Immature Permanent Incisors Research Articles

Delayed Replantation of Immature Permanent Central Incisor:1 Year Follow-Up

Delayed Replantation of Immature Permanent Central Incisor:1 Year Follow-Up

Comparative Evaluation of Platelet-rich Fibrin and Treated Dentin Matrix in Regenerative Endodontic Treatment of Nonvital Immature Permanent Teeth: A Randomized Clinical Trial.

Clinical and radiographic evaluation of the efficacy of platelet-rich fibrin (PRF) and treated dentin matrix (TDM) in regenerative endodontic treatment and periapical healing of nonvital immature permanent teeth with chronic apical periodontitis. Twenty-four children aged between 7 and 11 years, each presenting with a nonvital immature permanent upper central incisor, were selected. They were randomly allocated into two groups (n = 12), group I (PRF) and group II (TDM). Baseline clinical findings were recorded, and preoperative cone-beam computed tomography (CBCT) was taken. Follow-up was done clinically for 15 months at 3-month intervals (3, 6, 9, 12, and 15 months), and CBCT was taken at the end of the 15-month follow-up. Root length, apical diameter, radiographic root area (RRA), and size of the periapical lesion were quantitively assessed at the end of follow-up period and compared to the preoperative CBCT. Clinical success was 100% in both groups by the end of the follow-up period. Radiographically, after a 15-month follow-up, there was a significant increase in root length and RRA, and there was also a significant reduction in apical diameter and lesion size within each group (p < 0.05). However, there was no statistically significant difference between both groups regarding the mean percentage of increase in root length and mean percentage of reduction of apical diameter (p > 0.05). On the other hand, PRF showed more increase in RRA and more reduction in lesion size, with a statistically significant difference between both groups (p < 0.05). Both PRF and TDM were clinically successful. Platelet-rich fibrin showed better radiographic outcomes and periapical healing. Platelet-rich fibrin is a viable scaffold to aid further root development and resolution of periapical lesions of nonvital immature permanent teeth. Further studies with different forms of TDM are needed to assess the efficacy of TDM in regenerative endodontic treatment of nonvital immature permanent teeth. How to cite this article: Asal MA, Elkalla IH, Awad SM, et al. Comparative Evaluation of Platelet-rich Fibrin and Treated Dentin Matrix in Regenerative Endodontic Treatment of Nonvital Immature Permanent Teeth: A Randomized Clinical Trial. J Contemp Dent Pract 2024;25(6):563-574.

Comparing the technical quality and clinical outcomes of root canal treatment on immature permanent incisors in children: a retrospective evaluation of three bioceramic plug materials.

To assess the technical quality and clinical outcomes of non-surgical endodontic treatment of immature permanent incisor teeth with three different bioceramic plug materials and highlight variables which may influence treatment and quality outcomes. This cross-sectional analysis forms part of a retrospective service evaluation of the technical quality and clinical outcome of orthograde root canal treatment carried out in the Paediatric Dentistry Department of Charles Clifford Dental Hospital (United Kingdom). Twenty-five cases were identified chronologically, using the electronic patient record system, for three bioceramic plug materials: Mineral Trioxide Aggregate (MTA), Biodentine, and TotalFill Putty. All radiographs were analysed using standard conditions. Intra- and inter-examiner agreement was calculated using Kappa and weighted Kappa tests. Data were collected using a data collection tool, entered into Microsoft Excel, and analysed using descriptive statistics, exploratory analysis with Chi-squared tests, and multivariable analyses (logistic regression). At 12-month review, the success rate for each apexification material was MTA (84%), Biodentine (88%), and TotalFill Putty (92%). MTA had the highest frequency of post-operative coronal discolouration, with Biodentine most associated with apical extrusion. A number of variables and trends that affect the clinical outcome were identified, including the presence of pre-operative resorption, the number of operators involved in treatment, the number of appointments to complete treatment, as well as how non-use of local anaesthetic during apical plug placement had no adverse effect on technical quality or clinical outcome. MTA, Biodentine, and TotalFill Putty are highly effective apexification materials which produce excellent clinical outcomes. As such, logistical and situational factors, such as continuity of care from operators with increased levels of experience, skill and ability, rather than material choice, may be more prognostic regarding the technical quality and clinical outcome of immature endodontic treatment. Further high-quality evidence is required.

Management of Ellis Class II Fracture in Young Permanent Maxillary Central Incisor

Background: Tooth fracture is a condition of missing or lost fragments of a complete tooth. Tooth fracture usually occurs simultaneously with another oral injury. Objective: This case report discussed the management of Ellis class II fractures on an immature permanent central incisor of a patient who reported to Jenderal Achmad Yani University (Unjani) Dental Hospital. Case: An 11-year-old girl revealed a broken upper left tooth, sensitive to cold drinks that interfered with her appearance one year ago. The patient had a good general condition, no abnormalities during an extraoral examination, and a history of pain on the lower back tooth since a year ago. Case Management: Management of Ellis class II fracture in young permanent central incisor was conducted by using a class IV composite resin restoration. Conclusion: The management of Ellis class II fracture should be conducted holistically and systematically with subjective, intraoral, extraoral, and adjunctive examinations which should be performed correctly and considering the child’s psychology.

The traumatized immature permanent incisor with pulpal involvement: what conservative treatment options?

Traumatology is the second most common dental pathology, after caries and before periodontal pathologies. It is currently accepted that one child in two suffers an alveolar-dental trauma before leaving school, with a peak incidence between the ages of 8 and 12, all types of trauma combined. The maxillary central incisors are most affected (79.6%), with mainly "simple" or "complex" coronal fractures when the pulp is involved. The main objective in managing these complex fractures is to preserve pulpal vitality within an acceptable timeframe. The author presents three pulp vitality preservation therapies involving tissue preservation and regeneration techniques using bioactive materials applied directly to the pulp. Materials and clinical protocols are described. Knowledge of pulp biology and healing processes has led to the development of vitality-preserving therapeutic strategies that have become essential in the management of traumatized teeth in children and adolescents. The regenerative potential of immature tooth pulp is considerable, enabling dentine repair through the use of bioactive materials. These therapies require a rigorous surgical approach that determines prognosis, and precise monitoring to ensure that any complications are intercepted.

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.

Comparison of the vitality test with sensitivity tests in mature and immature teeth: clinical trial.

One of the most important steps in deciding on the treatment of a tooth is to determine the vitality and health status of the pulp. Since immature teeth innervation is not completed, the response to sensitivity tests may not yield definite results. Pulse oximetry (PO) which is considered as a vitality test, measures the arterial oxygen saturation (SpO2). This study aims to compare PO, electric pulp test (EPT) and cold test in mature and immature permanent teeth. 20 immature and 20 mature permanent incisors of 6-12-year-old ASA1 children who did not use any analgesics, were included in the study. Pulp vitality of the teeth was determined by EPT, cold test and PO. An infant probe of PO device (CMS60D, Contec Medical Systems Co. Ltd, China) was used to determine the SpO2 of the teeth. The SpO2 level is controlled on the patient's finger by a children's probe and an infant probe of PO. Shapiro-Wilk, Spearman rank correlation test and Kruskal-Wallis test/Dunn post-hoc analysis were used for statistical comparisons. There was no significant correlation between finger SpO2 and the mature/immature teeth SpO2 (r=-0.026, r = 0.253). Arterial oxygen saturation values in the immature teeth were significantly higher than in the mature teeth (p = 0.002). There was a high correlation between the vitality response of the EPT, cold test and PO. Pulse oximetry can be used as an effective vitality test compared to sensitivity tests in both immature and mature permanent incisors.

Adjunctive Use of Hyperbaric Oxygen Therapy in Veterinary Dentistry and Oral Surgery: A Case Series.

Hyperbaric oxygen therapy (HBOT) is utilized as an adjunctive treatment for human and veterinary patients with compromised tissues. Medical records from two veterinary hospitals with HBOT chambers were searched for small animal veterinary dentistry and oral surgery specialty patients. The HBOT records were combined with the medical records from the referring specialty veterinary dentistry and oral surgery services. Clinical indications for HBOT treatments associated with a positive outcome in this case series included resistant bacterial infections, electrical cord injury, bite wound injuries, osteomyelitis, crush/traumatic injuries including mandibular fractures, oral surgery performed at previously irradiated sites, and osteonecrosis, presumably radiation induced. Conditions within this case series that remained unchanged or were associated with partial improvement included preoperative treatment of stomatitis without steroid usage and delayed HBOT treatment for long-term endodontic health of laterally luxated immature permanent mandibular incisors. Eighty-eight percent of the HBOT sessions were tolerated well by the patients in this case series. The most common adverse event was mild anxiety. One patient required oral anxiolytic medications to complete the course of treatment. One patient experienced transient seizure activity and was able to complete that session as well as subsequent sessions at a lower chamber pressure. Future prospective studies are necessary to further evaluate and characterize the potential benefits of HBOT as well as to clarify optimal treatment protocols for specific conditions in veterinary dentistry and oral surgery.

In-vivo evaluation of the effects of short-term dehydration and rehydration on the color differences of immature permanent incisor teeth.

It is aimed to evaluate the color changes of upper central incisor teeth with different root maturation levels after 15 min of dehydration and rehydration. Using the Cvek classification, 60 participants were divided into five groups. A spectrophotometer, equipped with a specially designed jig, was utilized for color measurements. Following isolation, color measurements were conducted at the dehydration process intervals of baseline, 1st, 2nd, 3rd, 5th, 7th, 10th, and 15th minutes. After mouth rinsing, measurements were repeated at the same time intervals during the rehydration process. CIEDE2000 (ΔE00) values and the Whiteness Index (WID) were obtained to compare the color changes between the initial readings and each interval. Friedman and Repeated Measures ANOVA were applied to compare classes by time during the dehydration and rehydration periods, as well as ANOVA and Kruskal-Wallis tests to compare by classes for each time (p < 0.05). Significant differences emerged in the mean ΔE00 values during dehydration and rehydration periods across all Cvek Classes (p < 0.05). While no statistically significant differences were observed among Classes at different minutes during the rehydration period (p > 0.05), it was particularly noted that the mean ΔE00 values of Classes 2, 3, and 5 at the 2nd minute of dehydration were statistically significantly higher than the mean of Class 1 (p < 0.05). However, when evaluating the starting and ending measurements of both dehydration and rehydration processes, and the overall change in ΔE00 and ΔWID, no significant variations were detected across the Classes (p > 0.05). In teeth that have just erupted and are still undergoing root development, dehydration in the initial minutes results in noticeable color changes. However, the change in ΔE00 and ΔWID of the teeth was found to be similar after the dehydration and rehydration processes. According to the Cvek classification, the lower color change in Class 1 teeth within the first 2 min of dehydration and the need for more than 15 min of rehydration for immature teeth with an open apex to return to their initial state after a 15-min dehydration are crucial for clinicians in terms of color assessment timing.

Cone-beam computed tomographic evaluation of biodentine apexification for traumatized necrotic immature permanent incisors: One-year clinical study

Aim: The aim of this study was to assess the outcome of biodentine apexification for the management of traumatized immature teeth with necrotic pulp over a period of 12 months. Methods: Eighty-five human maxillary incisors with traumatized immature necrotic pulp in patients aged 10–50 years were selected for this study. Root canal treatment was initiated and the biodentine apexification procedure was performed in a single appointment for all teeth. Intraoral preoperative and postoperative periapical radiographs were used to assess periapical (PA) changes, changes in root length (RL), and radiographic root area (RRA). Preoperative and postoperative cone-beam computed tomography (CBCT) images were used to assess the three-dimensional (3D) volumetric changes. Patients were recalled at 12 months posttreatment for the evaluation of clinical symptom, percussion, and palpation examination. Descriptive statistics was computed for preoperative demographic, patient-centric data, and treatment success. Paired t-test was used to compare the preoperative and 12-month postoperative changes in RRA, RL, and 3D volumetric changes of the parameters. Results: Forty-eight out of the 49 teeth that completed the study were asymptomatic and functional. Comparing the preoperative and the 12-month review radiographs using the periapical index scores based on the size of the lesion, completely healed lesions were 79.16% while lesions in the process of healing were 20.83%. There was a significant (P &lt; 0.05) increase in RL (14.17%), RRA (40.87%), and dentin volume (26.63%). Conclusion: 3D volumetric analysis suggests that biodentine apexification has the ability to deposit hard tissue 3-dimensionally, and it is an effective alternative to the conventional apexification materials.

Management of discolored immature permanent incisor associated with triple antibiotic therapy: A case report

Management of discolored immature permanent incisor associated with triple antibiotic therapy: A case report

Management of Concomitant Intrusion and Complicated Crown-Root Fracture Injury of Maxillary Central Incisors in a Child

Dental intrusions are a severe type of injury because they impact the neurovascular supply of the tooth as well as the supporting tissues which predispose the tooth to necrosis and root resorption. Management of these injuries requires repositioning of the teeth under close monitoring to avoid complications. The management becomes more comprehensive when an intrusion is combined with other injuries, such as a crown-root fracture. This case report represents a 4-year follow-up of a child who suffered from a concomitant injury of intrusion and complicated crown-root fracture to the maxillary immature permanent central incisors. The management involved a multidisciplinary approach including endodontics, pedodontics, orthodontics, periodontics, and prosthodontics. Given the guidelines of dental trauma and the circumstances of the case, the fractured teeth were root canal treated, filled with a bioceramic plug and gutta-percha, and then restored with posts/cores and temporary crowns. The intrusion was managed initially by passive eruption followed by an active orthodontic eruption, after which the teeth were restored with permanent ceramic crowns. Throughout the course of treatment, the teeth showed no complications of root resorption or ankylosis, although one tooth developed a periapical infection which was managed by apical surgery. At the 4-year follow-up, the teeth revealed healthy periodontium and good esthetics.

Management of Bilateral Foreign Objects in Immature Permanent Maxillary Central Incisors: A Case Report

AbstractTraumatic dental injuries are more commonly seen in children and it often results in a complicated crown fracture. This case is unique as foreign objects in the form of hand-sewing needles were accidentally lodged bilaterally in both maxillary central incisors. A 13-year-old patient was referred to the Dental Clinics at the College of Dentistry, Jazan University with a complaint of broken needles in her front teeth and a history of trauma 3 years ago. Although the patient had the habit of using a hand-sewing needle to remove the lodged food particles from the open pulp chamber, she was not able to recollect the incidence of needle separations. Radiographic examination revealed radiopaque objects in the middle third of the right maxillary central incisor (#11) and in the apical third of the left maxillary central incisor (#21). Tooth #11 was clinically diagnosed as pulp necrosis with chronic apical abscess and tooth #21 as pulp necrosis with asymptomatic apical periodontitis. The micro tweezer from the broken instrument removal kit (Zumax Medical Co.,Ltd., Jiangsu, China) was used to retrieve the separated needle pieces under the operating microscope. The open apices were managed by the formation of mineral trioxide aggregate apical plug, and the procedure of root reinforcement was achieved by bonded resin cement and fiber resin posts. Finally, teeth were restored with dual cure core build-up composite material and direct composite veneers. Recommendations are made to treat complicated crown fractures, especially in children on priority to minimize the risk of foreign object impaction.

Long-term Outcome of Endodontically Treated Traumatized Immature Upper Incisors

IntroductionIn a growing child, preservation of traumatized immature permanent upper incisors is challenging. This study aimed to evaluate the long-term outcome of endodontically treated traumatized immature upper incisors and associated variables. MethodsA total of 183 traumatized immature upper incisors treated with pulpotomy, apexification, or regenerative endodontic procedure (REP), with follow-up between 4 and 15 years, were assessed for presence of pulpal responses or periodontal/bone responses using standardized clinical and radiologic criteria. Logistic regression, including stage of root development, type and complexity of traumatic event, type of endodontic intervention, and history of orthodontic management, were used to estimate impact on tooth survival and occurrence of tissue responses. Study approved by Ethics Committee Research UZ/KU Leuven (S60597). ResultsAfter a median follow-up of 7.3 years (interquartile range, 6.1–9.2), 159 teeth (86.9%) were still functional. From these teeth, 58 (36.5%) developed tissue responses. This was significantly associated with stage of root development at moment of trauma (root length <¾) and type of endodontic intervention (REP presenting worst outcome). Tooth loss (24 teeth, 13.1%) occurred after a mean time span of 3.2 years (±1.5) and was significantly associated with type and complexity of the traumatic event and type of endodontic intervention, with apexification showing better results than REP (odds ratio, 0.30; 95% confidence interval, 0.11–0.79). ConclusionsA large number of endodontically treated traumatized immature teeth could be kept functional. Very immature teeth, teeth with periodontal tissue damage, and teeth treated with REP were at highest risk for an unfavorable outcome.

C.E. Credit. Management of Severe Intrusive Injury in an Immature Permanent Incisor with Revascularization

C.E. Credit. Management of Severe Intrusive Injury in an Immature Permanent Incisor with Revascularization

Regeneration of immature incisor using platelet rich fibrin: report of a novel clinical application

BackgroundEndodontic treatment of young permanent teeth with necrotic pulp presents a clinical challenge for the dentist, and conventional endodontic treatment will result in tooth fracture along with a poor prognosis. Regenerative endodontics is a new protocol that has been advanced in the last decades for managing immature permanent teeth. Rare successful management of immature permanent incisors using platelet-rich fibrin is a technique-sensitive procedure.Case presentationA 08 years 04 months old female reported the chief complaint of pain in the upper front tooth region for one week. A blunderbuss canal was identified on radiographic examination, and revascularization using platelet-rich fibrin was planned and adopted. After the treatment, apical closure and root lengthening were noted without complications during subsequent follow-ups. Complete periapical healing with greater than 1.5 cm of dentinal thickness was noted.ConclusionRevascularization can be considered a viable treatment option for immature nonvital permanent teeth; with advancements in regenerative medicine and clinical practices, revascularization therapies could be developed as a novel mode of treatment in non-vital and dental traumatic cases.

Passive Re-Eruption of Immature Permanent Incisors: What Is the Prognosis? About a Case Report

Passive Re-Eruption of Immature Permanent Incisors: What Is the Prognosis? About a Case Report

Immature permanent incisors with complicated crown fractures treated with partial pulpotomy using white mineral trioxide aggregate and IRoot BP plus-a retrospective long-term study.

Calcium silicate cements have been widely used for pulpotomies in immature permanent teeth with complicated crown fractures due to their superior properties. However, few studies have evaluated the long-term outcomes of white mineral trioxide aggregate (WMTA) and iRoot BP Plus for partial pulpotomies. The aim of this study was to investigate the long-term clinical and radiographic outcomes of WMTA and iRoot BP Plus for partial pulpotomies in immature permanent incisors with complicated crown fractures. Children who had partial pulpotomies of immature permanent incisors with complicated crown fractures using WMTA or iRoot BP Plus as capping agents were enrolled. Eighty immature permanent incisors in 68 children (aged 8-13 years) were included. They were divided into two groups (WMTA and iRoot BP Plus) according to the capping agents. Clinical and radiographic information was collected during a 5-year follow-up period. Study data were analyzed using Chi-square tests or Fisher exact tests. The clinical and radiographic success rates in the WMTA (n=36) and iRoot BP Plus groups (n=44) were 94.4% versus 97.7% and 88.9% versus 97.7%, respectively (both p < .05). The average observation period was 74.5 ± 13.2months and 61.9 ± 1.6months in the WMTA and iRoot BP Plus groups, respectively (p < .01). Five cases presented with periapical radiolucencies. The WMTA group had four cases of pulp canal calcification (11.1%), while the iRoot BP Plus group had two cases (4.6%). There was crown discolouration in all cases in the WMTA group, but none in the iRoot BP Plus group. Both WMTA and iRoot BP Plus had favorable outcomes in promoting physiological development and maintaining the basic functions of immature permanent incisors with complicated crown fractures. As a partial pulpotomy material, iRoot BP Plus may be more suitable for the esthetic zone than WMTA.

COMPARATIVE EVALUATION OF TIMING AND CLOSURE OF IMMATURE ANTERIOR TEETH WITH OPEN APEX USING TWO DIFFERENT REGENERATIVE MATERIAL: A CASE REPORT-12 MONTHS FOLLOW-UP

Regenerative endodontic Procedures provide an unconventional approach which relies on the principle of tissue engineering. Pulp necrosis of immature permanent teeth may impair root development and apical closure of root canals. Completion of root development takes around 3 years after eruption of permanent teeth. Management of immature non vital teeth is very challenging for a clinician because teeth may have wide open apex and thin root canal walls that may diverge towards the apex. Conventional cleaning and shaping of the canals and obturation may not be possible because of the lack of apical stop. Since debridement of pulp canal space is difficult, there is an increased possibility of root perforation and cervical root fracture, besides the presence of an open immature root apex jeopardize the apical seal of a root canal treatment resulting in subsequent failure. The purpose of this report is to present the case of a patient wherein apexification of an immature permanent maxillary left central incisor tooth was induced by the Biodentine (Calcium trisilicate cement) and Metapex paste (Calcium hydroxide and Iodoform).

Clinical and CBCT Comparison of MTA Revascularization Versus Apexification for Immature Permanent Incisors

Clinical and CBCT Comparison of MTA Revascularization Versus Apexification for Immature Permanent Incisors