Abstract
Objective Pulp revascularization is an effective treatment for immature necrotic teeth. Calcium hydroxide has been used in pulp revascularization as an intracanal medication due to its antimicrobial action and the non-exhibition of crown discoloration and cytotoxicity for stem cells from the apical papilla. Our study aimed to investigate the clinical success and quantitative radiographic changes of root development in immature traumatized teeth using calcium hydroxide plus 2% chlorhexidine gel as intracanal medication.Methodology In this retrospective study, 16 patients were treated with a standardized pulp revascularization protocol. Calcium hydroxide and 2% chlorhexidine gel were manipulated in a 1:1 (v/v) ratio and inserted into root canals with Lentulo spirals (Dentsply Maillefer, Baillaigues, Switzerland). Patients were followed up for a period from 9 to 36 months for the evaluation of clinical and radiological data. Radiographic measurements of root length, root width, apical diameter, and MTA placement from the apex were quantified using software ImageJ. Wilcoxon test and t-test were used, according to nonparametric or parametric data, respectively, for changes over time in root length, root width, and apical diameter.Results Fifteen teeth survived during the follow-up period (93.75%) and met the criteria for clinical success. Although the changes seem to be very small in many cases, significant increases in the average root length (14.28%, p<0.0001), root width (8.12%, p=0.0196), and decrease in apical diameter (48.37%, p=0.0007) were observed. MTA placement from the apex and age at the time of treatment was not significantly associated with the quantitative radiographic outcomes.Conclusions Pulp revascularization in traumatized immature teeth treated with calcium hydroxide plus 2% chlorhexidine gel as intracanal medication had high success and survival rates, showing periodontal healing and resolution of signs and symptoms. However, concerning the continued root development, the outcomes can still be considered unpredictable.
Highlights
Calcium hydroxide has been used in pulp revascularization as an intracanal medication due to its antimicrobial action and the nonexhibition of crown discoloration and cytotoxicity for stem cells from the apical papilla
Our study aimed to investigate the clinical success and quantitative radiographic changes of root development in immature traumatized teeth using calcium hydroxide plus 2% chlorhexidine gel as intracanal medication
The changes seem to be very small in many cases, significant increases in the average root length (14.28%, p
Summary
Traumatic dental injuries mostly occur in kids between 7 and 14 years old, and pulp necrosis with interruption of root development is one of the main sequelae. If an injury occurs to an immature tooth without causing necrosis, reinnervation and reestablishment of the vascular supply are expected, allowing the tooth to continue its growth. if the pulp tissue becomes necrotic, blood supply is interrupted and, root development is suspended, resulting in a tooth with open apices and thin and fragile dentinal walls. The treatments proposed for this condition include a) apexification with periodic changes of calcium hydroxide-based medications; b) placement of an apical barrier with MTA (mineral trioxide aggregate), followed by root canal obturation with gutta-percha, and c) pulp revascularization.3Pulp revascularization has been consolidated as a viable and effective alternative for the treatment of immature necrotic teeth. It has advantages over the conventional techniques, such as the possibility of continued root development and the consequent strengthening of the dental structure. Its steps involve decontamination with root canal irrigants, insertion of intracanal medication, induction of a blood clot, and coronal sealing.. Traumatic dental injuries mostly occur in kids between 7 and 14 years old, and pulp necrosis with interruption of root development is one of the main sequelae.. If the pulp tissue becomes necrotic, blood supply is interrupted and, root development is suspended, resulting in a tooth with open apices and thin and fragile dentinal walls.. Pulp revascularization has been consolidated as a viable and effective alternative for the treatment of immature necrotic teeth.. Pulp revascularization has been consolidated as a viable and effective alternative for the treatment of immature necrotic teeth.3 It has advantages over the conventional techniques, such as the possibility of continued root development and the consequent strengthening of the dental structure..
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