Dentinal Wall Thickness Research Articles

A review of tissue engineering in regenerative endodontic treatment

Background: Regenerative endodontic treatments are classified based on approach in the procedures and principles. One is cell-free approach that involves a revitalization procedure to achieve continued root growth while the other is cell-based approach which involves pulp/dentin regeneration through isolation and ex vivo expansion of stem cells seeded in the scaffold and then transplanted into the canal space. Technically, the cell-free approach is simpler than cell-based approach because the former does not concern about external stem cell isolation and culture. Currently, the gold standard and the one that has been clinically performed is cell-free approach. Cell-based approach is still not a standard because currently the cell-based approach is still in the clinical trial stage. Purpose: to evaluate the biological basis and clinical protocols recently used in regenerative endodontic treatment and discuss potentially future treatment approaches. Review: The literature review was searched in PUBMED with the keywords: immature permanent teeth, pulp revascularization, stem cells and regenerative endodontics. The regenerative endodontic treatments with various procedures and techniques result in a significant increase in root length and dentinal wall thickness. Stimulation of stem cells in apical root canal system is required to induce tissue formation and continued root maturation. Conclusion: The success of regenerative endodontic therapy relies on the development of a technique that enables clinicians to create functional pulp tissue within cleaned and shaped root canal systems. It is hoped that further research studies are required to define advantages and limitations of cell-free and cell-based approach.

Evaluation of Outcomes in Immature Teeth After Revitalization or Apexification Procedures: A Systematic Review and Meta-Analysis.

There are two main treatment options for immature teeth with necrotic pulp and apical periodontitis. Apexification creates a mineralized tissue barrier, while revitalization aims to regenerate vital tissue in the canal space. There is no conclusive evidence to determine the most effective procedure regarding root length and dentin wall thickness. The objective of this systematic review was to compare the outcomes of revitalization and apexification procedures in immature non-vital teeth in terms of root length and dentin wall thickness. A literature search was conducted using the PubMed, ScienceDirect, Google Scholar, and Embase databases. Articles relevant to the study topic were gathered according to the selection criteria, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The included studies had to be published in English, conducted over a six-year period, and compared the outcomes of revitalization and apexification procedures in immature non-vital teeth. Data were collected using appropriate keywords from the eligible studies. Six articles were included for qualitative and quantitative analysis. The eligible studies showed a low risk of bias. In all revitalization cases, the root length increased significantly (mean difference (MD) (%) = 5.91; 95% confidence interval (CI) = 2.39-9.43; p = 0.0010; MD (mm) = 2.43; 95% CI = 2.05-2.80; p < 0.00001). The dentin wall thickness was statistically significant in most cases (MD (%) = 10.94; 95% CI = 7.01-14.88; p < 0.00001), MD (mm) = 0.16; 95% CI = 0.07-0.25; p = 0.0007). The systematic review and meta-analysis showed both procedures to be credible treatment options for necrotic immature teeth. Apexification had a positive impact, to some extent, on the development of root length. Revitalization yielded a significantly greater increase in root length and root dentin wall thickness and appeared to be superior in promoting root development.

Revascularization of Non-Vital, Immature, Permanent Teeth with Two Bioceramic Cements: A Randomized Controlled Trial

The aim of this study was to clinically and radiographically assess the effects of two bioceramic cements as coronal plug materials for the revascularization of non-vital, immature, permanent teeth with apical periodontitis. Twenty non-vital, immature, permanent, anterior teeth with apical periodontitis were included in this study. Samples were randomly divided into two groups based on the coronal plug materials used; group I (GI): Well Root PT (Vericom, Gangwon-do, Korea) and group II (GII): MTA Biorep (Itena Clinical, Paris, France) (n = 10). Follow-up was conducted clinically and radiographically for up to 12 months to evaluate the changes in root dimensions and resolution of the periapical disease and investigate the degree of success. Data were statistically analyzed using ANOVA tests and Mann–Whitney U tests at a 0.05 significance level. At 12 months, none of the patients in either test group had clinical signs/symptoms. There was a slight increase in root length (4.4% in GI and 3.4% in GII) and a slight increase in dentin wall thickness (10.2% in GI and 9.9% in GII) with no statistically significant (p &gt; 0.05) differences. Whilst there was a significant decrease in lesion dimension in all patients after 12 moths of treatment (93% in GI and 91% in GII), there were no statistically significant differences between the two study groups (p &gt; 0.05). Regarding the degree of success, all cases (100%) achieved the primary goal (the elimination of symptoms and the evidence of bony healing), while 60% in GI and 40% in GII achieved the secondary goal (increased root wall thickness and/or increased root length). No statistically significant difference was found between groups (p &gt; 0.05). Both bioceramic cements showed satisfactory clinical and radiographic findings. Premixed calcium aluminosilicate and tricalcium silicate cements could be used as coronal plug materials in revascularization procedures. Bioceramic cements can be considered promising coronal plug materials for the revascularization of immature, permanent teeth with necrotic pulps and apical periodontitis due to their physicochemical and biological properties.

Measurement of the Dentin Wall Thickness of the Maxillary Central Incisor in Relation to the Stage of Root Development: A Pilot Study.

The aim of this study was to determine the average dentin wall thickness (DWT) of the maxillary central incisor (MCI) required for performing finite element analysis (FEA) models of root development. A total of 137 intraoral periapical radiographs of MCI in children aged 7 to 11 years were examined and then classified into 5 groups according to root development stages, which included 1/2 of root development (S1), 3/4 of root development (S2), more than 3/4 of root development (S3), complete development with wide-open apex (S4) and complete development with closed apex (S5). DWT was measured at three reference (horizontal) lines: at a distance of 1 mm from the apex (M), 4 mm from the apex (L) and at the cervical line (K). The distal dentin wall thickness (M1, L1, and K1), the pulp thickness (M2, L2, and K2), the mesial dentin wall thickness (M3, L3, and K3), and the apex thickness (N) were measured using the diagnostic software Soredex Scanora 5.1.2.4. Statistical analysis compared the values of the parameters K, L, and M between developmental stages (multivariate ANOVA) and the linear correlations between the parameters (Pearson's correlation analysis). All analyses were performed at significance level α = 0.05. There were statistically significant differences between the developmental stages for parameters L and M, while no significant differences were found for parameter K. Most of the correlations between the parameters were statistically significant, with the values of the Pearson correlation coefficient R > 0.6 considered practically significant. All parameters on the same reference line for distal and mesial dentin wall thickness and for pulp thickness correlated well with each other (R = 0.46 - 0.68), but there was no statistically significant correlation with total root thickness on the same reference line (parameters K, L, or M), except for parameter K3 (R = 0.42). Despite the limitations of this study, the mean values of the selected parameters for the 5 groups of developmental stages of the maxillary central incisor could be used to model dentin wall thickness using finite element analysis.

In Vitro Dental Discoloration Provoked by Intracanal Calcium Silicate-based Dressing Used for Regenerative Endodontic Procedures: An One-year Spectrometric Analysis

IntroductionRegenerative endodontic procedures provide conditions for the continuity of apical formation and increase of the dentin wall thickness, being a useful technique to resume root development of necrotic teeth with incomplete apex. This study aimed to evaluate the coronal discoloration promoted by a new intracanal calcium silicate-based dressing and compare it with other intracanal dressings used in regenerative endodontic procedures. MethodsSixty bovine incisors were prepared to simulate teeth with incomplete apexes and divided according to the intracanal dressing used: triple antibiotic paste—double antibiotic paste—DAP, calcium hydroxide associated with 2% chlorhexidine gel, calcium hydroxide associated with saline solution, and Bio-C Temp. As control, no dressing was performed. The intracanal dressings remained in the simulated root canal for 21 days. Luminosity (ΔL) and color difference (ΔEab and ΔE00) were evaluated using long-term (1 year) spectrophotometric analysis. The results were analyzed using the ANOVA test with Tukey post hoc with a significance of 5%. ResultsTriple antibiotic paste showed the highest values of ΔEab and ΔE00 and lowest values of ΔL (P < .05). Bio-C Temp showed higher ΔEab than the other groups from 6 months (P < .05), higher ΔE00 and lower ΔL after 1 year (P < .05). ConclusionsBio-C Temp induced noticeable coronary discoloration after the 1-year analysis.

Regenerative Endodontics - A Case Report

The usual treatment modalities for an immature permanent tooth that has undergone pulpal necrosis is Apexification using Calcium Hydroxide or MTA. But both these approaches doesnot cause dentinal wall thickening, lengthening and apex maturation and closure. Regenerative Endodontic Procedures ensures that there is regeneration of the pulpal-dentin complex by migration of stem cells into the canal space , and there is thickening and lengthening of canal walls and apex maturation and closure. However the histological evidence of the tissues formed in the pulp canal space shows that there is repair instead of true regeneration. It is expected that with the further research works in this field there will be more modifications in the current procedure.

Endodontic pulp revitalization in traumatized necrotic immature permanent incisors: Early failures and long-term outcomes-A longitudinal cohort study.

AimThis prospective cohort study evaluates clinical and radiographical outcomes of endodontic pulp revitalization (PR) of traumatized necrotic incisors.MethodologyPulp revitalization was performed in 75 traumatized necrotic immature incisors from 71 patients. The radiographic outcome measures were continued root formation (width and length), root resorption, apex closure, periapical index, and root development stage. The clinical outcome measures were percussion pain, palpation pain, pathological tooth mobility, swelling, sinus tract, ankylosis, crown discolouration, response to pulp sensitivity test, and subjective pain. Treatment outcomes were categorized as a success based on the absence of clinical symptoms and when radiographic evidence was present for apical healing and continued root development. The performed statistical tests were repeated measures anova, pairwise comparisons of interactions (t‐test), McNemar's test, and linear regression model.ResultsIn 45 of 75 teeth (60%), PR was successful with the resolution of clinical and radiographic signs and continued root development. PR failed due to the absence of bleeding (n = 19) and persistent infection (n = 11). PR showed statistically significant increases in root length (11%), and dentinal wall thickness (30%), root maturation (pre‐operative 3.38 [CI 1.88; 4.88]; post‐operative 4.04, [CI 2.56; 5.52]) apical closure (71.4%), healing of pre‐operative apical periodontitis (100%), and healing of pre‐operative inflammatory root resorptions (100%). Three predictive variables for continued root maturation were identified – root development stage at entry (p = .0001, β 0.649), [CI 0.431; 0.867], trauma to the soft tissues (p = .026, β −0.012), [CI −0.0225; −0.015], and pre‐operative dentinal wall thickness (p = .009, β −0.001); [CI −0.001; 0.0001].ConclusionsOur findings indicate that PR provides satisfactory clinical and radiographical outcomes in traumatized necrotic incisors. The failed cases were related to lack of bleeding and persistent infections, indicating that new techniques are needed to improve the predictability of PR.

Long-term Complications of Previously Successful Regenerative Endodontic Procedures after Orthodontic Movement: A Report of 3 Different Complications after 4, 8, and 11 Years

There is a paucity of literature on late complications of regenerative endodontic procedures. The aim of this article was to report 3 cases of previously successful regenerative endodontic procedures with long-term follow-up that developed different complications after the application of orthodontic forces. In the first case, an 8-year-old female patient received a regenerative endodontic procedure in her previously intruded tooth (tooth no. 21) that had been rendered necrotic after a successful spontaneous repositioning procedure. The 5-year follow-up revealed uneventful healing, continuous root development, dentinal wall thickening, and regaining of pulp vitality for tooth no. 21. Four years later, the patient received orthodontic treatment with mild forces that lasted 2 years. The 11-year follow-up revealed severe external invasive cervical resorption, and the tooth had to be extracted. In the second case, a 6-year-old female patient suffered a lateral luxation injury in tooth no. 11. Six months after the injury, the tooth developed symptoms and discoloration and tested negative in pulp vitality testing. Single-step regenerative endodontic procedures were applied, and successful continuous root development, dentinal wall thickening, and apical closure were achieved at the 3-year follow-up. Two months after the initiation of orthodontic treatment, the tooth developed symptomatic apical periodontitis. Root canal treatment was performed to treat the disease, and the orthodontic treatment was continued. In the third case, a previously published successful regenerative endodontic procedure developed a perforating internal resorption 6 months after the application of orthodontic forces. The internal resorption was arrested with root canal treatment, the resorptive defect was repaired with bioceramic obturation, and the orthodontic treatment plan was modified. Previously successful regenerative cases might develop external invasive cervical resorption, regenerative tissue necrosis, or internal resorption after the application of orthodontic forces. Best practice/evidence-based guidelines on the appropriate orthodontic management of successful regenerative endodontic therapy teeth are lacking. Whenever possible, careful monitoring and partial or complete exclusion off orthodontic treatment might be necessary. In some cases, preventive root canal treatment before the initiation of orthodontic movement might be considered.

Do alternative scaffolds used in regenerative endodontics promote better root development than that achieved with blood clots?

The aim of this integrative review was to identify whether alternative scaffolds used in regenerative endodontics contribute to better root development, in relation to the increase in root length and thickness of dentin walls, compared with blood clot (BC) scaffolds. The literature search was conducted in PubMed, SciELO and Lilacs databases, using descriptors related to the topic. After applying the eligibility criteria, 11 articles were selected and analyzed according to the proposed aim. Five clinical and six in vivo studies, conducted in animals, compared different types of alternative scaffolds with BCs, with emphasis on platelet-rich plasma (PRP) and platelet-rich fibrin (PRF). All scaffolds, alternative or BC, promoted an increase in root length and dentin wall thickness, with varying percentages of increase between studies. In general, there was a significant increase in root length and dentin thickness promoted by PRF and PRP scaffolds, compared with BC. It was concluded that the majority of the scaffolds tested contributed to the increase in root length and thickness of dentin walls, with emphasis on PRF and PRP.

Deciduous Tooth Pulp Autotransplantation for the Regenerative Endodontic Treatment of Permanent Teeth With Pulp Necrosis: A Case Series

IntroductionIn young individuals, deciduous tooth pulp might be used as a natural, biologic scaffold for the regenerative endodontic treatment (RET) of young permanent teeth with necrotic pulps and apical periodontitis. The present case series demonstrates the clinical and radiographic outcomes of a novel RET using deciduous pulp autotransplantation in traumatized, necrotic young permanent incisors. MethodsFive previously traumatized maxillary incisors of four 8- to 11.5-year-old patients were treated with a RET protocol that used 2.5% NaOCl irrigation and placement of calcium hydroxide dressing in the first visit. After 4 weeks, the intracanal medication was removed, and the whole pulp tissue harvested from the neighboring maxillary deciduous canine was transplanted into the disinfected root canal without induced apical bleeding. Following placement of a mineral trioxide aggregate coronal barrier, the access cavities were restored with acid-etch resin composite. The root canals of donor primary canines were filled with calcium hydroxide-iodoform paste and were restored as with the permanent incisors. ResultsThree patients were followed-up for 24 months, and 1 patient for 12 months. All teeth demonstrated radiographic evidence of complete periapical healing, slight increase in dentinal wall thickness, and continued apical closure in the absence of clinical symptoms. A positive response to cold test was obtained in 1 incisor at 12 months and 2 at 24 months. ConclusionsBased on 12- and 24-month clinical and radiographic findings, the present cases demonstrate a favorable outcome of a RET protocol using deciduous pulp autotransplantation in young permanent incisors with pulp necrosis.

Mineral trioxide aggregate endodontic revascularization of nonvital anterior tooth

Context: Management of nonvital immature teeth requires careful management due to higher risk of root fracture. Aims: The aim of this study was done to evaluate the mineral trioxide aggregate (MTA) endodontic revascularization of permanent nonvital anterior tooth. Materials and Method: Forty patients in the age group of 18–30 years were included in the study. MTA revascularization procedure was done on immature necrotic upper anterior tooth with the presence or absence of periapical condition. The success was assessed with root lengthening, healing, apical closure, and dentinal wall thickness. Age group 18–23 years comprised 12 males and 10 females and 24–30 years had 10 males and 8 females. In 20% of cases, good healing and 80% had excellent healing were seen. Statistical Analysis Used: The obtained data were statistically evaluated using Mann–Whitney U-test for the comparison. Significance of the study was labeled at 0.05, highly significant at 0.01. Results: Mann–Whitney U-test showed a significant difference (P < 0.05). Twenty percent of teeth had fair, 30% had well, and 50% had excellent root lengthening. Apical closure was fair in 40%, good in 20%, and excellent in 40% teeth. Dentinal wall thickening was fair in 35%, good in 40%, and excellent in 25%. Conclusions: A successful revascularization procedure in nonvital permanent anterior teeth was seen both clinically and radiographically in terms of apical closure, greater healing, improved dentinal wall thickening, and root lengthening.

Influence of root width and dentin wall thickness evaluated by endoscopy upon the outcome of periapical surgery. A cohort study.

Background An analysis was made of the correlation between root width, the thickness of the remaining dentinal wall as determined by endoscopy, and the outcome of periapical surgery.Material and Methods A retrospective cohort study was carried out involving patients subjected to periapical surgery between 2017 and 2019 at the University of Valencia (Valencia, Spain).One year after surgery, cone-beam computed tomography (CBCT) was used to evaluate healing against the preoperative volumes. The maximum root width was measured on the postoperative CBCT scan at the apical section of the treated root. This measurement was transferred to the intraoperative endoscopic image, where the minimum root width, peripheral dentin thickness, and minimum dentin thickness were recorded. Root measurements, and the position (maxillary or mandibular) and type of tooth (roots of incisors, canines, premolars or molars) were further correlated to periapical surgery outcome.Results A total of 51 patients, comprising 52 teeth and 62 roots, were included in the study. The mean measurements were: maximum root width (4.13±0.84 mm), minimum root width (2.46±0.72 mm), peripheral dentin thickness (0.77±0.2 mm) and minimum dentin thickness (0.4±0.2 mm). The success rate was 82.2%. Premolar roots showed a greater minimum dentin thickness (0.58±0.25 mm) (p<0.003) than incisor roots. No significant association was found between the different measurements and the healing rate at one year, though the roots that failed to heal showed smaller minimum dentin thickness values than the roots that healed correctly. The position and type of tooth did not influence healing outcome.Conclusions The root width and thickness of the remaining dentin wall did not significantly influence healing. However, the roots that failed to heal showed smaller minimum dentin thickness values than the roots that healed correctly. Key words:Endodontic surgery, endoscope, dentin walls.

Platelet-Rich Fibrin Used in Regenerative Endodontics and Dentistry: Current Uses, Limitations, and Future Recommendations for Application.

Regenerative endodontics has introduced numerous procedures such as pulp implantation, revascularization, and postnatal stem cell therapy. Revascularization has been successfully implemented clinically nowadays, thus providing dentists with outrageous results. Platelet-rich fibrin (PRF) used either alone or along with bone graft promotes bone growth and vascularization. This matrix promotes migration, cell attachment, and proliferation of osteoblast that leads to bone formation. PRF consists of a packed fibrin complex consisting of leukocytes, cytokines, and glycoproteins such as thrombospondin. The usage of PRF has reported high success rates in surgical cases such as sinus lift procedures, healing of extraction sockets, and management of periapical abscesses. Compared to platelet-rich plasma, PRF is more economical, easy to prepare, and feasible to use in daily clinical practices. Revascularization compromised the induction of a blood clot into the root canal space, which emerged as a clinical triumph. This further led to platelet concentrates as an autologous scaffold on which revascularization could occur. The applications of PRF in regenerative endodontics are numerous, such as an agent for repairing iatrogenic perforation of the pulpal floor and for the revascularization of immature permanent teeth with necrotic pulps. It acts as a matrix for tissue ingrowth. Evidence of progressive thickening of dentinal walls, root lengthening, regression in the periapical lesion, and apical closure was reported. Further studies are needed to clarify the precise mechanism of action of PRF for dental pulp regeneration both in vitro and in vivo. The current review aims at the present uses of PRF in regenerative endodontics dentistry and its application with future recommendations and limitations.

Continued root development of immature permanent teeth after regenerative endodontics with or without a collagen membrane: A randomized, controlled clinical trial.

Recent studies evaluated the efficacy of a collagen membrane (Bio-Gide) to promote root development in regenerative endodontics (REPs). However, the influence of etiology and tooth type on the results was not assessed. To evaluate the quantitative and qualitative effect of a collagen membrane (Bio-Gide), with and without the effect of etiology and tooth type, in promoting root development in immature teeth after REPs. Eighty nonvital immature teeth were divided randomly into two groups (40 teeth in each group). REPs were performed with (experimental group) and without (control group) a collagen membrane. All teeth were subjected to regular clinical and radiographical follow-up. Seventy-six teeth were included in the final analyses. The average follow-up periods were 33.1 ± 21.8 months for the control group and 28.1± 18.6 months for the experimental group. Quantitative analysis of root development in the experimental group showed a greater increase in dentin wall thickness in the middle one-third of the root compared to the control group, with or without the effect of etiology and tooth type. Six types of root development were observed. There was no significant difference in the type of tooth development between the two groups. The use of a collagen membrane could promote an increase in dentin wall thickness in the middle one-third of the root, and it had no significant effect in terms of the type of subsequent root development.

Prospective cohort study of regenerative potential of non vital immature permanent maxillary central incisors using platelet rich fibrin scaffold

Regenerative endodontic procedures have gained momentum as a treatment modality of young immature permanent teeth. Literature reports reveal that platelet-rich fibrin (PRF) stimulates growth factors and induces regeneration. This study was undertaken to assess the regenerative potential of non-vital immature permanent maxillary central incisors using PRF with a follow-up for 2 yrs. 19 patients in the age group of 9–25 yrs with immature, non-vital permanent maxillary central incisors (n = 23) with/without signs and/or symptoms of periapical pathosis and open apex were included in this study. In the first appointment, access opening, canal disinfection and triple antibiotic paste placement were done. In the subsequent visit, PRF was prepared and placed inside the canal. Access was sealed with Mineral trioxide aggregate plug and composite. The patient was reviewed up to 24 mths. The mean difference was statistically analyzed using Friedman test followed by Dunn post hoc test and adjusted by Bonferroni correction (p < 0.05). As per AAE guidelines, the primary and secondary goals were achieved. A significant (p < 0.001) gradual increase in the root length, thickness of dentinal walls and decrease in apical diameter were observed. Within the limitations of this study, PRF placement was clinically and radiographically effective in inducing regeneration of non-vital immature permanent teeth.

Effect of canal preparation with XP-endo Shaper and ProTaper Next on root canal geometry and dentin thickness of mandibular premolars with radicular grooves and two canals: a micro-CT study.

This study aimed to evaluate the effects of different shaping protocols on the root canal geometry and remaining dentin thickness of mandibular premolars with radicular grooves (RG) and two canals by means of micro-CT. Mandibular premolars with RG and two canals were matched based on their similar morphological dimensions and assigned to 2 experimental groups according to the canal preparation (n=8): XP-endo Shaper (XPS) and ProTaper Next (PTN) systems. Before and after preparation, morphometric measurements of the volume, surface area, structure model index, area, perimeter, roundness, major and minor diameters, as well as untouched canal walls, canal transportation, and dentin wall thickness were evaluated. Data were statistically compared within and between groups using the independent sample t test (α=5%). XPS revealed less changes in volume, surface area, area, perimeter, and major and minor diameters (P<0.05). There was no significant difference in structure model index (SMI), roundness, and percentage of untouched canal walls between groups (P>0.05). XPS resulted in less apical canal transportation and a higher remaining dentin thickness toward the RG compared to PTN in lingual canals (P<0.05). XPS revealed fewer changes in root canal geometry as well as lower transportation and a greater remaining dentin thickness in the lingual canals toward the RG compared to PTN. Internal and external anatomical characteristics of mandibular premolars might have an influence on biomechanical preparation. Considering the risk of perforation, the canal preparation using XPS appears to be more conservative compared to PTN.

The Influence of Dentin Wall Thickness and Adhesive Surface in Post and Core Crown and Endocrown Restorations on Central and Lateral Incisors.

Post and core crowns and endocrowns perform similarly on fracture strength, but endocrowns have more repairable fractures.

Radiographic evaluation of immature traumatized incisors following different endodontic treatments.

Indirect pulp capping, pulpotomy, and apexification are three common endodontic treatments for immature traumatized incisors. They all affect tooth root development to some extent. The aim of this retrospective study was to compare the influence of these treatments on root development of immature permanent incisors following dental trauma. Twenty-one indirect pulp capping, 48 pulpotomy, and 58 apexification cases with a mean age of 8.4±1.0years and median follow up of 12months were included. NIH ImageJ with TurboReg plug-in was used to correct angular differences between the pre-operative and recall periapical radiographs, and to calculate variations of root length, dentin wall thickness, and apical closure. Kruskal-Wallis ANOVA followed by pairwise comparisons was applied to compare the radiographic variations. The type of apical closure was assessed qualitatively and analyzed using Fisher's exact test. The apexification group had a lower trend toward apical closure than the other two groups (P<.05). It also showed thinner dentin wall thickness compared with the pulpotomy group (P=.001). There was no significant difference between pulpotomy and indirect pulp capping in the trend to apical closure (P>.05) or dentin wall thickness (P=.775). There was no significant difference in the variation of root length among the three groups (P=.06). There was a moderate correlation between the treatment and the type of apical closure (Cramer's V Coefficient=.375). Pulpotomy tended to form a normal apical constriction rather than a calcific barrier while apexification showed the opposite inclination. Indirect pulp capping had no specific inclination toward any type of apical closure. Apexification resulted in an abnormal root development mostly by affecting the dentin wall thickness and apical closure. Pulpotomy was beneficial for normal root development of immature traumatized teeth.

A second attempt at pulp revascularisation on an immature traumatised anterior tooth: a case report with two‐year follow‐up

This report describes the second attempt at pulp revascularisation, using an association between 2% chlorhexidine (CHX) and calcium hydroxide (CH) as intracanal dressing, in an immature traumatised anterior tooth with pulp necrosis. A 21-year-old woman complained of pain and dental crown darkening of a permanent maxillary right central incisor. Her medical records presented a history of dental trauma, and at age 15, the first attempt at revascularisation was performed, using triple antibiotic paste (TAP) as the intracanal dressing. Recent radiographs then showed a periapical lesion associated with an immature root, which demonstrated the failure of the first attempt. The second pulp revascularisation was performed, using an association between CHX and CH as intracanal medication. The case was followed up for 24months. Observations showed evidence of root development, dentinal wall thickening and periapical healing. In this case, the association between CHX and CH showed favourable results as an intracanal medication.

Regenerative endodontics: a promising tool to promote periapical healing and root maturation of necrotic immature permanent molars with apical periodontitis using platelet-rich fibrin (PRF).

Currently, mineral trioxide aggregate (MTA) apexification is recommended as the preferred treatment for permanent anterior immature necrotic teeth. Apexification treatment does not enable further development and maturation of the teeth, resulting in short roots with thin root canal walls, that often are prone to cervical fractures. This study presents the regenerative endodontic procedure (REP) as an alternative treatment for immature necrotic molars with apical periodontitis or a chronic apical abscess. REP enables periapical healing as well as root lengthening and widening of the dentinal root canal walls. Six immature first molars teeth (five mandibular, one maxillary) with apical periodontitis or chronic apical abscess were treated with REP. Patients underwent periodic follow-up visits every 3months the first year and twice a year thereafter. The final clinical examination revealed no symptoms, no gingival pockets, and no sensitivity to percussion. Cold sensitivity tests were negative. Radiographs revealed full periapical healing in all the treated molars, remarkable root lengthening, and dentinal wall thickening. REP with PRF is feasible and may have some advantages over MTA apexification since it facilitates root elongation, dentinal thickening of the root canals walls, and narrowing of the apical foramen.