Regenerative Endodontic Procedures Using Contemporary Endodontic Materials

Simone Staffoli,Gianluca Gambarini,Gianluca Plotino,Antonella Polimeni,Maurizio Bossù,Nicola Grande,Barbara Nunez Torrijos

doi:10.3390/ma12060908

Simone Staffoli, Gianluca Gambarini + Show 5 more

Open Access

https://doi.org/10.3390/ma12060908

Copy DOI

Abstract

Calcium hydroxide apexification and Mineral Trioxide Aggregate (MTA) apexification are classical treatments for necrotic immature permanent teeth. The first tend to fail for lack of compliance given the high number of sessions needed; the second has technical difficulties such as material manipulation and overfilling. With both techniques, the root development is interrupted leaving the tooth with a fragile root structure, a poor crown-to-root ratio, periodontal breakdown, and high risk of fracture, compromising long-term prognosis of the tooth. New scientific literature has described a procedure that allows complete root development of these specific teeth. This regenerative endodontic procedure (REP) proposes the use of a combination of antimicrobials and irrigants, no canal walls instrumentation, induced apical bleeding to form a blood clot and a tight seal into the root canal to promote healing. MTA is the most used material to perform this seal, but updated guidelines advise the use of other bioactive endodontic cements that incorporate calcium and silicate in their compositions. They share most of their characteristics with MTA but claim to have fewer drawbacks with regards to manipulation and aesthetics. The purpose of the present article is to review pertinent literature and to describe the clinical procedures protocol with its variations, and their clinical application.

Highlights

Since the 1960s, the procedure indicated to treat immature permanent teeth with loss of vitality was apexification [1,2], a technique that aims to obtain a calcified apical barrier that permits the canal to be filled in a conventional way afterward [3], see Figure 1.This technique has been demonstrated to be predictable and successful; some complications remain [4]
Even if long-term outcome studies in humans do not yet exist [87], a recent systematic review and meta-analysis reported that revitalization and Mineral Trioxide Aggregate (MTA) apexification had high survival rates and positive outcomes with no significant differences between each other [87]
A retrospective study comparing the outcome of revascularization to MTA apexification and calcium hydroxide apexification reported a survival rate of 100% for revascularization at an average of 14 months after treatment

Summary

Introduction

Since the 1960s, the procedure indicated to treat immature permanent teeth with loss of vitality was apexification [1,2], a technique that aims to obtain a calcified apical barrier that permits the canal to be filled in a conventional way afterward [3], see Figure 1. This technique has been demonstrated to be predictable and successful; some complications remain [4]. The mineralization of an apical barrier is promoted by high pH and the absence of Materials 2019, 12, 908; doi:10.3390/ma12060908 www.mdpi.com/journal/materials

Objectives

Findings

Discussion

Conclusion