Regenerative Endodontic Procedures in Necrotic Mature Teeth with Periapical Radiolucencies: A Preliminary Randomized Clinical Study

Abstract

Introduction: This preliminary study compared clinical and radiographic outcomes of regenerative endodontic procedures (REPs) with that of conventional root canal treatment (CRCT) in necrotic mature teeth with periapical radiolucencies. Methods: Fifty-six mature necrotic teeth with large periapical radiolucencies were distributed into 2 groups: group 1, REPs and group 2, CRCT (n 5 28/group). Clinical and radiographic follow-up assessments were undertaken up to 12 months. Statistical analysis was performed using the independent samples t test and the chi-square test, and the level of significance was set at P 5 .05. Results: With a follow-up rate of about 73.4% of the total patients for 12 months, favorable clinical and radiographic outcomes were found in 92.3% and 80% in REPs and CRCT groups, respectively, and the difference was not statistically significant (P . .05). Half of the teeth treated with REPs responded to the electric pulp test. Conclusions: Regenerative endodontic procedures have the potential to be used as a treatment option for mature teeth with large periapical radiolucencies.

Cell-Free Approaches for Dental Pulp Tissue Engineering

“…It is conceivable to apply this concept to mature permanent teeth, possibly after enlargement of the apical foramen. Clinical cases with a provocation of bleeding as a biological root canal filling have already been reported 7 .…”

“…Whereas these expectations were not fulfilled, we currently have a more realistic assessment of the outcome after such a procedure. Evidence has accumulated not only from case series and cohort studies but also from randomized controlled trials, systematic reviews, and metaanalyses [5][6][7][8] . Histologically, the newly formed tissue in the root canals after revitalization is ectopic, mainly in the form of fibrous or periodontal tissue, cementum, or bone (Fig.…”

Clinical Perspectives of Pulp Regeneration

“…A large number of case reports, prospective and retrospective cohort studies, randomized clinical trials, and meta-analyses have been published on the clinical outcome of revitalization procedures under these clinical situations [22][23][24][25][26][27][28][29] . Clearly, a broad scientific basis exists for the assessment of revitalization treatments.…”

Tratamiento del Diente Permanente Necrótico. Un Cambio de Paradigma en el Campo de la Endodoncia

“…Adicionalmente, son artículos más recientes y los periodos de seguimiento son más cortos. Finalmente, los diseños metodológicos se limitan a reportes de caso (Gavino Orduna et al, 2017), estudios en animales (Gomes-Filho et al), y pocos ensayos clínicos aleatorizados (Arslan et al, 2019a).…”

“…Sin embargo, recientemente, estudios preliminares han expandido la aplicación de la endodoncia regenerativa a dientes maduros necróticos, es decir, en pacientes adultos (Arslan et al, 2019a,b). Los resultados son alentadores, ya que hay una resolución de la sintomatología clínica, curación de las lesiones periapicales y, en algunos casos, respuesta positiva a test de vitalidad pulpar (Arslan et al, 2019a). La investigación referente a la revitalización de dientes maduros se encuentra en etapas tempranas y requiere de un mayor nivel de evidencia antes de ser ofrecida sistemáticamente como terapia a pacientes adultos, sin embargo, los beneficios potenciales justifican mayor investigación al respecto.…”