A Prospective Study of Long-Term Regenerative Endodontics Outcomes of Necrotic Immature Permanent Teeth: An 8-Year Follow-Up.

Sawsan T Abu Zeid,Osama S Alothmani,Amna Y Siddiqui,Abeer A Mokeem Saleh,Ruaa A Alamoudi

doi:10.3390/healthcare9121670

Sawsan T Abu Zeid, Osama S Alothmani + Show 3 more

Open Access

https://doi.org/10.3390/healthcare9121670

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Abstract

For the management of necrotic immature teeth, regenerative endodontics offers the advantage of further root lengthening, thickening of dentin wall, and apical closure. This prospective study aimed to evaluate the long-term outcome of regenerative endodontics in immature necrotic permanent teeth. A total of 23 immature roots were medicated by triple antibiotic paste. After 21 days, bleeding was induced by over-instrumentation, and then mineral trioxide aggregate and coronal restoration were applied. Patients were scheduled for clinical and radiographic follow-up for 8 years. The radiographic changes of root dimensions were assessed using the ImageJ Plugin and statistically analyzed by Kruskal–Wallis test at a 95% confidence level. For qualitative evaluation, images were overlapped and analyzed using Photoshop software. All teeth were asymptomatic one month after the treatment. All teeth (n = 18) with preoperative periapical radiolucency showed complete resolution within 6–9 months. Recall rate at two, three, and eight years was 69.6%, 56.5%, and 34.8%, respectively. Continuous root development with a significant increase in root length and thickening of dentin wall accompanied by a significant decrease in apical canal diameter was seen at the end of the observation period (p < 0.001). In conclusion, the long-term outcome of regenerative endodontics revealed successful clinical and radiographic results with appropriate case selection.

Highlights

Dental trauma in young children can lead to pulp devitalization of immature permanent teeth and cessation of root development
The dentin bridge formed after Ca(OH)2 apexification showed a porous “Swiss Cheese configuration” with a lack of a fluid-tight seal [5]
The single appointment apexification technique using mineral trioxide aggregates (MTAs) apical plug demonstrated complete periapical healing with the formation of new apical hard tissue [3]. It did not provide root maturation [6]. Both apexification techniques are successfully managing apical periodontitis associated with immature necrotic permanent teeth, they failed to improve the radicular length and canal width [4], leading to poor crown/root ratio and compromised tooth prognosis [7,8]

Summary

Introduction

Dental trauma in young children can lead to pulp devitalization of immature permanent teeth and cessation of root development. The single appointment apexification technique using MTA apical plug demonstrated complete periapical healing with the formation of new apical hard tissue [3]. It did not provide root maturation [6]. Both apexification techniques are successfully managing apical periodontitis associated with immature necrotic permanent teeth, they failed to improve the radicular length and canal width [4], leading to poor crown/root ratio and compromised tooth prognosis [7,8]

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Conclusion