Abstract
Regenerative endodontic procedure (REP) is a progressive treatment modality for immature permanent teeth with necrotic pulp. The ambiguousness about the predictability of REP outcome in relation to complete disinfection of the root canal system and the occurrence of discoloration still exists. The aim of this retrospective study was to analyze two treatment protocols on clinical success rate, radiographic root development and the occurrence of discoloration. Eighteen patients were treated by a single operator by either treatment protocol according to the American Association of Endodontists (AAEP, n = 9) or a modified protocol (MP, n = 9) with the use of 5% sodium hypochlorite and sandblasting. Patients were followed up after 3, 6, 9, 12, 18 and 24 months and clinical success, radiographic root development and the occurrence of discoloration were assessed. The clinical success of MP was significantly higher in two years follow-up (p = 0.015), but the change in radiographic root area was higher for AAEP (p = 0.017) and the occurrence of discoloration was higher in AAEP (p = 0.029). The use of 5% sodium hypochlorite for a longer period of time leads to a higher success rate. The sandblasting of the access cavity reduces the occurrence of discoloration.
Highlights
Endodontic treatment of immature permanent teeth with necrotic pulp is one of the most challenging treatment options in endodontics because of the thin root wall and open apex
It has been shown that Regenerative endodontic procedure (REP) has an excellent success rate alone [1] or in comparison to a calcium silicate apical plug [2], but ambiguousness still exists about the predictability of REP outcome [1]
Based on the results of the Fisher’s exact test, the value of the Cvek’s classification, etiology or time in the development of symptoms did not depend on the applied protocol (AAEP or modified protocol (MP))
Summary
Endodontic treatment of immature permanent teeth with necrotic pulp is one of the most challenging treatment options in endodontics because of the thin root wall and open apex. These cases are usually caused by trauma, caries, or a developmental malformation, such as dens evaginatus or dens invaginatus, resulting in pulp necrosis and arrested root development. Regenerative endodontic procedure (REP, known as revascularization or revitalization) was proposed as an alternative to calcium hydroxide apexification or a calcium silicate apical plug in order to overcome the disadvantageous initial conditions such as a thin root wall or a wide-open apex. Previous studies have shown that the absence of bacteria is critical for successful revascularization or REP because the new tissue will stop at the level it meets bacteria in the canal space [4,5]
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