Revascularization of an Immature Permanent Tooth with Periapical Periodontitis Using Concentrated Growth Factor Assisted by Erbium Laser (2940 nm) Irrigation: A Case Report

Abstract

Revascularization has been incorporated into endodontic practice and become a viable treatment alternative for immature teeth with pulp necrosis. Thorough disinfection of the root canal is a key factor for successful revascularization. An erbium: yttrium–aluminium–garnet (Er: YAG) laser has been proved advantageous for efficient root canal disinfection. This article reports one case of periapical periodontitis caused by a fractured occlusal tubercle. Revascularization assisted by Er: YAG laser irrigation was carried out with long-term follow up. During the process of treatment, we opened drainage to relieve the acute symptoms first. The necrotic pulp was removed, and then the root canal was rinsed with 0.5% sodium hypochlorite (NaOCl) solution assisted by Er: YAG laser irrigation, dried, and filled with a triple-antibiotic paste. After two weeks, the intracanal medication was removed, and 9 mL of whole vein blood was taken from the patient to prepare concentrated growth factor (CGF) after failing to induce enough blood into the canal system by over-instrumenting. The newly prepared CGF was transferred into the root canal. A 3 mm mineral trioxide aggregate (MTA) was placed directly on the thrombus of the CGF and then restored with glass-ionomer cement (GIC). The case was followed up for more than four years to record the clinical symptoms and imaging manifestations. Er: YAG irrigation is an efficient root canal disinfection protocol with the advantages of easy operation and minimal risk, which might be applicable to the revascularization of necrotic immature permanent teeth.

Evaluation of concentrated growth factor and blood clot as scaffolds in regenerative endodontic procedures: A retrospective study

“…Good coronal seal restorations are essential for successful treatment in REPs [8]. We found that teeth sealed with CR (95.7%) had a higher success rate than those sealed with GIC (86.3%).…”

“…Thus, CGF is superior to PRP and PRF in terms of preparation and composition as an ideal biomaterial [6]. Given its characteristics of autogenesis, clinical applicability and biodegradability, CGF has gained popularity in periodontal regeneration, facial reconstruction and dental implants fields for repairing bone defects and promoting soft-tissue healing [6,8]. More recently, the application of CGF has been investigated as a possible scaffold for endodontic regeneration and has shown promising clinical and radiographic results [9,10].…”

Laser Applications in Regenerative Endodontics: A Review

“…33,34 These pairs of consecutive laser pulses produce shock waves and enhance fluid flow and photoacoustic currents, which eventually contribute to optimal root canal cleansing and disinfection. 31,32 Yu et al 35 described a case with periapical periodontitis treated with revascularization assisted with Er:YAG laser irrigation. Following the removal of necrotic pulp, the canal was rinsed with 0.5% sodium hypochlorite (NaOCl) solution.…”