Unpredictable Outcomes of a Regenerative Endodontic Treatment

Abstract

Regenerative endodontic treatment (RET) is a valuable treatment for necrotic immature teeth with many advantages such as increasing root length and thickness of root wall. The success of RETs is based on healthy stem cells, suitable scaffolds, and growth factors and takes place when bacterial contamination is well controlled. The aim of this article is to address controversy in a case with multiple success criteria. This paper reports a 9-year-old boy with a complicated crown fracture of the maxillary left central incisor about three years prior to referral with a diagnosis of intrusive luxation with spontaneous reeruption. The tooth had an underdeveloped root and a well-defined periapical radiolucent lesion around the root apex. RET was considered according to the stage of root development. Upon the three-week recall session, the clinical examination indicated that the patient was asymptomatic in the affected site. However, the patient returned two weeks later with a sinus tract pertaining to the apex of tooth #9. Therefore, debridement of the root canal space was repeated and the RET redone. On the second trial, the patient was symptom-free, but no more evidence of root maturation was observed on 18-month follow-up. The tooth was asymptomatic (without swelling, drainage, and pain) during this time, and esthetics was provided for the patient.

Evaluation of Attitude and Knowledge of Endodontic, Pedodontic and SBARD Residents in Saudi Arabia toward Regenerative Endodontics—A National Survey

“…Several factors can affect successful treatment with regenerative endodontics. Some of these factors are: (i) disinfection of the canal to achieve a clean environment, (ii) apex diameter, and (iii) the patient's age [2]. Different types of medications and solutions are available as disinfectants.…”

Review of guidance for the selection of regenerative endodontics, apexogenesis, apexification, pulpotomy, and other endodontic treatments for immature permanent teeth

“…This is because a failure to prevent microleakage and a failure to adequately disinfect the root canal will compromise healing and is likely to fail (Wikström et al, 2022). It is possible to provide a regenerative endodontic retreatment if any of these complications occur after the initial treatment, however it must be recognized that the outcomes may be unpredictable (Mohammadi et al, 2021). The size of periapical lesions may be reduced following regenerative endodontic treatment, but the periapical tissues are unlikely to be completely healed (Kandemir Demirci et al, 2020).…”