Immature Permanent Teeth Research Articles

Three Dimensional Analysis of Root Development and Bone Formation in an Immature Non Vital Permanent Molar Using Regenerative Endodontic Procedure: A Case Report

The Regenerative Endodontic Procedure (REP) is one of the latest biological procedures for successfully treating immature non vital teeth. Treating non vital immature teeth in children with associated bone resorption poses a challenge. In the present case, a 10- year-old male patient presented with an immature pulpally involved right permanent first molar, exhibiting a periapical radiolucency measuring 2×3.2×10.5 mm (distal root) and 4.4×5.2×10.5 mm (mesial root). The molar was non-surgically treated using a minimally invasive REP approach, aiming for anatomical healing and root completion. Mineral Trioxide Aggregate (MTA) was applied over a blood clot used as a scaffold. The radiolucency decreased significantly to a size of 0.9×1.3×0.2 mm (distal root) and 1×0.4×0.2 mm (mesial root). Continuous root formation was also observed, resulting in complete resolution of the Apical Bone Defect (ABD). The mesial and distal roots progressed from Nolla stage 8 (2/3rd of root formation) to Nolla stage 9 (root formation complete) over a twelve-month period. Three-dimensional (3D) analysis was employed to explain pathosis and the healing of lesions from every aspect. The present case demonstrates that REP may be the treatment of choice for managing non vital immature permanent posterior teeth with severe ABD in a paediatric patients, particularly when the surgical approach is contraindicated due to the presence of other developing structures. Furthermore, long-term follow-up is required, and the type of healing and root completion may vary depending on the stage of root formation, disinfection, and coronal seal achieved.

Evaluation of blood clot and collagen sponge in regeneration of nonvital immature permanent anterior teeth

Introduction Traumatic dental injuries (TDI) of permanent anterior teeth is a common dental problem among the children. Pulpal necrosis is the critical result of traumatic dental injury as it makes a challenge in endodontic and restorative procedures. Revascularization is one of most recent treatment of such teeth. Aim The purpose of this study was to evaluate and compare the regenerative potential of the blood clot and collagen sponge as scaffold in revascularization of nonvital immature permanent anterior teeth using biodentine for coronal bacterial tight seal. Materials and methods This study was conducted on 30 anterior teeth on healthy children aged from 7 to 9 years. The selected patients were divided into two groups according to scaffold used: group I (blood clot scaffold) and group II (combined blood clot and collagen scaffold). Clinical and radiographic outcomes were assessed at 3, 6, 9, 12, 15 and 18 months follow up. Results The results revealed that there was no statistically significant difference between the two groups regarding clinical and radiographic outcomes. Conclusion It was concluded that, the revascularization with blood clot and collagen sponge has no significant differences in clinical and radiographic evaluation criteria.

Complete Pulpotomy and Apexogenesis in Immature Permanent Tooth Diagnosed as Irreversible Pulpitis: A Case Report

Complete Pulpotomy and Apexogenesis in Immature Permanent Tooth Diagnosed as Irreversible Pulpitis: A Case Report

Effects of an Nd:YAP laser used for root canal disinfection in pulp regenerative therapy: a pilot study.

This study aimed to compare the disinfection effects between a triple antibiotic paste and neodymium-doped yttrium aluminum perovskite (Nd:YAP) laser in pulp regenerative therapy and evaluate corresponding therapeutic effects based on apical radiographs and cone-beam computed tomography (CBCT). Sixty-six immature permanent teeth in 66 patients diagnosed with acute or chronic apical periodontitis were analyzed. All teeth were given pulp regenerative therapy. The patients were categorized into a control (triple antibiotic paste) and an experimental (Nd:YAP laser) group. Teeth in the experimental group were disinfected using an Nd:YAP laser, while those in the control group were disinfected using a triple antibiotic paste. Clinical and radiological examinations were performed every 3-6 months after treatment and followed up for 24 months. Statistical analysis was performed after clinical examination and showed that after one week of treatment, symptoms persisted in two teeth in the control group and two teeth in the experimental group. Two weeks later, the clinical symptoms disappeared in all teeth (p > 0.05). After 24 months of follow-up, the clinical symptoms recurred in two teeth in the control group and one tooth in the experimental group. On radiographic examination, 31 and 27 teeth showed continued root development, and three and two teeth showed no obvious root development in the control and experimental groups, respectively. The pulp sensibility test was positive in four teeth in both groups, with no significant difference between the two groups (p > 0.05). The results of this study suggest that endodontic irradiation with an Nd:YAP laser could be an effective alternative to triple antibiotic paste during disinfection of pulp regenerative therapy. Treatment outcomes were assessed using apical radiographs and CBCT, and no negative prognostic effects of the Nd:YAP laser on pulp regenerative therapy were found.

Separate apical root formation of injured immature teeth: a case series and literature review

This report presents three cases of separated root tip formation following traumatic injury with or without inflammation. The first case showed continued separate apical root formation; however, development of the main root with bony ingrowth was absent. The second case showed that separated root formation continued under the 2-year inflammatory conditions, even after apexification. The third patient showed partially connected root tip formation after apexification. By summarizing previously reported similar cases, we assessed the injury type, prevalence age, treatment performed and pattern of root development. This phenomenon may be elucidated by the special features of the apical papilla (AP). Understanding the capability of AP could help with treatments, such as regenerative endodontic procedures and trauma management for immature permanent teeth.

Apexification of the mineral trioxide aggregate in nonvital immature anterior teeth with and without platelet-rich plasma: A preliminary clinical study

ABSTRACT Introduction: Treatment of permanent teeth with weak root dentin, exposed apex, necrotic pulp, periapical disease, and stunted root growth present a significant challenge to the practicing conservative dentistry. Necrotic immature permanent teeth with open apices are arduous to seal by thermo-plasticized or lateral condensation methods. Apexification methods have traditionally used a variety of materials including calcium hydroxide, biodentine, and mineral trioxide aggregate (MTA). Calcium hydroxide apexification takes a long time to develop an apical barrier and contains large pores, resulting in inadequate sealing ability and a bad outcome. MTA is a biomimetic and bio-inductive substance that has been employed to construct a single-step apical barrier in immature open apices with and without periapical pathology. Endodontic in this 21st century uses regenerative procedures in a nonvital, immature tooth with wide-open apices but it is also a very lengthy procedure and poor patient compliance due to slow biologic healing and long-term follow-up of the patients. Platelet-rich plasma (PRP) contains various growth factors such as platelet-derived growth factors and transforming growth factors and has been proposed as a potentially ideal scaffold for accelerated wound healing. Aims and Objectives: To evaluate and compare the clinical and radiographic outcome of MTA apexification with and without PRP in periapical healing kinetics in nonvital, immature teeth. Materials and Methods: An analysis was performed on patient with immature teeth, open-apex, maxillary front nonvital that were randomly divided into two groups of eighteen patients (eighteen roots permanent upper anterior) each: Group I in which MTA apexification was performed without PRP and Group II consisting of 18 roots where MTA apexification were carried out on a collagen sponge supplemented with PRP. Results: The cases were followed up at 6 months and 12 months after treatment, both clinically and radiographically, by two independent assessors. Periapical healing (PAH) was good in 6–18 roots, and in Group I-11 roots showed excellent healing. In Group II-17 roots showed excellent results. Case number 18 and case number 9 were lost to follow-up due to migration to groups I and II, respectively. Apical closure was 100% in Group II and 77% in Group I. Conclusions: Single-step MTA apexification with PRP is a conservative and effective method for inducing PAH and is time-saving in managing nonvital, immature teeth with an open apex.

The Use of Regenerative Endodontic Procedures for the Treatment of Immature Teeth

Regenerative endodontic procedures (REPs) are a biologically based treatment approach for immature permanent teeth that have been diagnosed with pulp necrosis. The primary objective of REPs is to regenerate the pulp-dentin complex, thereby increasing the tooth's lifespan and restoring its normal function. The success of REPs depends on several factors, including patient age, apical opening size, root development stage, and the presence of infection. Biomaterials used in REPs have also been shown to influence clinical outcomes. Several challenges and limitations still need to be addressed to improve the clinical outcomes of REPs, including disinfection of the root canal, selection of biomaterials, and availability of stem cells. Future research should focus on developing novel disinfection strategies, identifying the ideal biomaterials for REPs, and exploring alternative sources of stem cells. With continued research and development, REPs have the potential to become a viable alternative to traditional endodontic procedures for treating immature teeth with open apices.

Effects of different calcium-silicate based materials on fracture resistance of immature permanent teeth with replacement root resorption and osteoclastogenesis.

This study evaluated the effects of Biodentine (BD), Bio-C Repair (BCR), and mineral trioxide aggregate (MTA) plug on the fracture resistance of simulated immature teeth with replacement root resorption (RRR) and in vitro-induced osteoclastogenesis. Sixty bovine incisors simulating immature teeth and RRR were divided into 5 groups: BD and BCR groups, with samples completely filled with the respective materials; MTA group, which utilized a 3-mm apical MTA plug; RRR group, which received no root canal filling; and normal periodontal ligament (PL) group, which had no RRR and no root canal filling. All the teeth underwent cycling loading, and compression strength testing was performed using a universal testing machine. RAW 264.7 macrophages were treated with 1:16 extracts of BD, BCR, and MTA containing receptor activator of nuclear factor-kappa B ligand (RANKL) for 5 days. RANKL-induced osteoclast differentiation was assessed by staining with tartrate-resistant acid phosphatase. The fracture load and osteoclast number were analyzed using 1-way ANOVA and Tukey's test (α = 0.05). No significant difference in fracture resistance was observed among the groups (p > 0.05). All materials similarly inhibited osteoclastogenesis (p > 0.05), except for BCR, which led to a lower percentage of osteoclasts than did MTA (p < 0.0001). The treatment options for non-vital immature teeth with RRR did not strengthen the teeth and promoted a similar resistance to fractures in all cases. BD, MTA, and BCR showed inhibitory effects on osteoclast differentiation, with BCR yielding improved results compared to the other materials.

Microbial identification from traumatized immature permanent teeth with periapical lesions using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry

BackgroundThis study aims at identifying the microbiota in traumatized immature permanent teeth with periapical lesions using Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS).MethodsThe study included 16 immature maxillary central incisors with periapical lesions in 13 patients. Field decontamination and negative control samples were performed before and after access cavity preparation. Root canal samples were taken using sterile stainless-steel hand files following field decontamination. In-office inoculation and pure sub-cultures were performed. Bacterial isolates were prepared for MALDI-TOF MS (Bruker, Billerica, MA USA) analysis using the formic acid extraction method. A comparison of the prevalence of isolated microorganisms was done using a one-sample chi-square test. Comparisons between identified microbial species with the, cone beam computed tomography periapical index (CBCT PAI) scores and lesion volume were also conducted. The Chi-square test was applied to investigate the association between the categorical variables .ResultsOut of the forty isolates recovered from the 16 traumatized teeth included in the present study with the mean patients’ age of 10.93 ± 1.77, 37 isolates were reliably identified by MALDI-TOF MS. Twelve teeth (62.5%) were polymicrobial. The recovered bacteria belonged to five phyla, 15 genera and 25 species. Firmicutes were the predominant phylum (P < 0.001) over Bacteroidetes, Proteobacteria, Actinobacteria and Fusobacteria. Gram positive bacteria were significantly more prevalent than Gram negative (p = 0.03). Facultative anaerobes were the most prevalent (P < 0.001) compared to the obligate anaerobes and the obligate aerobes. The latter were the least prevalent. Statistically, significant differences existed in the comparison between CBCT PAI scores according to bacterial gram staining.ConclusionTraumatized immature permanent teeth with periapical lesions showed a significant predominance of Gram-positive facultative anaerobes. MALDI-TOF MS provided accurate identification of numerous viable endodontic microbes.

Concentration of sodium hypochlorite disinfection in regenerative endodontic procedure: A systematic review

Objectives: To evaluate whether low concentration sodium hypochlorite (NaOCl) disinfectant protocol can achieve a sufficient amount of disinfection to provide a conducive environment for clinical and radiographic success of regenerative endodontic procedure. Materials and methods: This systematic review includes necrotic immature permanent anterior teeth below 20 years of age using triple antibiotic paste as an intra-canal medicament and autologous platelet concentrates as scaffold. The interventional group was low concentration (≤2%) NaOCl and comparator group included high concentration (&gt;2%) NaOCl as disinfectant. Cochrane risk of bias assessment 2 (RoB 2) tool was used for assessment of risk of bias. Included studies were evaluated for the absence of clinical signs and symptoms, increase in root length and apical closure on radiograph, and positive response to vitality testing. Results: After evaluation, seven studies were included. Clinical success rate was seen in 98.33% cases in low concentration (≤2%) and 95% cases in high concentration (&gt;2%) NaOCl. The radiographic success rate was 86.66% in low concentration (≤2%) and 80% in high concentration (&gt;2%) NaOCl disinfection. Positive response for vitality testing was seen in 46.66% cases in low concentration (≤2%) and 38.70% in high concentration NaOCl (&gt;2%). Conclusion: Low concentration (≤2%) NaOCl is as effective as high concentration (&gt;2%) to achieve disinfection of the root canal. However, an increased success rate is associated with the use of low concentration (≤2%) NaOCl. Response to pulp vitality is observed to be superior with low concentration (≤ 2%) NaOCl although it might be attributed to a longer follow-up period.

Advanced Platelet-rich Fibrin-mediated Regeneration of Necrotic Immature Permanent Teeth: A Clinico-radiographic Observational Study.

The objective of the study was to assess the regenerative potential of advanced platelet-rich fibrin (APRF) in the regenerative treatment of necrotic immature permanent teeth (NIPT) in the maxillary incisor region. After institutional review board clearance, 10 children aged between 8 and 14 years with NIPT in the maxillary incisor region undergoing APRF treatment were enrolled in a prospective clinico-radiographic exploratory observational study. Baseline clinical, radiographic, and vitality testing before the start of treatment were noted. Patients were followed up at 3, 6, and 12 months posttreatment. After 3, 6, and 12 months of follow-up, all patients (100%) showed complete resolution of clinical signs and symptoms. All patients (100%) showed periradicular healing, and 9 out of 10 patients (90%) showed a clear hard tissue bridge formation at various levels in the root canal on postoperative radiographs. None of the patients (0%) showed a positive response to vitality testing. APRF is a promising biomaterial in regenerative endodontic treatment (RET). Future randomized trials can be planned to establish superiority or equivalence to conventional PRF. Wakhloo T, Shukla S, Chug A, et al. Advanced Platelet-rich Fibrin-mediated Regeneration of Necrotic Immature Permanent Teeth: A Clinico-radiographic Observational Study. Int J Clin Pediatr Dent 2022;15(4):402-406.

A retrospective study of iRoot BP Plus pulpotomy compared with Vitapex pulpectomy for irreversible pulpitis of primary molars with the presence of coronal pulp tissue.

Pulpotomy has been successfully performed in immature and mature permanent teeth with irreversible pulpitis but rarely in primary teeth. To evaluate the outcomes of iRoot BP Plus pulpotomy and Vitapex pulpectomy in primary molars with irreversible pulpitis. We selected 130 primary molars of 99 patients, aged 3-7 years, diagnosed with irreversible pulpitis with coronal pulp tissue and treated with iRoot BP Plus pulpotomy or Vitapex pulpectomy (median follow-up period: 18 months). They were divided into the pulpotomy (n= 88) and pulpectomy (n= 42) groups according to treatment procedure. The pulpotomy group was further divided into asymptomatic (n= 46) and symptomatic (n= 42) subgroups according to preoperative symptoms. The chi-squared test and Cox regression were performed to analyze the outcomes. Clinical and radiographic success rates were significantly higher in the pulpotomy group (98.9% and 95.5%) than in the pulpectomy group (88.1% and 54.8%) and did not differ significantly between asymptomatic and symptomatic pulpotomy subgroups. Irreversible pulpitis of primary molars with coronal pulp tissue can be successfully treated with iRoot BP Plus pulpotomy. Early intraradicular resorption of materials is the main adverse outcome of Vitapex pulpectomy.

Nanofibrous scaffolds for regenerative endodontics treatment.

Untreated dental caries, tooth trauma and dental anatomical variations such as dens invaginatus can result in pulpitis. However, standard root canal therapy cannot treat immature permanent teeth due to an open apical foramen and thin dentinal walls. Thus, regenerative endodontics treatment (RET) following a disinfection step with pulp regeneration has been developed. Pulp connective-tissue, dentin formation, revascularization and reinnervation can occur in this procedure which should be supplemented with intelligent biomaterials to improve repeatability and support well-coordinated regeneration. Furthermore, nanofibrous scaffolds, as one of the most commonly used materials, show promise. The purpose of this article is to highlight the advantages of nanofibrous scaffolds and discuss the future modification and application of them.

Are platelet concentrate scaffolds superior to traditional blood clot scaffolds in regeneration therapy of necrotic immature permanent teeth? A systematic review and meta-analysis.

The effectiveness of platelet concentrates in promoting root development of necrotic immature permanent teeth is unclear. The present study evaluated whether the platelet concentrate protocol was superior to the traditional blood clot protocol in regeneration therapy. We searched Electronic databases, such as PubMed, Cochrane Library, ClinicalTrials and EMBASE. Randomized controlled trial studies, cohort studies, case-control studies and cross-sectional studies were included, in which platelet-rich concentrates were tested for periapical healing and root development, with the blood clot treatment protocol as the control group. Clinical and radiographic outcomes were considered. Selected articles were assessed for risk of bias. Pooled risk ratios (risk ratio, RR) were calculated for clinical success, responses to cold and electric pulp tests, periapical lesions, apex closure, root lengthening, and thickening of the dentin walls. Subgroup meta-analysis were conducted according to the type of platelet concentrate used. Of the 1272 screenedstudies, 13 randomized controlled studies, 2 case-control studies and 1 cohort study were selected, in which 465 immature necrotic permanent teeth, particularly incisors and premolars, were treated. Of these 465 teeth, 457 (98.2%) in both the control and experimental groups remained clinically asymptomatic for the entire study duration, whereas eight (1.8%) showed signs and symptoms of failure, including spontaneous pain, sensitivity to percussion or reinfection. Compared with control teeth, teeth treated with PRP achieved better apical healing than BC group (RR 1.13, 95% CI 1.01-1.26, P = 0.03), and teeth treated with platelet concentrates showed improved apical closure (RR 1.04, 95% CI 0.86-1.25, P = 0.69), root lengthening (RR 1.01, 95% CI 0.74-1.39, P = 0.93), and thickening of the dentin walls (RR 1.35, 95% CI 0.95-1.93, P = 0.09), although these differences were not statistically significant. Platelet concentrates can be used as successful scaffolds for regenerative endodontic treatment of necrotic immature permanent teeth, and PRP as a scaffold may achieve better periapical healing of teeth with periapical inflammation, although they did not differ significantly from conventional blood clot scaffolds in development of the root.

Neural Regeneration in Regenerative Endodontic Treatment: An Overview and Current Trends

Pulpal and periapical diseases are the most common dental diseases. The traditional treatment is root canal therapy, which achieves satisfactory therapeutic outcomes-especially for mature permanent teeth. Apexification, pulpotomy, and pulp revascularization are common techniques used for immature permanent teeth to accelerate the development of the root. However, there are obstacles to achieving functional pulp regeneration. Recently, two methods have been proposed based on tissue engineering: stem cell transplantation, and cell homing. One of the goals of functional pulp regeneration is to achieve innervation. Nerves play a vital role in dentin formation, nutrition, sensation, and defense in the pulp. Successful neural regeneration faces tough challenges in both animal studies and clinical trials. Investigation of the regeneration and repair of the nerves in the pulp has become a serious undertaking. In this review, we summarize the current understanding of the key stem cells, signaling molecules, and biomaterials that could promote neural regeneration as part of pulp regeneration. We also discuss the challenges in preclinical or clinical neural regeneration applications to guide deep research in the future.

Vital pulp therapy: the past, present and future

Vital pulp therapy (VPT) aims to preserve pulpal sensation. Historically VPT was considered a treatment option for deciduous teeth or young immature permanent teeth. Carious pulp exposure in permanent mature teeth was considered a contraindication for VPT and warranted root canal treatment (RCT). Recently, VPT has been used for management of carious pulp exposures in mature permanent teeth, with good outcomes, even in the presence of clinical signs and symptoms suggestive of irreversible pulpitis. VPT is a simple and conservative alternative to root canal treatment in a few clinical situations. It is imperative that dentists understand its indications and techniques. CPD/Clinical Relevance: The reader should understand the evidence-based changes in approach to VPT and the future direction of this treatment modality.

Modified pulpotomy procedure in immature permanent teeth with apical periodontitis: a randomised controlled trial

ObjectivesThe objective of this study was to evaluate the effectiveness of a modified pulpotomy (MP) procedure in immature permanent teeth with apical periodontitis (AP).DesignRandomised controlled trial.SettingOne public hospital in Shanghai,...

Dental niche cells directly contribute to tooth reconstitution and morphogenesis.

Mammalian teeth develop from the inductive epithelial-mesenchymal interaction, an important mechanism shared by many organs. The cellular basis for such interaction remains elusive. Here, we generate a dual-fluorescence model to track and analyze dental cells from embryonic to postnatal stages, in which Pitx2+ epithelium and Msx1+ mesenchyme are sufficient for tooth reconstitution. Single-cell RNA sequencing and spatial mapping further revealed critical cellular dynamics during molar development, where tooth germs are organized by Msx1+Sdc1+ dental papilla and surrounding dental niche. Surprisingly, niche cells are more efficient in tooth reconstitution and can directly regenerate papilla cells through interaction with dental epithelium. Finally, from the dental niche, we identify a group of previously unappreciated migratory Msx1+ Sox9+ cells as the potential cell origin for dental papilla. Our results indicate that the dental niche cells directly contribute to tooth organogenesis and provide critical insights into the essential cell composition for tooth engineering.

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.

Immature Permanent Teeth with Pulp Damage

Immature Permanent Teeth with Pulp Damage