Conventional apexification and revascularization induced maturogenesis of two non-vital, immature teeth in same patient: 24 months follow up of a case

Vivek Aggarwal, Sanjay Miglani, Mamta Singla, Vivek Aggarwal, Sanjay Miglani, Mamta Singla

Abstract

Various authors have demonstrated the regenerative process in immature, non vital teeth by revascularization induced maturogenesis. The aim of this case report is to compare calcium hydroxide apexification and pulp revascularization induced maturation procedures in the same patient, in two different teeth. The right maxillary central incisor in this individual was treated with conventional calcium hydroxide induced apexification procedure followed by guttaperchaobturation, and the left maxillary central incisor was treated by pulp revascularization induced maturation procedures. 24 months follow-up shows root elongation and apical closure in the tooth treated with revascularization induced maturation procedures. Revascularization induced maturogenesis, where indicated, can provide several advantages over conventional apexification procedures.

Keywords: Apexification; apex formation; maturogenesis; revascularization.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
(a) Intra oral radiograph of upper central incisors showing wide root canals and immature apices. Note that the mesial dentinal wall of left central incisor is short than distal. Also there is associated peri-apical radiolucency. Revascularization procedure was induced in left central incisor. (b) 6 months follow-up radiograph showing healing of associated peri-apical radiolucency. There is slight thickening of the lateral dentinal walls of left central incisor. A small remaining portion of the antibiotic placed during the operative procedure can be seen as slight radiographic opacity in the middle/1/3rd of the canal
Figure 2
Figure 2
(a) 12 months follow-up intra oral radiograph showing complete healing of peri- apical radiolucency. The increase in the length of mesial root wall of left central incisor can be appreciated. (b) 18 months follow-up intra oral radiograph showing narrowing of apex and lateral dentinal wall thickening in left central incisor. Note there is no appreciable change in root length or dentinal thickening in right central incisor. (c) 24 months follow up radiograph revealing maturation of root with thickening and lengthening of dentinal walls of left central incisor. There is complete healing of peri-apical radiolucency. Apical closure can also be appreciated

References

    1. Kleier DJ, Barr ES. A study of endodonticallyapexified teeth. Endod Dent Traumatol. 1991;7:112.
    1. Andreasen JO, Farik B, Munksgaard Long-term calcium hydroxide as a root canal dressing may increase the risk of root fracture. Dent Trautamol. 2002;18:134–7.
    1. Andreasen M, Lund A, Andreasen JO, Andreasen FM. In vitro solidity of human pulp tissue in calcium hydroxide and sodium hypochorite. Endod Dent Traumatol. 1992;8:104–8.
    1. Rosenberg B, Murray PE, Namerow K. The effect of calcium hydroxide root filling on dentin fracture strength. Dent Traumatol. 2007;23:26–9.
    1. Cvek M. Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with guttapercha. Endod Dent Traumatol. 1992;8:45–55.
    1. Simon S, Rilliard F, Berdal A, Machtou P. The use of mineral trioxide aggregate in one-visit apexification treatment : A prospective study. IntEndod J. 2007;40:186–97.
    1. Iwaya S, Ikawa M, Kubota M. Revascularization of an immature permanent tooth with apical periodontitis and sinus tract. Dent Traumatol. 2001;17:185–7.
    1. Banchs F, Trope M. Revascularization of immature permanent teeth with apical periodontitis : New treatment protocol? J Endod. 2004;30:196–200.
    1. Chueh LH, Huang GT. Immature teeth with periradicular periodontitis or abscess undergoing apexogenesis : A paradigm shift. J Endod. 2006;32:1205–13.
    1. Shah N, Logani A, Bhaskar U, Aggarwal V. Efficacy of revascularization to induce apexification/apexogensis in infected, nonvital, immature teeth : A pilot clinical study. J Endod. 2008;34:919–25.
    1. Jung IY, Lee SJ, Hargreaves KM. Biologically based treatment of immature permanent teeth with pulpal necrosis : A case series. J Endod. 2008;34:876–87.
    1. Cotti E, Mereu M, Lusso D. Regenerative treatment of an immature, traumatized tooth with apical periodontitis : Report of a case. J Endod. 2008;34:611–6.
    1. Ding RY, Cheung GS, Chen J, Yin XZ, Wang QQ, Zhang CF. Pulp revascularization of immature teeth with apical periodontitis : A clinical study. J Endod. 2009;35:745–9.
    1. Huang GT. A paradigm shift in endodontic management of immature teeth : Conservation of stem cells for regeneration. J Dent. 2008;36:379–86.
    1. Weisleder R, Benitez CR. Maturogenesis : Is it a new concept? J Endod. 2003;29:776–8.
    1. Ham JW, Patterson SS, Mitchell DF. Induced apical closure of immature pulpless teeth in monkeys. Oral Surg Oral Med Oral Pathol. 1972;33:438–49.
    1. Cvek M, Cleaton-Jones P, Austin J, Lownie J, Kling M, Fatti P. Pulp revascularization in reimplanted immature monkey incisors - predictability and the effect of antibiotic systemic prophylaxis. Endod Dent Traumatol. 1990;6:157–69.
    1. Skoglund A, Tronstad L, Wallenius K. A microangiographic study of vascular changes in replanted and autotransplanted teeth of young dogs. Oral Surg Oral Med Oral Pathol. 1978;45:17–28.
    1. Rule DC, Winter GB. Root growth and apical repair subsequent to pulpal necrosis in children. Br Dent J. 1966;120:586–90.
    1. Huang GT, Sonoyama W, Liu Y, Liu H, Wang S, Shi S. The hidden treasure in apical papilla : The potential role in pulp/dentin regeneration and bioroot engineering. J Endod. 2008;34:645–51.
    1. Murray PE, Garcia-Godoy F, Hargreaves KM. Regenerative endodontics : A review of current status and a call for action. J Endod. 2007;33:377–90.
    1. Heithersay GS. Stimulation of root formation in incompletely developed pulpless teeth. Oral Surg Oral Med Oral Pathol. 1970;29:620–30.
    1. Lin L, Shovlin F, Skribner J, Langeland K. Pulp biopsies from the teeth associated with periapical radiolucency. J Endod. 1984;10:436–48.
    1. Frank AL. Therapy for the divergent pulpless tooth by continued apical formation. J Dent Assoc. 1966;72:87–93.
    1. Heithersay GS. Stimulation of root formation in incompletely developed pulpless teeth. Oral Surg Oral Med Oral Pathol. 1970;29:620–30.
    1. Nevins A, Wrobel W, Valachovic R, Finkelstein F. Hard tissue induction into pulpless open-apex teeth using collagen-calcium phosphate gel. J Endod. 1977;3:431–3.
    1. Shabahang S, Torabinejad M, Boyne PP, Abedi H, McMillan P. A comparative study of root-end induction using osteogenic protein-I, calcium hydroxide and mineral trioxide aggregate in dogs. J Endod. 1999;25:1–5.
    1. Gronthos S, Brahim J, Li W, Fisher LW, Cherman N, Boyde A, et al. Stem cell properties of human dental pulp stem cells. J Dent Res. 2002;81:531–5.
    1. Wang Q, Lin XJ, Lin ZY, Liu GX, Shan XL. Expression of vascular endothelial growth factor in dental pulp of immature and mature permanent teeth in human. Shanghai Kou Qiang Yi Zue. 2007;16:285–0.

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