurgery requires the creation of a favorable apical microenvironment that allows further healing of periapical tissues, which implies the recruitment of growth factors and cellular differentiation [ 67 , 68 , 69 ]. Thus, after preparing the apical cavity, root-end filling should include the use of a biocompatible and bioactive material, such as MTA or Biodentine, which promotes the repair/regeneration of the apical tissues [ 68 , 70 ].…”