Interventions for the endodontic management of non-vital traumatised immature permanent anterior teeth in children and adolescents: a systematic review of the evidence and guidelines of the European Academy of Paediatric Dentistry

M Duggal, H J Tong, M Al-Ansary, W Twati, P F Day, H Nazzal, M Duggal, H J Tong, M Al-Ansary, W Twati, P F Day, H Nazzal

Abstract

Aim: This systematic review was undertaken in order to develop guidelines for the European Academy of Paediatric Dentistry for the management of non-vital permanent anterior teeth with incomplete root development.

Methods: Three techniques were considered; apexification by single or multiple applications of calcium hydroxide, use of Mineral Trioxide Aggregate (MTA) for the creation of an apical plug followed by obturation of the root canal, and finally a Regenerative Endodontic Technique (RET). Scottish Intercollegiate Guideline Network (SIGN) Guidelines (2008) were used for the synthesis of evidence and grade of recommendation.

Results: Variable levels of evidence were found and generally evidence related to these areas was found to be weak and of low quality. It was not possible to produce evidence-based guidelines based on the strength of evidence that is currently available for the management of non-vital immature permanent incisors.

Conclusions: Based on the available evidence the European Academy of Paediatric Dentistry proposes Good Clinical Practice Points as a guideline for the management of such teeth. It is proposed that the long term use of calcium hydroxide in the root canals of immature teeth should be avoided and apexification with calcium hydroxide is no longer advocated. The evidence related to the use of a Regenerative Endodontic Technique is currently extremely weak and therefore this technique should only be used in very limited situations where the prognosis with other techniques is deemed to be extremely poor. The current review supports the use of MTA followed by root canal obturation as the treatment of choice.

Keywords: Calcium Hydroxide apexification; Endodontics; Immature non vital incisors; Mineral Trioxide aggregate; Regeneration/revitalisation; Trauamtized teeth.

Conflict of interest statement

This article is a systematic review of the literature and no experiments involving humans or animals were performed by any of the authors. The authors have no conflict of interest to declare.

Figures

Fig. 1
Fig. 1
Success of calcium hydroxide apexification in three studies

References

    1. Adamidou V. In vitro investigation of teeth discolouration with different endodontic medicaments. Leeds: University of Leeds; 2010.
    1. Al-Ansari A. Which type of post and core system should you use? Evidence-based dentistry. 2007;8(2):42. doi: 10.1038/sj.ebd.6400489.
    1. Al-Jundi SH. Type of treatment, prognosis, and estimation of time spent to manage dental trauma in late presentation cases at a dental teaching hospital: a longitudinal and retrospective study. Dent Traumatol. 2004;20(1):1–5. doi: 10.1111/j.1600-4469.2004.00218.x.
    1. Alobaid AS, Cortes LM, Lo J, et al. Radiographic and clinical outcomes of the treatment of immature permanent teeth by revascularization or apexification: a pilot retrospective cohort study. J Endod. 2014;40(8):1063–1070. doi: 10.1016/j.joen.2014.02.016.
    1. American Association of Endodontics (2016) AAE Clinical Considerations for a Regenerative Procedure (online). American Association of Endodontics. . Accessed 06 Aug 2016.
    1. Andreasen J, Farik B, Munksgaard E. Long-term calcium hydroxide as a root canal dressing may increase risk of root fracture. Dent Traumatol. 2002;18:134–137. doi: 10.1034/j.1600-9657.2002.00097.x.
    1. Banchs F, Trope M. Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol? J of Endod. 2004;30(4):196–200. doi: 10.1097/00004770-200404000-00003.
    1. Bateman G, Ricketts DN, Saunders WP. Fibre-based post systems: a review. Br Dent J. 2003;195(1):43–48. doi: 10.1038/sj.bdj.4810278.
    1. Bezgin T, Yilmaz AD, Celik BN, Kolsuz ME, Sonmez H. Efficacy of platelet-rich plasma as a scaffold in regenerative endodontic treatment. J Endod. 2015;41(1):36–44. doi: 10.1016/j.joen.2014.10.004.
    1. Bose R, Nummikoski P, Hargreaves K. A retrospective evaluation of radiographic outcomes in immature teeth with necrotic root canal systems treated with regenerative endodontic procedures. J Endod. 2009;35(10):1343–1349. doi: 10.1016/j.joen.2009.06.021.
    1. Cochrane Collaboration . Assessing risk of bias in included studies. In: Higgins J, Altman D, Sterne J, editors. Cochrane handbook for systematic reviews of interventions. 5.1.0. Chichester: Wiley; 2011.
    1. Coviello J, Brilliant JD. A preliminary clinical study on the use of tricalcium phosphate as an apical barrier. J Endod. 1979;5(1):6–13. doi: 10.1016/S0099-2399(79)80141-7.
    1. Cvek M. prognosis of luxated non-vital luxated maxillary incisors treated with calcium hydroxide- A retrospective clinical study. Dent Traumatol. 1992;8(2):45–55.
    1. Damle SG, Bhattal H, Loomba A. Apexification of anterior teeth: a comparative evaluation of mineral trioxide aggregate and calcium hydroxide paste. J Clin Pediatr Dent. 2012;36(3):263–268. doi: 10.17796/jcpd.36.3.02354g044271t152.
    1. Dominguez Reyes A, Munoz Munoz L, Aznar Martin T. Study of calcium hydroxide apexification in 26 young permanent incisors. Dent Traumatol. 2005;21(3):141–145. doi: 10.1111/j.1600-9657.2005.00289.x.
    1. Doyon GE, Dumsha T, von Fraunhofer JA. Fracture resistance of human root dentin exposed to intracanal calcium hydroxide. J of Endod. 2005;31(12):895–897. doi: 10.1097/.
    1. El-Meligy OA, Avery DR. Comparison of apexification with mineral trioxide aggregate and calcium hydroxide. Pediatr Dent. 2006;28(3):248–253.
    1. Elshamy FM, Singh G, Elraih H, Gupta I, Idris FA. Antibacterial effect of new bioceramic pulp capping material on the main cariogenic bacteria. J Contemp Dent Pract. 2016;17(5):349–353. doi: 10.5005/jp-journals-10024-1854.
    1. Gazelles B, Olgart L, Edwall B. Restored vitality in luxated teeth assessed by laser Doppler flowmeter. Endod Dent Traumatol. 1988;4:265–268. doi: 10.1111/j.1600-9657.1988.tb00645.x.
    1. Hargreaves KM, Diogenes A, Teixeira FB. Treatment options: Biological basis of regenerative endodontic procedures. J Endod. 2013;39:S30–43.
    1. Harker R, Morris J. Children’s dental health in England 2003. London: Office for National Statistics; 2003.
    1. Hoshino E, Kurihara-Ando N, Sato I, et al. In-vitro antibacterial susceptibility of bacteria taken from infected root dentine to a mixture of ciprofloxacin, metronidazole and minocycline. Int Endod J. 1996;29(2):125–130. doi: 10.1111/j.1365-2591.1996.tb01173.x.
    1. Huang G, Sonoyama W, Liu Y, et al. The hidden treasure in apical papilla: the potential role in pulp/dentin regeneration and bioroot engineering. J Endod. 2008;34:645–651. doi: 10.1016/j.joen.2008.03.001.
    1. Jadhav G, Shah N, Logani A. Revascularization with and without platelet-rich plasma in nonvital, immature, anterior teeth: a pilot clinical study. J Endod. 2012;38(12):1581–1587. doi: 10.1016/j.joen.2012.09.010.
    1. Jeeruphan T, Jantarat J, Yanpiset K, et al. Mahidol study 1: comparison of radiographic and survival outcomes of immature teeth treated with either regenerative endodontic or apexification methods: a retrospective study. J Endod. 2012;38(10):1330–1336. doi: 10.1016/j.joen.2012.06.028.
    1. Kim J, Kim Y, Shin S, Park J, Jung I. Tooth discoloration of immature permanent incisor associated with triple antibiotic therapy: a case report. J of Endod. 2010;36:86–91.
    1. Kontakiotis EG, Filippatos CG, Tzanetakis GN, Agrafioti A. Regenerative endodontic therapy: a data analysis of clinical protocols. J Endod. 2015;41(2):146–154. doi: 10.1016/j.joen.2014.08.003.
    1. Lenherr P, Allgayer N, Weiger R, et al. Tooth discoloration induced by endodontic materials: a laboratory study. Int Endod J. 2012;45(10):942–949. doi: 10.1111/j.1365-2591.2012.02053.x.
    1. Lindeboom JA, Frenken JW, Kroon FH, van den Akker HP. A comparative prospective randomized clinical study of MTA and IRM as root-end filling materials in single-rooted teeth in endodontic surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100(4):495–500. doi: 10.1016/j.tripleo.2005.03.027.
    1. Liu S, Wang S, Dong Y. Evaluation of a bioceramic as a pulp capping agent in vitro and in vivo. J Endod. 2015;41(5):652–657. doi: 10.1016/j.joen.2014.12.009.
    1. Lovelace TW, Henry MA, Hargreaves KM, Diogenes A. Evaluation of the delivery of mesenchymal stem cells into the root canal space of necrotic immature teeth after clinical regenerative endodontic procedure. J Endod. 2011;37(2):133–138. doi: 10.1016/j.joen.2010.10.009.
    1. Mackie IC, Hill F, Worthington HV. Comparison of two calcium hydroxide pastes used for endodontic treatment of non-vital immature incisor teeth. Dent Traumatol. 1994;10(2):88–90. doi: 10.1111/j.1600-9657.1994.tb00066.x.
    1. Martin DE, De Almeida JF, Henry MA, et al. Concentration-dependent effect of sodium hypochlorite on stem cells of apical papilla survival and differentiation. J Endod. 2014;40(1):51–55. doi: 10.1016/j.joen.2013.07.026.
    1. Merglova V. The treatment of non-vital permanent teeth by filling of root canals with calcium hydroxide. Eur J Paediatr Dent. 2001;1:38–44.
    1. Moore A, Howley MF, O’Connell AC. Treatment of open apex teeth using two types of white mineral trioxide aggregate after initial dressing with calcium hydroxide in children. Dent Traumatol. 2011;27(3):166–173. doi: 10.1111/j.1600-9657.2011.00984.x.
    1. Nagata JY, Gomes BP, Rocha Lima TF, et al. Traumatized immature teeth treated with 2 protocols of pulp revascularization. J Endod. 2014;40(5):606–612. doi: 10.1016/j.joen.2014.01.032.
    1. Nagy MM, Tawfik HE, Hashem AA, Abu-Seida AM. Regenerative potential of immature permanent teeth with necrotic pulps after different regenerative protocols. J Endod. 2014;40(2):192–198. doi: 10.1016/j.joen.2013.10.027.
    1. Narang I, Mittal N, Mishra N. A comparative evaluation of the blood clot, platelet-rich plasma, and platelet-rich fibrin in regeneration of necrotic immature permanent teeth: a clinical study. Contemp Clin Dent. 2015;6(1):63–68. doi: 10.4103/0976-237X.149294.
    1. Nazzal H, Kenny K, Kang J, Duggal MS. A prospective clinical study of regenerative endodontic treatment of traumatised non-vital immature teeth. Int J Paediatr Dent. 2015;25(Suppl. 1):73.
    1. Nicoloso GF, Potter IG, Rocha RO, Montagner F, Casagrande L. A comparative evaluation of endodontic treatments for immature necrotic permanent teeth based on clinical and radiographic outcomes: a systematic review and meta-analysis. Int J Paediatr Dent. 2016;27(3):217–27.
    1. Nygaard-Ostby B. The role of the blood clot in endodontic therapy. An experimental histologic study. Acta Odontol Scand. 1961;19:324–353.
    1. Pace R, Giuliani V, Pini Prato L, Baccetti T, Pagavino G. Apical plug technique using mineral trioxide aggregate: results from a case series. Int Endod J. 2007;40(6):478–484. doi: 10.1111/j.1365-2591.2007.01240.x.
    1. Pradhan DP, Chawla HS, Gauba K, Goyal A. Comparative evaluation of endodontic management of teeth with unformed apices with mineral trioxide aggregate and calcium hydroxide. J Dent Child (Chic). 2006;73(2):79–85.
    1. Quality guidelines for endodontic treatment Consensus report of the European Society of Endodontology. Int Endod J. 2006;39(12):921–930. doi: 10.1111/j.1365-2591.2006.01180.x.
    1. Roberts SC, Jr, Brilliant JD. Tricalcium phosphate as an adjunct to apical closure in pulpless permanent teeth. J of Endod. 1975;1(8):263–269. doi: 10.1016/S0099-2399(75)80038-0.
    1. Rosenberg B, Murray PE, Namerow K. The effect of calcium hydroxide root filling on dentin fracture strength. Dent Traumatol. 2007;23(1):26–29. doi: 10.1111/j.1600-9657.2006.00453.x.
    1. Scottish Intercollegiate Guidelines Network . Sign 50: a guideline developer's handbook. Edinburgh: Scottish Intercollegiate Guidelines Network; 2008.
    1. Simon S, Rilliard F, Berdal A, Machtou P. The use of mineral trioxide aggregate in one-visit apexification treatment: a prospective study. Int Endod J. 2007;40(3):186–197. doi: 10.1111/j.1365-2591.2007.01214.x.
    1. Sonoyama W, Liu Y, Yamaza T, et al. Characterization of the apical papilla and its residing stem cells from human immature permanent teeth: a pilot study. J Endod. 2008;34(2):166–171. doi: 10.1016/j.joen.2007.11.021.
    1. Trevino EG, Patwardhan AN, Henry MA, et al. Effect of irrigants on the survival of human stem cells of the apical papilla in a platelet-rich plasma scaffold in human root tips. J Endod. 2011;37(8):1109–1115. doi: 10.1016/j.joen.2011.05.013.
    1. Twati W, Wood D, Liskiewicz T, Duggal M. Effect of non-setting calcium hydroxide and MTA on human dentine following long term application. Int J Paediatr Dent. 2009;19(S1):43.
    1. Twati W, Wood D, Liskiewicz T, Willmott N, Duggal M. An evaluation of the effect of non-setting calcium hydroxide on human dentine: a pilot study. European Archives of Paediatric Dentistry. 2009;10:104–109. doi: 10.1007/BF03321610.
    1. Twati W, Percival R, Duggal M. The antimicrobial effect of various root canal medicaments used in management of immature non vital anterior teeth. Int J Paediatr Dent. 2011;21(S1):35.
    1. Wigler R, Kaufman AY, Lin S, et al. Revascularization: a treatment for permanent teeth with necrotic pulp and incomplete root development. J Endod. 2013;39(3):319–326. doi: 10.1016/j.joen.2012.11.014.
    1. Yates JA. Barrier formation time in non-vital teeth with open apices. Int Endod J. 1988;21(5):313–319. doi: 10.1111/j.1365-2591.1988.tb01141.x.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel