Regenerative Endodontic Treatment: Report of Two Cases with Different Clinical Management and Outcomes

Mehrfam Khoshkhounejad, Noushin Shokouhinejad, Salma Pirmoazen, Mehrfam Khoshkhounejad, Noushin Shokouhinejad, Salma Pirmoazen

Abstract

Endodontic intervention in necrotic immature permanent teeth is usually a clinical challenge. With appropriate case selection, regenerative treatment can be effective, providing a desirable outcome. However, there is still no consensus on the optimal disinfection protocol or the method to achieve predictable clinical outcome. This article presents two cases of regenerative treatment in necrotic immature teeth, using mineral trioxide aggregate (MTA) and Biodentine(TM) as coronal barriers and different irrigants, which led to different clinical outcomes.

Keywords: Dental Pulp Necrosis; Endodontics; Regeneration; Stem Cells.

Figures

Fig. 1.
Fig. 1.
(A) Preoperative periapical radiograph of tooth #21. Note the immaturity of root. (B) After placing MTA on blood clot and temporary filling. (C) After completion of regenerative endodontic procedure and permanent coronal restoration. (D) Six-month follow-up. Note the periapical radiolucent lesion. (E and F) After placing MTA plug as apical barrier and obturation of coronal part of the root. (G) One-year follow-up. The healing of periapical lesion was observed.
Fig. 2.
Fig. 2.
Cavity on the occlusal surface of tooth #45 and a sinus tract in the lingual side of the tooth.
Fig. 3.
Fig. 3.
Panoramic radiograph. Note the immaturity of tooth #45.
Fig. 4.
Fig. 4.
(A) Blunderbuss short root of tooth #45 with thin dentinal walls and a radiolucency embracing the root. (B) After regenerative endodontic treatment and permanent coronal restoration. (C) Six-month follow-up. (D)
Fig. 5.
Fig. 5.
End of first appointment. Note the non-traceable sinus tract in the lingual side of tooth #45.
Fig. 6.
Fig. 6.
After permanent restoraion.

References

    1. Khetarpal A, Chaudhary S, Talwar S, Ravi R, Verma M. Revascularization of immature permanent tooth with periapical lesion using a new biomaterial - A case report. Int J Dent Sci Res. 2013. September;1(1):20–2.
    1. Rafter M. Apexification: a review. Dent Traumatol. 2005. February; 21 (1): 1– 8.
    1. Torabinejad M, Chivian N. Clinical applications of mineral trioxide aggregate. J Endod. 1999. March; 25 (3): 197– 205.
    1. Nosrat A, Homayounfar N, Oloomi K. Drawbacks and unfavorable outcomes of regenerative endodontic treatments of necrotic immature teeth: a literature review and report of a case. J Endod. 2012. October; 38 (10): 1428– 34.
    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. May; 35 (5): 745– 9.
    1. Huang GT. A paradigm shift in endodontic management of immature teeth: conservation of stem cells for regeneration. J Dent. 2008. June; 36 (6): 379– 86.
    1. Chen MY, Chen KL, Chen CA, Tayebaty F, Rosenberg PA, Lin LM. Responses of immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscess to revascularization procedures. Int Endod J. 2012. March; 45 (3): 294– 305.
    1. Banchs F, Trope M. Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol? J Endod. 2004. April; 30 (4): 196– 200.
    1. Reynolds K, Johnson JD, Cohenca N. Pulp revascularization of necrotic bilateral bicuspids using a modified novel technique to eliminate potential coronal discolouration: a case report. Int Endod J. 2009. January; 42 (1): 84– 92.
    1. Shin SY, Albert JS, Mortman RE. One step pulp revascularization treatment of an immature permanent tooth with chronic apical abscess: a case report. Int Endod J. 2009. December; 42 (12): 1118– 26.
    1. Petrino JA, Boda KK, Shambarger S, Bowles WR, McClanahan SB. Challenges in regenerative endodontics: a case series. J Endod. 2010. March; 36 (3): 536– 41.
    1. Chueh LH, Huang GT. Immature teeth with periradicular periodontitis or abscess undergoing apexogenesis: a paradigm shift. J Endod. 2006. December; 32 (12): 1205– 13.
    1. Chueh LH, Ho YC, Kuo TC, Lai WH, Chen YH, Chiang CP. Regenerative endodontic treatment for necrotic immature permanent teeth. J Endod. 2009. February; 35 (2): 160– 4.
    1. Thibodeau B, Trope M. Pulp revascularization of a necrotic infected immature permanent tooth: case report and review of the literature. Pediatr Dent. 2007. Jan-Feb; 29 (1): 47– 50.
    1. Hoshino E, Kurihara-Ando N, Sato I, Uematsu H, Sato M, Kota K, 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. March; 29 (2): 125– 30.
    1. Hargreaves KM, Cohen S, Berman LH. Cohen’s pathways of the pulp expert consult: 10th ed Mosby, St. Louis; 2011: 614.
    1. Considerations for Regenerative Procedures. [Internet]. American Association of Endodontics; 2013. [cited October 1, 2013]. Available at:
    1. Levitan ME, Himel VT. Dens evaginatus: literature review, pathophysiology, and comprehensive treatment regimen. J Endod. 2006. January; 32 (1): 1– 9.
    1. da Silva LA, Nelson-Filho P, da Silva RA, Flores DS, Heilborn C, Johnson JD, et al. Revascularization and periapical repair after endodontic treatment using apical negative pressure irrigation versus conventional irrigation plus triantibiotic intracanal dressing in dogs’ teeth with apical periodontitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010. May; 109 (5): 779– 87.
    1. Trevino EG, Patwardhan AN, Henry MA, Perry G, Dybdal-Hargreaves N, Hargreaves KM, 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. August; 37 (8): 1109– 15.
    1. Yamauchi N, Yamauchi S, Nagaoka H, Duggan D, Zhong S, Lee SM, et al. Tissue engineering strategies for immature teeth with apical periodontitis. J Endod. 2011. March; 37 (3): 390– 7.
    1. Ring KC, Murray PE, Namerow KN, Kuttler S, Garcia-Godoy F. The comparison of the effect of endodontic irrigation on cell adherence to root canal dentin. J Endod. 2008. December; 34 (12): 1474– 9.
    1. Zanini M, Sautier JM, Berdal A, Simon S. Biodentine induces immortalized murine pulp cell differentiation into odontoblast-like cells and stimulates biomineralization. J Endod. 2012. September; 38 (9): 1220– 6.
    1. Lin LM, Shimizu E, Gibbs JL, Loghin S, Ricucci D. Histologic and histobacteriologic observations of failed revascularization/revitalization therapy: a case report. J Endod. 2014. February; 40 (2): 291– 5.
    1. Lenzi R, Trope M. Revitalization procedures in two traumatized incisors with different biological outcomes. J Endod. 2012. March; 38 (3): 411– 4.
    1. Wang X, Thibodeau B, Trope M, Lin LM, Huang GT. Histologic characterization of regenerated tissues in canal space after the revitalization/revascularization procedure of immature dog teeth with apical periodontitis. J Endod. 2010. January; 36 (1): 56– 63.
    1. Fouad AF, Nosrat A. Pulp regeneration in previously infected root canal space. Endod Topics. 2013. May; 28 (1): 24– 37.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅