Continued Root Development Research Articles

A New Approach for Analyzing Root Development in Autogenous Tooth Transplants Using Computed Tomography.

The aim of this study was to evaluate root development in autotransplanted teeth using cone-beam computed tomography (CBCT) images. Twelve premolars with incomplete root formation, which were selected to replace prematurely lost upper central incisors, were analyzed by CBCT on two different occasions. The first CBCT examination (T1) was conducted before tooth autotransplantation. The second CBCT examination (T2) was performed over a follow-up period of at least 12 months and < 5 years. Three previously calibrated evaluators assessed root development. The positions of the tomographic planes were standardized. The mean root length in sagittal and coronal tomographic sections was used to validate the root length at T1 and T2. Longitudinal root development of the transplanted tooth was determined by calculating the difference in root length between T2 and T1. The intraclass correlation coefficient (ICC), paired t-test, and Pearson test were applied, with significance set at 5%. The mean time elapsed between T1 and T2 was 962 days/2.6 years. The ICC was > 0.75. The measurements obtained at T2 were significantly greater than at T1 (p = 0.001). The mean increase in root length was 2.83 mm. There was no significant correlation (p = 0.413; r = 0.261) between root length increase and the time elapsed between T1 and T2. Premolar teeth with incompletely formed roots transplanted to the upper central incisor region showed continued root development during postoperative follow-up.

Outcome of regenerative endodontic procedures in delayed replanted immature permanent teeth with apical periodontitis: A retrospective study.

Regenerative endodontic procedures (REPs) is effective for treating young permanent teeth with pulp necrosis. However, its efficacy on delayed replanted avulsed teeth is unclear. This retrospective study aimed to assess the efficacy of REPs in treating delayed replanted immature permanent teeth with apical periodontitis. Avulsed teeth receiving REPs were systematically screened based on predetermined criteria. This study assessed the REP outcomes, postoperative periodontal healing, and overall treatment efficacy. Samples were grouped by REP outcomes and root development stage, with Fisher's exact tests used to compare outcomes among different groups. Among the included 17 teeth, 47.1% exhibited successful REPs and periodontal healing. Another 47.1%, due to replacement resorption or REP failure, were categorized as tooth survival. Healing of periapical lesions was observed in 88.2% of the cases, but only 41.2% demonstrated continued root development. Although differences were not significant (p = 0.05), teeth with continued root development had a higher rate of functional healing (85.7%) compared to those without (30%). Within the limitations of this study, REPs presented reliable outcomes for treating delayed replanted immature permanent teeth with apical periodontitis mainly in periapical lesion healing. Teeth with continued root development after REPs exhibited a higher rate of functional healing. Further investigation is required to explore potential synergies between REP outcomes and periodontal healing.

Mahidol Study 2: Treatment Outcomes and Prognostic Factors of Regenerative Endodontic Procedures in Immature Permanent Teeth

IntroductionStudies on the clinical outcomes and prognostic factors of regenerative endodontic procedures (REPs) in a large population and long-term recall period have been limited. Therefore, the aims of this study were to evaluate treatment outcomes and prognostic factors of REPs. MethodsImmature permanent teeth treated with REPs with a minimum one-year follow-up period were included. Treatment outcomes (functional retention, healed rate, root development, and sensibility test response) and any prognostic factors were analyzed with multivariable Cox regression, linear regression, and modified Poisson regression. ResultsOne-hundred-twenty REPs teeth with a mean 41.7-month recall period were included with a functional retention rate of 97.5%. The healed, healing, and diseased rates of REPs were 80%, 9.2%, and 10.8%, respectively. Significant prognostic factors for healed were age (<12 years old) and root development stage (stages 4 and 5). Changes in the apical diameter, root length, root width, and radiographic root area after REPs were 56.8%, 8.3%, 23.2%, and 21.7%, respectively. Significant prognostic factors for continued root development were age and etiology of pulpal disease (from caries or dental anomalies). The sensibility test response rate was 41.7% with significant positive factors of ethylenediaminetetraacetic acid irrigation and capping material level above the cemento-enamel junction. ConclusionREPs demonstrated high functional retention and healed rates. Patients <12 years old presented a higher healed rate and continued root development (excluding root length). Dental caries or anomalies had higher continued root development compared with dental trauma. The sensibility test response was related to ethylenediaminetetraacetic acid irrigation and level capping material.

Enriched advanced platelet-rich fibrin plus gold nanoparticles against Enterococcus faecalis for its potential use in revascularization for necrotic immature permanent teeth.

Regenerative endodontic procedures allow reinforcement of root canal wall and continuation of root development, opening new therapeutic possibilities. The root canal system of infected teeth is colonized by a variety of microorganisms, which hinder the regenerative process, leading to treatment failure if not adequately addressed, thereby requiring careful attention to microbial control. The aim of the study was to assess the antimicrobial activity of advanced platelet-rich fibrin (A-PRF) and gold nanoparticles (AuNps) against Enterococcus faecalis. Intravenous blood (5-6 ml) was drawn from four healthy individuals, and A-PRF was prepared through centrifugation at 1500 revolutions per minute (rpm) for 14 min. A-PRF was doped with 3 µl of AuNps and centrifuged at 1000 rpm for 1 min. Antimicrobial activity was assessed using disk diffusion; inhibition zones were measured. For minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC), A-PRF + AuNps were added to the microbial broth at varying concentrations to determine growth inhibition and microbial death. Disk diffusion assays revealed significant antibacterial effects against E. faecalis. Norfloxacin displayed the highest mean zone of inhibition (20.33 ± 1.53 mm), followed by the Test group (A-PRF + AuNPs) (19.33 ± 0.58 mm). Multiple comparisons indicated significant differences (P < 0.001). MIC of A-PRF + AuNPs against E. faecalis was 0.031 mg/ml, with MBC at 0.015 mg/ml. The addition of AuNPs to A-PRF offers the potential for sustained growth factor release while maintaining the sterility of the canal, leading to successful revitalization and regeneration. The combined use of A-PRF + AuNps shows promise for enhancing revascularization in necrotic immature permanent teeth.

Comparative evaluation of the clinical and radiographic success of regenerative endodontic procedures in immature versus mature permanent incisors with apical periodontitis: A prospective observational study

ABSTRACT Aim: The aim of the study was to know the clinical and radiographic outcomes of regenerative endodontic procedures of immature versus mature in young permanent incisors with apical periodontitis. Methods: Twenty non-vital, young permanent incisors with traumatic exposure between the age of 7 and 13 years were taken. Patients were divided into two groups: Group I – immature (number of teeth included = 10) and Group II – mature (number of teeth included = 10). The procedure was performed by the blood clot method as a scaffold. Biodentine (about 2–3 mm) was placed as a capping material at the cementoenamel junction. Evaluation was based on the clinical (pain, sinus, tender on percussion, swelling, mobility, intact restoration) and radiographical (Nolla stage, thickening of walls, lamina dura continuity, calcification of pulp chamber and canal, periapical healing, PAI score) parameters. Results: All 19 teeth were clinically asymptomatic after the 12-month follow-up. Radiographically, the percentage of continuous root development (in the immature group) was 100% at 12 months (P = 0.000**). Radiography revealed a reduction in the PAI scores at 12 months in the immature and mature groups. None of the treated teeth responded to the cold test after a 12-month follow-up. One patient did not come for intervention in the mature group. All the statistical tests (Chi-square, Mann–Whitney U-test, and Fisher’s exact test) were performed at a 5% significance level. Conclusion: Outcomes did not differ significantly between immature and mature groups.

Role of Platelet Concentrates in Dental-Pulp Regeneration: A Systematic Review of Randomized Clinical Trials.

Treatment of immature necrotic teeth is a problematic situation. Conventional root canal therapy is challenging and leaves a weak, fragile, and undeveloped tooth for lifetime. This review was aimed to assess the outcome of available randomized clinical trials (RCTs) on the efficacy of platelet concentrates (PC) in dentine-pulp complex regeneration. In this systematic review, an electronic search was conducted on MEDLINE, EMBASE, Cochrane, and Google scholar databases. A further manual search was performed on the list of related articles in order to ensure inclusion of potentially missed articles in earlier electronic search. Those proved RCTs matched with the standard criteria were included following an initial assessment of abstracts and the text independently by the reviewers. From the total 602 harvested articles, only 13 met the criteria and were evaluated with 11 having parallel design and 2 split mouth. Only one study featured low risk of bias, while three had moderate risk and the rest were at high risk of bias. Six studies had used platelet rich plasma (PRP), 4 employed platelet rich fibrin (PRF), one utilized injectable platelet rich fibrin (I-PRF), and three used both PRF and PRP for their experimental groups while blood clot (BC) was used as the control group for all. The success rate was reported at 87.3% judged by the absence of pathologic signs and symptoms. Dentin wall thickening, root lengthening and apex closure were higher in PC groups, however, these differences were not statistically significant in reported studies. It can be concluded that PCs promote the pulp tissue revitalization and continuation of root development. However, a consensus on its potency for true pulp regeneration is yet to be reached.

An innovative cell-based transplantation therapy for an immature permanent tooth in an adult: a case report

BackgroundImmature teeth with necrotic pulps present multiple challenges to clinicians. In such cases, regenerative endodontic procedures (REPs) may be a favorable strategy. Cells, biomaterial scaffolds, and signaling molecules are three key elements of REPs. Autologous human dental pulp cells (hDPCs) play an important role in pulp regeneration. In addition, autologous platelet concentrates (APCs) have recently been demonstrated as effective biomaterial scaffolds in regenerative dentistry, whereas the latest generation of APCs—concentrated growth factor (CGF), especially liquid phase CGF (LPCGF)—has rarely been reported in REPs.Case presentationA 31-year-old woman presented to our clinic with the chief complaint of occlusion discomfort in the left mandibular posterior region for the past 5 years. Tooth #35 showed no pulp vitality and had a periodontal lesion, and radiographic examination revealed that the tooth exhibited extensive periapical radiolucency with an immature apex and thin dentin walls. REP was implemented via transplantation of autologous hDPCs with the aid of LPCGF. The periodontal lesion was managed with simultaneous periodontal surgery. After the treatment, the tooth was free of any clinical symptoms and showed positive results in thermal and electric pulp tests at 6- and 12-month follow-ups. At 12-month follow-up, radiographic evidence and three-dimensional models, which were reconstructed using Mimics software based on cone-beam computed tomography, synergistically confirmed bone augmentation and continued root development, indicating complete disappearance of the periapical radiolucency, slight lengthening of the root, evident thickening of the canal walls, and closure of the apex.ConclusionhDPCs combined with LPCGF represents an innovative and effective strategy for cell-based regenerative endodontics.

FTO Positively Regulates Odontoblastic Differentiation via SMOC2 in Human Stem Cells from the Apical Papilla under Inflammatory Microenvironment.

Odontoblastic differentiation of human stem cells from the apical papilla (hSCAPs) is crucial for continued root development and dentin formation in immature teeth with apical periodontitis (AP). Fat mass and obesity-associated protein (FTO) has been reported to regulate bone regeneration and osteogenic differentiation profoundly. However, the effect of FTO on hSCAPs remains unknown. This study aimed to identify the potential function of FTO in hSCAPs' odontoblastic differentiation under normal and inflammatory conditions and to investigate its underlying mechanism preliminarily. Histological staining and micro-computed tomography were used to evaluate root development and FTO expression in SD rats with induced AP. The odontoblastic differentiation ability of hSCAPs was assessed via alkaline phosphatase and alizarin red S staining, qRT-PCR, and Western blotting. Gain- and loss-of-function assays and online bioinformatics tools were conducted to explore the function of FTO and its potential mechanism in modulating hSCAPs differentiation. Significantly downregulated FTO expression and root developmental defects were observed in rats with AP. FTO expression notably increased during in vitro odontoblastic differentiation of hSCAPs, while lipopolysaccharide (LPS) inhibited FTO expression and odontoblastic differentiation. Knockdown of FTO impaired odontoblastic differentiation, whereas FTO overexpression alleviated the inhibitory effects of LPS on differentiation. Furthermore, FTO promoted the expression of secreted modular calcium-binding protein 2 (SMOC2), and the knockdown of SMOC2 in hSCAPs partially attenuated the promotion of odontoblastic differentiation mediated by FTO overexpression under LPS-induced inflammation. This study revealed that FTO positively regulates the odontoblastic differentiation ability of hSCAPs by promoting SMOC2 expression. Furthermore, LPS-induced inflammation compromises the odontoblastic differentiation of hSCAPs by downregulating FTO, highlighting the promising role of FTO in regulating hSCAPs differentiation under the inflammatory microenvironment.

Peptide KN-17-Loaded Supramolecular Hydrogel Induces the Regeneration of the Pulp-Dentin Complex.

Regenerating the pulp-dentin complex remains a decisive factor during apexification for immature permanent teeth. Peptide KN-17, which was modified based on the structure of cecropin B, could effectively interfere with bacterial growth and induce the migration of human bone marrow stromal cells (hBMSCs). This study aimed to investigate the effect of KN-17 on the tissue regeneration. To our surprise, KN-17 can significantly stimulate angiogenesis in vitro and in vivo, which may provide a guarantee for apical closure. Herein, a novel peptide/KN-17 coassembled hydrogel is developed via a heating-cooling process. Npx-FFEY/KN-17 supramolecular hydrogel can induce vessel development, stimulate odontogenic differentiation of human dental pulp stem cells (hDPSCs), and exert an antibacterial effect on Enterococcus faecalis (E. faecalis). Furthermore, coronal pulp excised rat molars are supplied with KN-17 or KN-17-loaded hydrogel and transplanted subcutaneously in BALB/c-nu mice. After 4 weeks, the hydrogel Npx-FFEY/KN-17 stimulates the formation of multiple odontoblast-like cells and dentin-like structures. Our findings demonstrate that the KN-17-loaded hydrogel can promote the regeneration of the pulp-dentin complex for continued root development.

Long-term Success of Regenerative Endodontic Procedures

ABSTRACT Background: Regenerative endodontic procedures (REPs) have emerged as a transformative approach to treating immature permanent teeth with necrotic pulp tissue Materials and Methods: A prospective study was conducted, enrolling 100 patients with immature permanent teeth requiring REPs. All procedures were performed by a single experienced endodontist following established protocols. Patients were followed up for a minimum of 5 years’ post-treatment. Clinical examinations, radiographic assessments, and patient-reported outcomes were recorded at regular intervals. Data were analyzed using statistical methods to determine the success rates, complications, and factors influencing long-term outcomes. Results: The results of this original research reveal a significant and sustained success rate for REPs. After a minimum follow-up period of 5 years, an arbitrary value of 92% for tooth survival was achieved. Radiographic assessments demonstrated consistent healing of apical lesions, and continued root development was observed in the majority of cases. Patient-reported outcomes indicated a high level of satisfaction with the procedure. Complications such as crown discoloration and tooth fracture occurred in a minority of cases but were effectively managed without compromising the overall success of REPs Conclusion: This original research provides strong evidence for the long-term success of REPs in the treatment of immature permanent teeth with necrotic pulp tissue. The high tooth survival rate, continued root development, and patient satisfaction support the efficacy of REPs as a reliable treatment option.

Current Aspects of Regenerative Endodontics: A Systematic Review

Relevance. The modern concept of endodontic treatment in most clinical cases involves extirpation of the pulp with the loss of its plastic, trophic, sensory, and protective functions. In this regard, the search for ways to recreate lost cells and the main substance of the pulp and periodontium to replace the intraradicular space with “vital” tissue. Regenerative endodontics based on the principles of tissue engineering and offers techniques for restoring damaged tissues of the pulp-dentin complex based on the use of stem cells, growth factors, and an organic matrix. Aim. Systematize information presented in scientific articles about research conducted, opportunities and development prospects in the field of regenerative endodontics. Materials and methods. A search of literature sources was carried out in the PubMed, dissercat.com, elibrary database.ru, cyberleninka.ru, by keywords, “regenerative endodontics”, “stem cells”, “growth factors”, “pulp-dentin complex” with a choice of article types “Clinical Trial”, “Meta-Analysis”, “Review”, "Systematic Review". Results. After analyzing the literature review, an idea was obtained about the current stage of development of regenerative endodontics, preclinical and clinical studies on the restoration of the pulp-dentin complex. Clinical cases based on the triad of regenerative endodontics are presented, as well as an algorithm for performing these therapeutic procedures. Conclusions. Regenerative endodontics is a rapidly developing discipline whose clinical advances are primarily related to the treatment of immature tooth roots, which results in continued root development. Subsequent scientific research is aimed at obtaining significant results in the treatment of a fully formed permanent tooth, which will ensure a unique restoration of the immunological, sensory and protective properties of the pulp-dentine complex.

Analysis of the achievement of primary and secondary goals and influencing factors in single-rooted immature permanent teeth after regenerative endodontic procedures: a retrospective study

ObjectiveThis study explored the achievement of primary and secondary goals and factors influencing their achievement in regenerative endodontic procedures (REPs) for immature permanent teeth.MethodsDental records of all patients who received REPs for immature permanent teeth at the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology between January 2012 and January 2023 were retrieved. The evaluation of the primary goal was based on medical and radiographic records. The achievement of the primary goal was defined as the absence of clinical signs and symptoms, such as pain, swelling, or sinus tract and the absence of periapical radiolucency, as assessed on postoperative periapical radiographs. The achievement of secondary goal represented increased root wall thickness and/or increased root length, that is, continued root development. Periapical radiographs before and after treatment were used to evaluate the achievement of the secondary goal. The secondary goal was required to be achieved alongside the achievement of primary goal.ResultsA total of 436 teeth (136 anterior and 300 posterior teeth) were included in this study, 96.1% of which demonstrated achievement of the primary goal. Signs of failure (17 teeth) included crown fracture and uncontrolled and recurrent periapical lesions. In addition, 77.8% of teeth demonstrated achievement of the secondary goal, and more than half of the teeth exhibited a complete root development. Evaluation factors included patients’ age, sex, tooth type, etiology, preoperative periapical lesion, duration of clinical signs and symptoms, follow-up period, and stage of root development. The achievement of the primary and secondary goals were significantly related to age and tooth type (p < 0.05).ConclusionsChildren with a younger initial visit age are more likely to achieve primary and secondary goals. Additionally, posterior teeth had an advantage over anterior teeth in achieving primary and secondary goals.

Vital Pulp Therapy of Young First Permanent Molars: A Retrospective Study on Radiographic Findings 24 Months Post-treatment.

With success rates comparable to that of root canal treatment, vital pulp therapy (VPT) has gained clinical interest and has been used in the management of young permanent teeth with inflamed pulps. The aim of the present study was to retrospectively evaluate the radiographic success of VPT in young first permanent molars 24 months post-treatment and correlate findings with tooth and treatment-related characteristics. Dental records of all patients with first permanent molars which received VPT in the Department of Paediatric Dentistry (National and Kapodistrian University of Athens) were retrieved. Demographic characteristics and data regarding the treatment performed were recorded. Patients' radiographs were evaluated at 6, 12 and 24 months post-treatment by two qualified paediatric dentists blinded regarding the treatment performed. Radiographic success, reasons for failure and continuation of root development were evaluated. Differences were tested using the Χ2 and Student's t-test, and possible correlations were determined by calculating the odds ratio. Overall radiographic success rate at 24 months was 77%, ranging between 50% for direct pulp capping and 92% for full pulpotomy. Differences were not statistically significant. Continuation of root development was recorded in almost 1/3 of the teeth and completion in almost 1/5. No statistically significant association was recorded between the outcome and any tooth and treatment-related variables. VPT seems to be a reliable option in the long term for the treatment of deep carious lesions in young permanent molars.

The efficacy of concentrated growth factor and platelet-rich fibrin as scaffolds in regenerative endodontic treatment applied to immature permanent teeth: a retrospective study

BackgroundThe aim of this retrospective study was to compare the efficacy of concentrated growth factor (CGF) and platelet-rich fibrin (PRF) as scaffolds in regenerative endodontic therapy (RET).MethodsNecrotic immature permanent teeth treated with regenerative endodontic therapy during January 2018 to August 2022 were divided into the CGF and PRF groups according to the scaffold. The CGF and PRF groups included 7 and 6 teeth, respectively. The efficacy of regenerative endodontic therapy was analyzed based on the clinical and radiological outcomes at three different follow up periods: T1 (3–6 months), T2 (6–12 months) and T3 (12–24 months). Statistical analysis was performed using the independent T test, Mann-Whitney test and Fisher’s exact test at a significance level of 0.05.ResultsThe success rate of each stage in both groups was 100%. Through quantitative comparison of radiographic outcomes, there was no statistically significant difference between the two groups in terms of root development and periapical lesion healing at each stage, except that the increase rate of radiographic root area in PRF group in the T3 stage was above one in CGF group with statistically significance.ConclusionsBoth CGF and PRF had a similar clinical performance regarding resolution of clinical signs and symptoms, periapical lesion healing, and continued root development as scaffolds in RET. Further prospective studies with large samples for longer follow-up periods are needed.

Regenerative endodontic treatment of immature permanent teeth after mechanical instrumentation with XP-Endo Finisher.

The traditional treatment of immature permanent teeth with necrotic pulp involves creating an apical barrier by using calcium hydroxide or an MTA plug for an extended period of time. A novel therapeutic approach called regenerative endodontic procedures (REP) is used to allow root development to continue.

Is Etiology a Key Factor for Regenerative Endodontic Treatment Outcomes?

IntroductionThis study aimed to evaluate treatment outcomes of regenerative endodontic treatment (RET) in nonvital immature permanent teeth due to developmental malformation and trauma, and to analyze the influence of etiology on the prognosis. MethodsFifty-five cases were included and divided into a malformation group (n = 33) and a trauma group (n = 22). Treatment outcomes were classified as healed, healing, and failure. Root development was evaluated in terms of root morphology and the percentage changes in root length, root width, and apical diameter during a follow-up period of 12–85 months (mean 30.8 months). ResultsThe mean age and the mean degree of root development in the trauma group were significantly younger than that in the malformation group. The success rate of RET was 93.9% (81.8% healed, 12.1% healing) in the malformation group and 90.9% (68.2% healed, 22.7% healing) in the trauma group, showing no statistically significant difference. The proportion of type I–III root morphology in the malformation group (97%, 32/33) was significantly higher than that in the trauma group (77.3%, 17/22) (P < .05), whereas there was no significant difference in the percentage changes of root length, root width, and apical diameter between the 2 groups. Six cases (6/55, 10.9%) showed no significant root development (type IV–V) (1 in the malformation group and 5 in the trauma group). Six cases (6/55, 10.9%) revealed intracanal calcification. ConclusionsRET achieved reliable outcomes regarding the healing of apical periodontitis and continued root development. The etiology seems to influence the outcome of RET. Malformation cases presented with a better prognosis than trauma cases after RET.

Multifunctional and biodegradable methacrylated gelatin/Aloe vera nanofibers for endodontic disinfection and immunomodulation

Currently employed approaches and materials used for vital pulp therapies (VPTs) and regenerative endodontic procedures (REPs) lack the efficacy to predictably achieve successful outcomes due to their inability to achieve adequate disinfection and/or lack of desired immune modulatory effects. Natural polymers and medicinal herbs are biocompatible, biodegradable, and present several therapeutic benefits and immune-modulatory properties; thus, standing out as a clinically viable approach capable of establishing a conducive environment devoid of bacteria and inflammation to support continued root development, dentinal bridge formation, and dental pulp tissue regeneration. However, the low stability and poor mechanical properties of the natural compounds have limited their application as potential biomaterials for endodontic procedures. In this study, Aloe vera (AV), as a natural antimicrobial and anti-inflammatory agent, was incorporated into photocrosslinkable Gelatin methacrylate (GelMA) nanofibers with the purpose of developing a highly biocompatible biomaterial capable of eradicating endodontic infection and modulating inflammation. Stable GelMA/AV nanofibers with optimal properties were obtained at the ratio of (70:30) by electrospinning. In addition to the pronounced antibacterial effect against Enterococcus faecalis, the GelMA/AV (70:30) nanofibers also exhibited a sustained antibacterial activity over 14 days and significant biofilm reduction with minimal cytotoxicity, as well as anti-inflammatory properties and immunomodulatory effects favoring healing. Our results indicate that the novel GelMA/AV (70:30) nanofibers hold great potential as a biomaterial strategy for endodontic infection eradication and enhanced healing.

Regenerative therapy in young permanent tooth: Case report

Pulp necrosis in immature permanent teeth represents a challenge for clinical management. The dentin wall in immature teeth is thin and the root is short, leading to an unfavorable long-term prognosis due to the risk of root fracture. Regenerative endodontic procedures have been shown to be effective and improve the prognosis of the compromised immature tooth by re-establishing functional pulp tissue that promotes continued root development and immune competence. The objective of the study was to report a case of a young permanent molar, diagnosed with necrosis and incomplete rhizogenesis. A female patient, 08 years old, attended the clinic of the specialization course in Endodontics, Faculty of Dentistry São Leopoldo Mandic, Belo Horizonte Unit. Regenerative therapy was proposed, which involved the following steps: anesthesia, opening, odontometry, minimal instrumentation, disinfection with 2% chlorhexidine gel, irrigation with saline solution, intracanal medication with calcium hydroxide paste, induction of bleeding to form a blood clot, cervical sealing with mineral trioxide aggregate and composite resin. The patient remained symptom-free up to 5 months after treatment. However, radiographically, an increase in the periapical radiolucent area was noted, so it was decided to carry out the conventional endodontic treatment. Regenerative therapy can be an alternative to apexification in immature teeth in cases of irreversible pulpitis and pulp necrosis associated or not with a periapicalesionson. It is a simple treatment with advantageous results as it promotes an increase in the length and thickness of the dentin wall and apical closure as seen in the case described in this work.

Revascularization of an Immature Permanent Tooth with Periapical Periodontitis: A Case Report

To prove pulp revascularization is a valuable dental treatment technique for immature but necrotic teeth and allows continuous root development. This report describes a successful case of revascularization in the treatment of first maxillary premolars with severe apical periodontitis. Installed rubber barrier under local anesthesia. After entering the pulp cavity, the root canal was rinsed with 1% sodium hypochlorite, 17% EDTA and physical saline. A scaffold was created by inducing the formation of a blood clot within the canal. Then we inserted MTA into the root canal and sealed it with glass ionomer material temporarily. Finally, temporary sealing material was removed and resin filling repair was carried out. During the follow-up period of 10 months after the operation, the teeth were asymptomatic, the clinical examination showed good recovery, and the imaging examination showed that the root was well-developed and had normal function. This case adds evidence for the effectiveness and clinical potential of revascularization in the treatment of young permanent teeth with pulp necrosis. MTA is a reliable and effective material in dental pulp treatment in children.

The Influence of Pulp Capping Procedures on the Long-Term Prognosis and Survival of Teeth

Pulp capping is a dental procedure to treat deep caries and preserve the vitality of affected teeth. It involves placing a biocompatible material directly on the exposed pulp (direct pulp capping) or using a medicated liner to protect the pulp (indirect pulp capping). The choice of biomaterials, such as calcium hydroxide or mineral trioxide aggregate (MTA), significantly impacts the success of pulp capping. Patient-related factors, including age, oral hygiene, and systemic health conditions, influence treatment outcomes. Younger patients generally have better results due to higher pulp vitality and regenerative capacity. Maintaining good oral hygiene and managing systemic health conditions are crucial for long-term success. Complications and treatment failure can occur in pulp capping, depending on factors like cavity size, infection, and initial pulp condition. Early detection and intervention are important to prevent further issues. Success in pulp capping is assessed based on factors like continuous root development, preserved pulp vitality, minimal inflammation, and formation of reparative dentin. Success rates may decrease over time, and further research is needed to understand why. Understanding procedural techniques, biomaterial selection, patient-related factors, and complications are vital for informed decision-making, optimizing outcomes, and increasing the longevity of pulp-capped teeth