Necrotic Immature Teeth Research Articles

Evaluation the Effect of Using of Apical Matrix With Apexification Procedure on Apical Healing of Necrotic Immature Teeth

Evaluation the Effect of Using of Apical Matrix With Apexification Procedure on Apical Healing of Necrotic Immature Teeth

Combined Effect of Levofloxacin and N-Acetylcysteine against Enterococcus faecalis Biofilm for Regenerative Endodontics: An in Vitro Study.

Endodontic treatment of necrotic immature teeth poses several clinical challenges. A major problem is the elimination of microorganisms from the root canal system. This study evaluates the in vitro antibacterial efficacy of ciprofloxacin (CIP), levofloxacin (LEV), and their combination with N-acetylcysteine (NAC) in root canals infected with Enterococcus faecalis (E. faecalis). A total of 120 human extracted teeth with single canals were prepared and randomly divided into six groups: Calcium hydroxide (CH), ciprofloxacin (CIP), levofloxacin (LEV), ciprofloxacin and N-acetylcysteine (CIP+NAC), levofloxacin and N-acetylcysteine (LEV+NAC), and normal saline as a positive control. According to the name of the groups, intracanal medicaments were placed into the canals and the teeth were restored with a temporary filling. After one week, intracanal medicament was removed and the final count of bacteria was measured. Antibacterial effect of medicament was assessed by measuring the percentage reduction in the colony counts (RCC) and scanning electron microscopy (SEM). The Mann-Whitney U test and the Kruskal-Wallis test were used to compare the overall antibacterial efficacy of the intracanal medicaments at significance level of 0.05. All intracanal medicaments were significantly more effective than calcium hydroxide (P<0.05). The combination of LEV and NAC caused significantly higher reduction in colony count in comparison with other tested medicaments (P=0.001). The combination of LEV and NAC showed greater antibacterial activity compared with other tested medicaments against biofilm of E. faecalis. Thus, it has the potential to be used in regenerative endodontic treatments.

Single-visit apexification in immature necrotic teeth using mineral trioxide aggregate as an apical plug: Case series

Apexification is a procedure for closure of the open apex in an immature necrotic tooth. Apexification with calcium hydroxide is considered as the gold standard. However, this technique is associated with certain difficulties such as very long treatment period, possibility of tooth fracture, and incomplete calcification of the bridge. Single-visit mineral trioxide aggregate (MTA) apexification has become popular over the calcium hydroxide technique. In this article, three case reports of 3 months to 1-year follow-up are presented, which were treated by the single visit apexification procedure which includes recent artificial barrier methods with MTA as the apical plug and the rest of the canal was obturated with thermoplastisized gutta-percha.

Regenerative Endodontic Treatment of Bilateral Necrotic Immature Permanent Maxillary Central Incisors with Platelet-rich Plasma versus Blood Clot: A Split Mouth Double-blinded Randomized Controlled Trial.

ABSTRACTAimClinical and radiographic assessment of the regenerative potential of bilateral immature permanent maxillary central incisors with necrotic pulps using blood clot (BC) and platelet-rich plasma (PRP) scaffolds.Trial designThis is a split mouth double-blinded parallel randomized controlled clinical trial.Subjects and methodsRandomization and blinding: the study started with 15 patients with bilateral maxillary immature permanent central incisors with necrotic pulp. The two upper bilateral central incisors were randomly assigned to either the control (BC scaffold) group I or examined (PRP scaffold) group II. Participant: 13 patients aged 8–14 years fulfilled the study requirements. A follow-up was done for 3, 6, 9, and 12 months. Standardized radiographs were collected during the follow-up period, and radiographic changes were measured using Image J software. Primary outcome measured were clinical: pain, mobility, swelling, and sinus/fistula. Radiographic outcome included increased root length and increase in root thickness. Secondary outcomes were clinical: discoloration and sensibility test. Radiographic outcome included an increase in bone density measurements and a decrease in apical diameter. Standardized radiographs were collected during the follow-up period, and radiographic changes were measured using Image J software.ResultsAll 26 treated teeth survived during the 12-month follow-up period with 100% success rate. PRP-treated teeth showed a statistically significant increase in radiographic root length, width, periapical bone density, and a decrease in apical diameter when compared with BC. At the end of 12 months, all treated teeth did not respond to the sensibility test. BC displayed a significantly higher amount of crown discoloration compared to the PRP group.ConclusionFor necrotic immature teeth, regenerative endodontic treatment using PRP is a desirable alternative to BC and shows excellent 12-months prognosis.How to cite this articleRizk HM, AL-Deen MSS, et al. Regenerative Endodontic Treatment of Bilateral Necrotic Immature Permanent Maxillary Central Incisors with Platelet-rich Plasma versus Blood Clot: A Split Mouth Double-blinded Randomized Controlled Trial. Int J Clin Pediatr Dent 2019;12(4):332–339.

Management of Immature Necrotic Permanent Teeth with Regenerative Endodontic Procedures - A Review of Literature

Immature necrotic permanent tooth presents a distinctive challenge for the endodontist. Various treatment modalities have been employed to create hard tissue barrier at the apex, which includes non-vital pulp therapy with calcium hydroxide, apexification with mineral trioxide aggregate, pulp revascularisation and regeneration. Regenerative endodontics is a novel modality which involves physiological replacement of the damaged structures of tooth like dentin, root and cells of the pulp-dentin complex. Numerous published case reports have revealed increased dentinal wall thickness, continued root development and apical closure, but there is still lack of sound scientific evidence regarding histological nature of the type of tissue. The current literature review was planned to summarise the evidence regarding the treatment of immature necrotic permanent teeth by regenerative endodontic procedures.

Management of an Immature Necrotic Permanent Molar with Apical Periodontitis Treated by Regenerative Endodontic Protocol Using Calcium Hydroxide and MM-MTA: A Case Report with Two Years Follow Up

Traditionally, immature teeth diagnosed with necrotic pulp and periapical periodontitis were treated by apexification with long-term calcium hydroxide or in one session with mineral trioxide aggregate (MTA) or Biodentine apical plug. However, these teeth become fragile and susceptible to root fracture. Regenerative endodontic procedure is a new therapeutic approach that promotes continuation of root growth in immature necrotic teeth potentially preventing root fracture. Only few case reports have shown the success of this procedure on molar cases. The current case report demonstrates a regeneration of a lower first molar with necrotic pulp and chronic apical abscess treated with Micro Mega-MTA (MM-MTA), a new endodontic biomaterial that has not been described previously. Calcium hydroxide was used as an intracanal medicament for two weeks. Next, calcium hydroxide was removed and after blood clot creation, MM-MTA® was placed over it. Apical healing and continuation of root growth were evident at nine months follow-up. CBCT at two years follow-up confirmed apical closure and complete healing. This case shows that a regenerative endodontic procedure for management of an immature necrotic permanent molar is feasible and can be successfully done using Ca(OH)2 and MM-MTA.

Study of antibacterial and antifungal efficacy of platelet-rich fibrin and platelet-rich fibrin matrix.

Background:Platelet concentrates are extensively utilized in the medical and dental field to promote tissue regeneration. The profusion of endogenous growth factors in platelets α-granules transmit their use for enhanced wound healing. However, little attention has been given to study their antimicrobial potential. This study was conducted to assess the antibacterial and antifungal property of platelet-rich fibrin (PRF) and PRF matrix (PRFM).Materials and Methodology:Blood samples were obtained from 16 participants, PRF and PRFM were processed as per the protocol prescribed by Choukroun et al. and Lucarelli et al., respectively. The susceptibility test against microbiota in the root canal and Candida albicans was assessed through minimum inhibition zone by agar diffusion technique.Results:PRF showed an effective antibacterial property, however, did not perform well against C. albicans strains. PRFM did not show any antibacterial or antifungal properties.Conclusions:The antibacterial efficacy of PRF may prove beneficial when used in the revascularization procedure of immature necrotic teeth.

Applications of Fibrin-based products in Endodontics: A Literature Review

Introduction: Endodontic treatment of necrotic immature teeth is quite challenging. Current concepts for revitalization of these teeth known as regenerative endodontic treatment (RET) is based on key elements necessary for tissue engineering including stem cells, three-dimensional (3D) scaffolds, and growth factors. Utilizing an applicable scaffold for narrow root canal space with adequate properties is essential for successful outcome. Fibrin-based products are materials with various advantages as a scaffold. This review article aims to discuss the properties of different types of fibrin-based products and debates whether they are appropriate scaffolds for RET or not? Methods: An electronic search was performed using databases such as Google Scholar, PubMed, PubMed Central, Science Direct, and Scopus. Keywords such as (“scaffold”)AND (“fibrin gel” OR “fibrin sealant” OR “fibrin glue” OR “fibrin tissue adhesive” OR “fibrin hydrogel” OR “platelet concentrate”) AND (“tooth” OR “teeth”) AND/OR (“regenerative endodontics” OR “dentistry”) were used. Exclusion criteria included studies published in a language other than English and abstracts from congress. Results: Fibrin gel is a protein-based natural polymer hydrogel scaffold which can be easily used in the root canal. Platelet concentrates are autologous fibrin-based products used as scaffolds for RET with various favorable properties especially due to containing various growth factors. Conclusion: It seems that fibrin gel and platelet concentrates have adequate properties for use in RET; however, more evidence is required regarding the clinical outcome of applying these products as scaffolds for RET.

Ability of two single-step restorative materials to avoid crown darkening caused by intracanal minocycline paste.

This study aimed to quantitatively assess the ability of two single-step restorative materials to avoid crown darkening caused by the use of minocycline as an intracanal medicament. After coronal access and instrumentation, 120 maxillary incisors were divided into four groups (n = 30). Two experimental groups according to the restorative material applied to the inner walls of the access cavity: OB, OptiBond All-In-One + minocycline intracanal paste; U200, RelyX U200 + minocycline intracanal paste. Two control groups without restorative materials: MIN, minocycline intracanal paste and SL, saline intracanal. Color determination was performed using a spectrophotometer at five time points, immediately after materials were applied (baseline), and at 7, 14, 21, and 28days from the baseline. Decrease in the mean values of L* (luminosity) was observed after insertion of minocycline paste in all groups at all time points. Statistically significant differences were absent between the time points (P > .05). After 28days, MIN showed significantly more darkening (ΔL*) (- 10.6 ± 7.3) than OB (- 5.4 ± 6.2), U200 (- 5.8 ± 3.9) and SL (- 2.3 ± 1.2) (P < .05). Crown darkening can be minimized by the previous application of RelyX U200 or OptiBond All-In-One to the inner walls of the access cavity before a minocycline-containing paste is applied as an intracanal medication. The American Association of Endodontists Clinical Considerations for Regenerative Procedures in necrotic immature teeth suggests the triple antibiotic paste as an intracanal medication (2018). However, discoloration and crown darkening are common unfavorable outcomes. The clinical protocol suggested in this paper has shown to be able to minimize crown darkening, predictably leading to a better patient-centered clinical success.

Ratio and Rate of Induced Root Growth in Necrotic Immature Teeth

Ratio and Rate of Induced Root Growth in Necrotic Immature Teeth

Sealing Ability of the Formed Apical Calcified Bridge in Open Apex Roots

A successful endodontic treatment requires that the apex of the treated tooth becompletely and densely sealed with root canal filling material. One of the mostdifficult endodontic problems is the management of necrotic immature tooth due tothe blunderbuss apex and the difficulty in achieving a tight seal between the root canalsystem and the external surface of the tooth. The aim of this study was to evaluate thesealing ability the apical calcified bridge formed by calcium hydroxide paste, whiteMTA or gray MTA during apexification procedure.Thirty premolars with single root canals were prepared to simulate an open apex.These roots were divided into 3 groups as follow: Group A: 10 roots filled withCa(OH)2 paste, Group B: 10 roots filled with white MTA, and Group C: 10 rootsfilled with gray MTA. Each root was placed in a polyethylene vial containing 25 m1of synthetic tissue fluid (STF) and incubated at 37°C for 3 months. After 3 monthsand the formation of calcified bridge, each root was immersed in 2% freshly preparedMethylene blue dye in 5 ml plastic vial for seven days. After the leakage period, theroots were removed from the dye and the leakage in all roots was examined bymeasuring the linear extent of dye penetration from the apical end of the canalpreparation to the coronal direction by means of a light stereomicroscope at (40 X)magnification with calibrated grid.Ca(OH)2 paste group has the highest mean value of apical dye penetrationfollowed by WMTA, while GMTA group shows the lowest mean value of apical dyepenetration. There was a highly significant difference in the apical dye penetration(p&lt;0.01) among these groups, statistically a high significant difference is found(p&lt;0.01) between Ca(OH)2 group and WMTA group, and between Ca(OH)2 groupand GMTA group; whereas, significant difference is found (p&lt;0.05) between WMTAgroup and GMTA group.The apical calcified bridge formed by GMTA has the best sealing ability followedby that formed by WMTA. While the apical calcified bridge formed by Ca(OH)2 pastehas the lowest sealing ability as compared with that formed byWMTA and GMTA.

Induced post-traumatic apexification: 20 year follow-up and morphological study after new fracture

Apexification is an endodontic technique used in immature necrotic teeth, the primary goal of which is to induce a calcified barrier in roots with open apices and to promote the continuation of apical root development. A 7-year-old patient with a coronal fracture in a maxillary central incisor was treated with an apexification technique using calcium hydroxide. The apical closure was obtained after one year, then a permanent root canal filling was performed. The tooth was monitored for a period of 20 years, up to when a trauma caused its extraction. The newly formed root was analyzed macroscopically, histologically and through scanning electron microscopy. A morphologically normal root was observed, with a large apex and accessory foramina, showing a combination of tissue structures similar to secondary and tertiary dentine, close to amorphous mineralized areas. Despite the final evolution of the case, calcium hydroxide apexification is a good therapy in order to treat pulp necrosis in an immature tooth, leading to complete development of the root and allowing the tooth to be kept in the mouth.

Tooth Discoloration and Internal Bleaching after the use of Triple Antibiotic Paste for Regenerative Endodontic Treatment of an Immature Necrotic Permanent Tooth: A Case Report

Recently, regeneration of immature necrotic pulp has become an alternative conservative treatment option for young permanent teeth and is a subject of great interest in the field of endodontics. The primary goal of these procedures is to activate the potential of the pulp for dentine deposition and produce a stronger mature root that withstands the forces better. However, the current protocol has potential clinical and biological complications. Amongst them, crown discoloration caused by triple antibiotic paste is deemed to be very frustrating for the dentist and the patient. In the case presented, there was a successful reversal of the crown discoloration by an internal bleaching procedure with superoxol at follow up periods of 3, 6 and 12 months. However, further long-term clinical trials and histological studies are needed to evaluate the long-term outcomes of walking bleach with superoxol in regenerative endodontic procedures.

Regenerative Endodontics in Traumatized Young Permanent Tooth

Introduction: Revascularization is new treatment modality and is very valuable treatment option for immature necrotic teeth with open apex. Methods: An 8-year-old boy with traumatized upper right central incisor. The clinical and radiographical examinations revealed uncomplicated crown fracture, tenderness and periapical radiolucency with immature root. Revascularization was planned to treat the tooth. The tooth root canal was irrigated 2.5% NaOCl, followed by 2 weeks of triple antibiotic (metronidazole, ciprofloxacin and minocycline) paste. Then antibiotic paste was removed, bleeding was induced, and cavity was sealed with MTA. Results: In clinical and radiographical examinations in follow up visits the tooth was asymptomatic and functional, periapical radiolucency was healed, and root continued to develop with apical foramen became narrower. Conclusion: Revascularization is an effective treatment for immature necrotic teeth. In addition, triple antibiotic paste provides sterile environment for regeneration.

Revascularization of Immature Necrotic Teeth

The objective of this review is to provide an overview of the past and present advancements in regenerative endodontics. Available literature clearly demonstrates high-clinical success of regenerative endodontic procedures (REP). Several recommendations made by the American Association of Endodontists (AAE) with regard to REP protocols are based on recent work demonstrating these as stem cell-based therapies. This review summarizes the role of stem cells and therefore the rationale for the currently recommended guidelines. Clinical success of REP lies between 80 and 100% with root development observed in a significant number of treated cases. These procedures provide a unique advantage of continued root growth despite premature pulp necrosis in immature teeth. Research in the field of stem cell biology has greatly increased our understanding of tissue engineering in endodontics. Overall, REPs appear to be a viable treatment option for immature teeth with pulp necrosis.

A CBCT evaluation of pulp regeneration of single rooted immature necrotic teeth using two different scaffolds

A CBCT evaluation of pulp regeneration of single rooted immature necrotic teeth using two different scaffolds

Treatment Options for Failing Regenerative Endodontic Procedures: Report of 3 Cases

IntroductionRegenerative treatments in necrotic immature teeth are suggested as alternatives to conventional multiple or single-step apexification procedures. Although case reports and case series provide promising results, the treatment protocol is not yet fully established and regenerative procedure might fail. Once failure is encountered, the apexification treatment options still remain. MethodsRepetition of the regenerative procedure after initial revitalization failure has not been suggested yet. Here, 3 cases of failing regenerative endodontic procedures are reported. All 3 cases had been initially treated by single-step disinfection/revascularization procedures. In different time intervals, all cases showed signs of recurrent disease. The first case was managed with renegotiation and apical mineral trioxide aggregate plug placement; the second case was managed with renegotiation and conventional root canal treatment; and the third case was managed with renegotiation, long-term calcium hydroxide disinfection, and repetition of the regenerative endodontic procedure. ResultsTwo years after the second intervention, all cases were considered successful. ConclusionsRepetition of failed regenerative treatment procedures might be a viable alternative to conventional apexification procedures.

Use of Platelet-rich Plasma in Endodontic Procedures in Adults: Regeneration or Repair? A Report of 3 Cases with 5 Years of Follow-up

IntroductionRegenerative endodontic procedures (REP) are a promising alternative for necrotic immature teeth in adolescents and children, but very little evidence is available on this alternative in long-lasting necrotic teeth with open apices in adults. REPs are designed to replace damaged structures of the pulp-dentin complex, but no regeneration has been obtained in any of the cases described in necrotic immature permanent teeth with apical periodontitis with histologic results. The results are limited to periapical tissue repair with increasing root length, thickening of the root walls, and apical closure in young patients. In this series of cases, we report on the outcomes of the adjuvant use of autologous platelet-rich plasma (PRP) in endodontic therapy in adults by monitoring periapical tissue healing with periodic periapical radiographs and cone-beam computed tomographic scanning. MethodsThree teeth with apical periodontitis and open apices in 3 different patients from 21 to 35 years-old were evaluated. An REP was performed with the adjuvant use of PRP. ResultsAt controls, complete disappearance of the radiolucent lesions and the presence of calcified structures forming bridges occupying the pulp lumen were observed but not an ostensible thickening of root walls with a regeneration of pulp-dentin complex. ConclusionsThe repair of periapical tissues with REPs of open apex teeth with apical periodontitis and in nonsurgical endodontic retreatment appears to be feasible in adults, but no regeneration was obtained in any of the present cases. The use of PRP may be a good choice as an autologous matrix because of its stability and induction; it contains growth factors and bioactive molecules like transforming growth factor beta, bone morphogenic proteins, insulinlike growth factors, and angiogenetic growth factors, which stimulate collagen production, angiogenesis, and cell differentiation. Anti-inflammatory and antibacterial properties have also been reported for this preparation, which are involved in all processes of repair.

Management of Mucosal Fenestration Associated With Immature Necrotic Tooth: A Combined Orthodontic Endodontic Approach

Management of Mucosal Fenestration Associated With Immature Necrotic Tooth: A Combined Orthodontic Endodontic Approach

High survival and clinical success rates, but also high discoloration rates, in immature necrotic teeth treated with regenerative endodontic procedures

Chan EK, Desmeules M, Cielecki M, Dabbagh B, Ferraz Dos Santos B. Longitudinal cohort study of regenerative endodontic treatment for immature necrotic permanent teeth. J Endod. 2017;43(3):395-400. http://dx.doi.org/10.1016/j.joen.2016.10.035.