Abstract
PurposeTo evaluate and assess the current knowledge about apexification and regenerative techniques as a meaningful treatment modality and to map the scientific evidence for the efficacy of both methods for the management of traumatised immature teeth with pulp necrosis and apical periodontitis.MethodsThis systematic review searched five databases: PubMed, Web of Science, Cochrane Library, Ovid (Medline), and Embase. Published articles written in English were considered for inclusion. The following keywords were used: Regenerative endodontic treatment OR regenerat* OR revital* OR endodontic regeneration OR regenerative endodontics OR pulp revascularization OR revasculari* OR ‘traumatized immature teeth’. Only peer-reviewed studies with a study size of at least 20 cases followed up for 24 months were included. Eligibility assessment was performed independently in a blinded manner by three reviewers and disagreements were resolved by consensus. Subgroup analyses were performed on three clinical outcomes: survival, success, and continued root development.ResultsSeven full texts out of 1359 citations were included and conventional content analysis was performed. Most of the identified citations were case reports and case series.ConclusionsIn the present systematic review, the qualitative analysis revealed that both regenerative and apexification techniques had equal rates of success and survival and proved to be effective in the treatment of immature necrotic permanent teeth. Endodontic regenerative techniques appear to be superior to apexification techniques in terms of stimulation of root maturation, i.e. root wall thickening and root lengthening. Knowledge gaps were identified regarding the treatment and follow-up protocols for both techniques.
Highlights
Traumatic dental injuries to permanent dentition are a global health issue and are the most common aetiological factor for pulp necrosis
For the reasons outlined above, this review critically evaluates whether regenerative endodontics can routinely be recommended in the treatment of traumatised immature teeth with pulp necrosis and infection assuming that the treatment modality will benefit the long-term survival of traumatised teeth and eventually the well-being of the patient
We appraised and synthesised the research evidence for endodontic treatment of traumatised immature teeth in order to insure that the literature study findings are an accurate representation of the studies it contains (Thomas 2005)
Summary
Traumatic dental injuries to permanent dentition are a global health issue and are the most common aetiological factor for pulp necrosis. Pulp necrosis arrests root formation where the root remains short and the dentin walls thin, increasing the risk for cervical fractures (Tsilingaridis et al 2012). The combined effect of these factors makes it challenging to perform an adequate antibacterial endodontic treatment (Kakoli et al 2009; Orstavik and Haapasalo 1990). Much effort has been made to find alternatives to conventional endodontic treatment since it does not lead to further root formation, leaving the tooth susceptible. The problem is that the open apices of traumatised immature teeth make it challenging to perform an adequate root filling without intra-operative complications, such as extrusion of root-filling material into the periapical tissue, s.c. overfilling (Trope 2010)
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