Abstract
PurposeTo evaluate the effectiveness of apexification versus revascularization in the treatment of necrotic immature teeth and determine which strategy affords the greatest radiological success rate.MethodsAn analysis was made of 18 teeth subjected to mineral trioxide aggregate (MTA) apical plugging and regenerative endodontic treatment, assessing healing of the apical lesions and the changes in root dimensions.ResultsSignificantly greater root growth was observed with revascularization in terms of the percentage change in length (12.75% at 6 months) and dentin thickness (34.57% at 6 months) (p < 0.05). There were no significant differences between the two treatments in terms of the apical healing scores after 6 months of follow-up (p > 0.05).ConclusionApexification with an MTA apical plug and pulp regeneration are reliable treatments for non-vital immature teeth. The radiographic outcomes are comparable between the immature teeth subjected to MTA apexification versus those subjected to revascularization. The results of the present study indicate a greater increase in root length and width with regenerative endodontic treatment.
Highlights
Pulp tissue alterations in immature permanent teeth can lead to loss of pulp vitality and directly affect root development, resulting in short roots with very thin walls
A problem with calcium hydroxide is that it can alter the mechanical properties of dentin and cause the treated tooth to be more vulnerable to root fracture (Andreasen et al 2002)
During the study period 2010–2018, a total of 18 nonvital immature teeth were subjected to apexification with mineral trioxide aggregate (MTA) or revascularization
Summary
Pulp tissue alterations in immature permanent teeth can lead to loss of pulp vitality and directly affect root development, resulting in short roots with very thin walls. This in turn increases the risk of fracture and complicates conventional root canal treatment (Guerrero et al 2018). Among the different treatment options in such situations, mention must be made of apexification, which induces the formation of a calcified apical barrier in an incompletely formed root in which pulp necrosis has been diagnosed (Nicoloso 2017). Apexification may require one or more monthly patient visits to place calcium hydroxide in the root canal and eliminate intracanal infection, stimulating calcification and resulting in apical sealing, allowing filling to be performed The time elapsed from the first patient visit to the end of treatment varies due to the multiple visits required, which complicates continuous patient monitoring and increases the vulnerability of coronal restoration, with a risk of canal reinfection
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