Revascularization of immature permanent teeth with apical periodontitis

Abstract

The aim of this minireview was to identify and review the scientific evidence regarding regenerative endodontic protocols claiming to revascularize permanent immature teeth with apical periodontitis. The literature was identified using the PubMed/MEDLINE, Scopus, Scirus, EMBASE and Cochrane databases up to February 2013. Studies were selected independently by two different researchers (kappa index: 0.88), based on established inclusion/exclusion criteria. The methodological quality of the reviewed papers was classified as high, medium or low (HQ, MQ, LQ). The search strategy identified 285 titles. Nine studies, both human and animal based, were selected after application of the criteria (LQ:5; MQ:4). In most of these studies (seven of nine), the revascularization protocol included a triple antibiotic combination as canal disinfectant for a period of 1-4 weeks after blood clot formation (LQ:5; MQ:4), although there is no clear consensus about the treatment protocol. Two studies reported tooth discoloration after the revascularization process (LQ:2), and only three (LQ:1; MQ:2) reported a success rate of 54.9% in dogs and 73.6% and 80% in humans, respectively. Revascularization of immature permanent teeth with apical periodontitis is possible and preferable to apexification. Nevertheless, there is a widespread lack of randomized clinical trials and blinded measures. In addition, the small sample sizes that are common in these studies as well as the generally low quality of the analysed publications require the results to be viewed with caution. There is a high risk of bias, with a low quality of available information, for developing clinical guidelines for regenerative endodontic protocols; rigorous randomized clinical trials are therefore needed.

A biocompatible decellularized pulp scaffold for regenerative endodontics

“…, Moreno‐Hidalgo et al . , Nazzal & Duggal ). Despite the continuation of root development reported in some studies, it is unclear whether such development is the result of stem cell repopulation, revascularization, regeneration or merely maturogenesis (Galler et al .…”

A prospective clinical study of regenerative endodontic treatment of traumatized immature teeth with necrotic pulps using bi‐antibiotic paste

“…Despite the growing use of revitalization endodontic technique (RET) in the management of immature teeth with necrotic pulps in the last decade, these techniques have shown unpredictable outcomes especially with regard to continuation of root development and thickening of root dentinal walls (Moreno-Hidalgo et al 2013, Kontakiotis et al 2014. Although a RET protocol has been published by the European Society of Endodontology and the American Association of Endodontics (American Association of Endodontics 2016, European Society of Endodontology 2016), several RET techniques, medicaments and success criteria have been reported (Kontakiotis et al 2014).…”

“…Kontakiotis et al 2015), a growing base of randomized controlled trials(Nagata et al 2014, Nagy et al 2014, Bezgin et al 2015, several systematic reviews(Moreno-Hidalgo et al 2013, Kontakiotis et al 2014) and a meta-analysis(Nicoloso et al 2016)…”

Influence of Poly-L-Lactic Acid Scaffold's Pore Size on the Proliferation and Differentiation of Dental Pulp Stem Cells

“…Also, there is an additional challenge to obtain an appropriated apical seal in IPT by applying CET (6). Currently, necrosed immature permanent teeth are subjected to multiple-visit apexification with Ca(OH) 2 -based materials to induce formation of an apical mineralized barrier (6,7). Despite the good prognosis, the long-term Ca(OH) 2 -based apexification presents a series of drawbacks (8), such as multiple treatment appointments, probable recontamination of the root canal system during treatment and increased brittleness of the root dentin, which increases the risk of future cervical root fractures (7).…”