Alternative to Avoid Tooth Discoloration after Regenerative Endodontic Procedure: A Systematic Review.

Luciane Geanini Pena Dos Santos,Fernanda Geraldo Pappen,Flávio Fernando Demarco,Wilson Tadeu Felippe,Luiz Alexandre Chisini,Mara Cristina Santos Felippe,Camila Guerner Springmann,Beatriz Dulcineia Mendes De Souza

doi:10.1590/0103-6440201802132

Luciane Geanini Pena Dos Santos, Fernanda Geraldo Pappen + Show 6 more

Open Access

https://doi.org/10.1590/0103-6440201802132

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Abstract

This systematic review aimed to evaluate whether alternative materials to conventional triple antibiotic paste (TAP - metronidazole, ciprofloxacin, and minocycline) and grey mineral trioxide aggregate (GMTA) could avoid tooth discoloration in teeth submitted to Regenerative Endodontic Procedure (REP). It was also investigated if dental bleaching is able to reverse the color of darkened teeth due to REP. The search was conducted in four databases (Medline via PubMed, Scopus, ISI Web of Science and BVS - Virtual health library), following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The retrieved papers were uploaded in the software EndNoteTM and two reviewers independently selected the studies and extracted the data. Only studies in humans (case reports, case series, clinical trials) were included in the review. From 1,122 potentially eligible studies, 83 were selected for full-text analysis, and 38 were included in the review. The included studies were mainly case reports (76.3 %). The studies described a total of 189 teeth submitted to REP. From these, about 54% of teeth presented some degree of discoloration. Most teeth presenting color alteration were treated with TAP, especially when combined with GMTA. Only three studies performed dental bleaching to restore the color of teeth and neither bleaching technique was able to restore the original color of the crowns. The use of alternative materials to TAP and GMTA, such as double antibiotic paste or Ca(OH)2 pastes and white mineral trioxide aggregate or BiodentineTM, reduces the occurrence of tooth discoloration.

Highlights

Regenerative endodontic procedure (REP) has been proposed as a treatment option for necrotic immature permanent teeth (NIPT) in detriment to apexogenesis with calcium hydroxide (CaOH2) and apexification with trioxide mineral aggregate (MTA) [1]
Forty-five studies were excluded after full-text reading once they did not report the color maintenance or the tooth discoloration [23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62], or since the tooth discoloration described had occurred prior to revascularization procedure [63,64,65,66,67,68]
More than 50% of the revascularized teeth presented some color alteration, mainly when Triple antibiotic paste (TAP) was used as intracanal medication and grey MTA (GMTA) as cervical sealing material

Summary

Introduction

Regenerative endodontic procedure (REP) has been proposed as a treatment option for necrotic immature permanent teeth (NIPT) in detriment to apexogenesis with calcium hydroxide (CaOH2) and apexification with trioxide mineral aggregate (MTA) [1]. REP is based on the formation of blood clot into the root canal space creating a natural scaffold that serves as anchorage site for cells from apical papilla and periodontal tissues. In the Clinical Considerations for a Regenerative Procedure, the American Association of Endodontists (AAE) [3] recommends for root canal disinfection the use of CaOH2 or triple antibiotic paste (TAP - metronidazole, ciprofloxacin and minocycline), for a short period [3]. It was proposed to seal the coronal dentinal tubules with bonding agent prior to the use of TAP as intracanal medication [6] as well as the replacement or eliminating minocycline from TAP composition. Some studies have adopted only the elimination of minocycline of conventional TAP, so called Double antibiotic paste (DAP - metronidazole, ciprofloxacin) [10,11]

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