Abstract
Immature necrotic permanent tooth presents a distinctive challenge for the endodontist. Various treatment modalities have been employed to create hard tissue barrier at the apex, which includes non-vital pulp therapy with calcium hydroxide, apexification with mineral trioxide aggregate, pulp revascularisation and regeneration. Regenerative endodontics is a novel modality which involves physiological replacement of the damaged structures of tooth like dentin, root and cells of the pulp-dentin complex. Numerous published case reports have revealed increased dentinal wall thickness, continued root development and apical closure, but there is still lack of sound scientific evidence regarding histological nature of the type of tissue. The current literature review was planned to summarise the evidence regarding the treatment of immature necrotic permanent teeth by regenerative endodontic procedures.
Highlights
Various treatment modalities have been described in literature to create hard tissue barrier at the apex, which includes non-vital pulp therapy with calcium hydroxide, apexification with mineral trioxide aggregate (MTA), pulp revascularisation and regeneration.[1,3,6]
The principal drawback is the long duration of about 6 and 18 months required for the formation of hard tissue apical barrier and required follow-ups every 3 months to check the progression of barrier formation.[8,9]
Slow irrigation with 1.5% NaOCl and saline, placing the irrigating needle at a distance of 1mm from the apex followed by dressing with triple antibiotic paste (TAP) ensuring that it remains below the cementoenamel junction (CEJ) so as to minimise the risk of staining.[66,71]
Summary
Permanent immature teeth with necrotic pulp and periapical disease is a constant problem and area of keen interest for endodontists.[1,2] Disinfection of root canal space is difficult to achieve in these teeth with endodontic files using standard protocol.[1,2] Another difficulty arises during root canal filling due to lack of apical barrier in open apex and its impingement on periodontal tissues.[1,2] Even if these challenges are faced and sorted out, the roots of these teeth are very thin that constitute a high risk of fracture.[3,4,5] Various treatment modalities have been described in literature to create hard tissue barrier at the apex, which includes non-vital pulp therapy with calcium hydroxide, apexification with mineral trioxide aggregate (MTA), pulp revascularisation and regeneration.[1,3,6]The traditional non-vital pulp (NVP) therapy with calcium hydroxide (Ca(OH)2) has been studied largely and is reported to have a good outcome.[7].
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