Deciduous Tooth Pulp Autotransplantation for the Regenerative Endodontic Treatment of Permanent Teeth With Pulp Necrosis: A Case Series

Abstract

IntroductionIn young individuals, deciduous tooth pulp might be used as a natural, biologic scaffold for the regenerative endodontic treatment (RET) of young permanent teeth with necrotic pulps and apical periodontitis. The present case series demonstrates the clinical and radiographic outcomes of a novel RET using deciduous pulp autotransplantation in traumatized, necrotic young permanent incisors. MethodsFive previously traumatized maxillary incisors of four 8- to 11.5-year-old patients were treated with a RET protocol that used 2.5% NaOCl irrigation and placement of calcium hydroxide dressing in the first visit. After 4 weeks, the intracanal medication was removed, and the whole pulp tissue harvested from the neighboring maxillary deciduous canine was transplanted into the disinfected root canal without induced apical bleeding. Following placement of a mineral trioxide aggregate coronal barrier, the access cavities were restored with acid-etch resin composite. The root canals of donor primary canines were filled with calcium hydroxide-iodoform paste and were restored as with the permanent incisors. ResultsThree patients were followed-up for 24 months, and 1 patient for 12 months. All teeth demonstrated radiographic evidence of complete periapical healing, slight increase in dentinal wall thickness, and continued apical closure in the absence of clinical symptoms. A positive response to cold test was obtained in 1 incisor at 12 months and 2 at 24 months. ConclusionsBased on 12- and 24-month clinical and radiographic findings, the present cases demonstrate a favorable outcome of a RET protocol using deciduous pulp autotransplantation in young permanent incisors with pulp necrosis.