Abstract
Periapical health is the primary goal of endodontic treatment in mature and immature teeth. In addition, the goals of treatment of immature teeth with arrested root development include root growth to length and maturation of the apex, as well as thickening of the canal wall. These goals are valid for immature teeth that have been subjected to trauma and dental caries or that are the result of developmental anomalies that expose the tooth to the risk of pulp necrosis and consequently result in the cessation of root maturation. Regenerative endodontic procedures (REPs) have been described as a “paradigm shift” in the treatment of immature teeth with pulp necrosis and underdeveloped roots, as there is the potential for further root maturation and return of vitality. Treatment with REPs is advocated as the treatment of choice for immature teeth with pulp necrosis. REP protocols involve the use of alkaline biomaterials, primarily sodium hypochlorite, calcium hydroxide, mineral trioxide aggregates and Biodentine, and are the essential components of a successful treatment regimen.
Highlights
The development of pulp necrosis subsequent to trauma or extensive caries places the immature tooth at risk of cessation of root growth in length, the thickening of root canal walls and the maturation of the apex
With the introduction of regenerative endodontic procedures (REPs) in 2001, a biologically based framework was presented in which further root maturation can occur [6]
Alkaline materials play an integral role in Regenerative endodontic procedures (REPs) as disinfecting irrigants, intracanal medicaments and cements used for the creation of an intracanal barrier over the blood clot
Summary
The development of pulp necrosis subsequent to trauma or extensive caries places the immature tooth at risk of cessation of root growth in length, the thickening of root canal walls and the maturation of the apex. Traditional methods for the treatment of these teeth include calcium hydroxide apexification, which requires multiple visits over an extended period of time This results in a delay of root canal obturation and placement of permanent restoration [2,3]. Recent advancements in dental materials, such as the development of calcium silicate cements, have made it possible to implement a barrier technique with mineral trioxide aggregates (MTAs) in a one-step apexification procedure. This approach has resulted in a greatly shortened treatment time and favourable treatment outcome [5]. With the introduction of regenerative endodontic procedures (REPs) in 2001, a biologically based framework was presented in which further root maturation can occur [6]
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