Revascularization Of Immature Permanent Teeth Research Articles

Revascularization of immature permanent teeth with peri-apical lesions- A case series

When immature permanent teeth become non-vital, the prognosis of the teeth is compromised. Disinfection and obturation of root canals with open apices can be challenging. Revascularization is a useful tool for the treatment of permanent teeth with necrosed pulp and open apex. Clinically, Revascularization procedures consist of disinfection by intra-canal medicaments followed by inducing blood clot in the root canal or implantation of autologous fibrin matrices like PRP/PRF. Such procedures may improve prognosis of necrosed teeth with open apices. Existing studies indicate that regenerative procedures lead to increase in length and wall thickness of radicular dentin. This article presents a case series of three cases where revascularization procedures were successfully carried out.

Revascularization of an Immature Permanent Tooth with Periapical Periodontitis Using Concentrated Growth Factor Assisted by Erbium Laser (2940 nm) Irrigation: A Case Report

Revascularization has been incorporated into endodontic practice and become a viable treatment alternative for immature teeth with pulp necrosis. Thorough disinfection of the root canal is a key factor for successful revascularization. An erbium: yttrium–aluminium–garnet (Er: YAG) laser has been proved advantageous for efficient root canal disinfection. This article reports one case of periapical periodontitis caused by a fractured occlusal tubercle. Revascularization assisted by Er: YAG laser irrigation was carried out with long-term follow up. During the process of treatment, we opened drainage to relieve the acute symptoms first. The necrotic pulp was removed, and then the root canal was rinsed with 0.5% sodium hypochlorite (NaOCl) solution assisted by Er: YAG laser irrigation, dried, and filled with a triple-antibiotic paste. After two weeks, the intracanal medication was removed, and 9 mL of whole vein blood was taken from the patient to prepare concentrated growth factor (CGF) after failing to induce enough blood into the canal system by over-instrumenting. The newly prepared CGF was transferred into the root canal. A 3 mm mineral trioxide aggregate (MTA) was placed directly on the thrombus of the CGF and then restored with glass-ionomer cement (GIC). The case was followed up for more than four years to record the clinical symptoms and imaging manifestations. Er: YAG irrigation is an efficient root canal disinfection protocol with the advantages of easy operation and minimal risk, which might be applicable to the revascularization of necrotic immature permanent teeth.

Revascularization of immature permanent teeth via blood clot or PRF Platelet rich fibrin: A review

Regenerative endodontic procedure in an immature nonvital tooth is a biological treatment approach. Case reports have shown clinical and radiographic success following regenerative procedures and successful continued root development as well as strengthening of the root structure. Even though the primary goal of this treatment is to regenerate functional pulp tissue, a different outcome has been shown in histological analysis. This review discusses the conventional and Platelet rich fibrin (PRF) revascularization and also histological analysis of regenerated tissue in the root canal in animal and human studies.

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.

Radiographic and histopathologic outcomes of immature dog teeth with apical periodontitis after revascularization using propolis. An in vivo study

Introduction: This study aimed to assess the radiographic and histopathologic outcomes of immature dog teeth with apical periodontitis after revascularization using propolis. Materials and Methods: Periapical pathosis was induced in 48 double-rooted premolars in six dogs aged 6–9 months. The root canals were irrigated with 10 mL of 2.25% NaOCl per tooth. The teeth were divided into two groups (24 teeth each) according to the disinfection of root canals as follows: Group I (propolis group): disinfected with propolis paste and Group II (control group): without disinfectant. After 3 weeks, bleeding was induced to fill the canal spaces, the pulp chamber of the teeth was plugged with mineral trioxide aggregate, and the access cavities were sealed with glass ionomer cement. Samples were classified into three subgroups depending on the evaluation period as follows: subgroup i: 2 weeks, subgroup ii: 4 weeks, and subgroup iii: 8 weeks. Increase in the root length and root thickness and decease of apical diameter were assessed by radiography, and new hard tissue, vital tissue, and apical closure scores were assessed by histology. All data were statistically analyzed. Results: There were statistically significant differences between both groups regarding the increase in root length, increase in root thickness, decrease in apical diameter, new hard tissue, and vital tissue in all subgroups (P ≤ 0.05). There was a statistically significant difference between both groups regarding the apical closure at 8 weeks only (P Conclusion: Propolis is capable of inducing hard-tissue deposition and soft-tissue formation inside the necrotic pulp after revascularization of immature permanent teeth.

Regenerative Endodontics: A Paradigm Shift in Clinical Endodontics.

ABSTRACTPreserving the natural dentition in its normal form and function is one of the major goals of endodontic treatment. Re-establishing the lost vitality and development of root maturation in immature permanent teeth with pulp necrosis/apical periodontitis is quiet challenging clinically. The very basis of regenerative endodontics relies on the concept of tissue engineering using stem cells, biomimetic scaffold, and bioactive growth factors to regenerate the pulp tissue damaged by microbial infection, injury, or developmental defects. In clinical endodontics, this approach is referred to as a “paradigm shift.” Even though repair instead of true regeneration is achieved with current protocols, it is hoped that further research in the area of stem-cell-based tissue engineering will allow for true regeneration and improved treatment outcomes. The aim of this review is to discuss about the various aspects of regenerative endodontics, current clinical protocols, and the future of pulp regeneration techniques.

Histological evaluation of platelet-rich fibrin for revascularization of immature permanent teeth in dogs

AimThe aim of this study was to evaluate the platelet rich fibrin as a scaffold for revascularization of immature root canals in dogs. Study designSixteen double rooted teeth divided into two main groups A and B (contaminated and non-contaminated). Each group included two sub groups, one experimental (platelet rich fibrin subgroup) and the other is control (calcium hydroxide subgroup). After six months, dogs were sacrificed and histological evaluation of prepared sections was done for apical closure, internal root thickness and new vital pulp tissue formation. ResultsIn contaminated root canals regarding all parameters used (apical closure, internal root thickness and new vital pulp tissue formation), PRF subgroup showed higher values than control subgroup with significant difference only in hard tissue formation in internal root surface. Non-contaminated PRF treated root canals showed better results than control subgroup and significant difference was in new intra canal vital pulp tissue formation only. No significant difference was clear between the two main groups. ConclusionPlatelet rich fibrin is a good intra-canal scaffold for revascularization of immature permanent teeth.

Is revascularization of immature permanent teeth an effective and reproducible technique?

Revascularization has been proposed as an improved alternative treatment for irreversibly damaged pulp of immature teeth as it has been shown to preserve the potential for continued root growth in treated teeth. To review clinical cases of revascularization in humans to evaluate their utility and reproducibility. A structured electronic search of scientific articles published between 2001 and 2014 was carried out using the following keywords: 'pulp revascularization', 'pulp revitalization' and/or 'immature tooth'. Clinical revascularization cases conducted on human subjects were selected, reviewed and organized into two charts including patient information, diagnostic information, treatment and results in follow-up visits. Ninety-seven of 101 teeth (96.0%) were successfully treated with the revascularization technique. The range of technique variations available for irrigation, disinfection and blood clot induction have a negligible impact on the clinical outcome variables tested in our analysis. During the follow-up visits, apical closure was detected in fewer cases (55.4%) as compared to the other apexogenesis phenomena (increased root length, 76.2%; increased root width, 79.2%). The review shows that the revascularization technique showed marked increase in the root length, width and apical closure in the cases that were reported independently of clinical variables such as operator and material selection and individual differences in protocols.

Pulp revascularization of immature permanent teeth: a review of the literature and a proposal of a new clinical protocol.

Tissue engineering is a growing field. In the near future, it will probably be possible to generate a complete vital tooth from a single stem cell. Pulp revascularization is dependent on the ability of residual pulp and apical and periodontal stem cells to differentiate. These cells have the ability to generate a highly vascularized and a conjunctive rich living tissue. This one is able to colonize the available pulp space. Revascularization is a new treatment method for immature necrotic permanent teeth. Up to now, apexification procedures were applied for these teeth, using calcium dihydroxide or MTA to produce an artificial apical barrier. However, the pulp revascularization allows the stimulation of the apical development and the root maturation of immature teeth. Two pulp revascularization techniques are used in the literature, one using calcium dihydroxide and the second using a triple antibiotic paste. Based on these two different pulp revascularization protocols, which obtain the desired therapeutic success, the literature will be reviewed and analyzed according to the relevance of their choice of materials. Based on the literature, we propose a new relevant protocol and a new mixture of antibiotics.

Revascularization of immature permanent teeth with apical periodontitis

The aim of this minireview was to identify and review the scientific evidence regarding regenerative endodontic protocols claiming to revascularize permanent immature teeth with apical periodontitis. The literature was identified using the PubMed/MEDLINE, Scopus, Scirus, EMBASE and Cochrane databases up to February 2013. Studies were selected independently by two different researchers (kappa index: 0.88), based on established inclusion/exclusion criteria. The methodological quality of the reviewed papers was classified as high, medium or low (HQ, MQ, LQ). The search strategy identified 285 titles. Nine studies, both human and animal based, were selected after application of the criteria (LQ:5; MQ:4). In most of these studies (seven of nine), the revascularization protocol included a triple antibiotic combination as canal disinfectant for a period of 1-4 weeks after blood clot formation (LQ:5; MQ:4), although there is no clear consensus about the treatment protocol. Two studies reported tooth discoloration after the revascularization process (LQ:2), and only three (LQ:1; MQ:2) reported a success rate of 54.9% in dogs and 73.6% and 80% in humans, respectively. Revascularization of immature permanent teeth with apical periodontitis is possible and preferable to apexification. Nevertheless, there is a widespread lack of randomized clinical trials and blinded measures. In addition, the small sample sizes that are common in these studies as well as the generally low quality of the analysed publications require the results to be viewed with caution. There is a high risk of bias, with a low quality of available information, for developing clinical guidelines for regenerative endodontic protocols; rigorous randomized clinical trials are therefore needed.

Revascularization of an immature tooth with a necrotic pulp using platelet‐rich fibrin: a case report

To discuss the clinical and radiological outcome of a revascularization procedure in an immature tooth with a necrotic pulp using platelet-rich fibrin (PRF), a second-generation platelet concentrate. A 7-year-old male reported with pain in the maxillary anterior region as a result of the injury to his immature right maxillary central incisor tooth. After preparation of the access cavity, the necrotic pulp was removed and the canal irrigated using 5.25% sodium hypochlorite solution. The canal was then dried and packed with triantibiotic paste for 3weeks. After removal of the antibiotic paste, a 5mL sample of whole venous blood was drawn from the patient's forearm to prepare PRF. The freshly prepared PRF was condensed in the canal until the cementoenamel junction. Three millimetres of white MTA was placed directly over the PRF clot. Three days later, the tooth was restored using a permanent restoration. At 7-, 12- and 15-month recall, the tooth was asymptomatic with no sensitivity to percussion or palpation. At 12- and 15-month follow-up, the tooth responded positively to cold and an electric pulp test, and similarly to adjacent lateral incisor and canine teeth. Radiographic examination demonstrated continued thickening of root canal walls, root lengthening and apical closure. Platelet-rich fibrin might serve as a potentially ideal scaffold in revascularization of immature permanent teeth with necrotic pulps as it is rich in growth factors, enhances cellular proliferation and differentiation, and acts as a matrix for tissue ingrowth.

Regenerative potential following revascularization of immature permanent teeth with necrotic pulps

To assess the regenerative potential of immature teeth with necrotic pulps following revascularization procedure in dogs. Necrotic pulps and periapical pathosis were created by infecting 108 immature teeth, with 216 root canals in nine mongrel dogs. Teeth were divided into three equal groups according to the evaluation period. Each group was further subdivided into six subgroups according to the treatment protocol including MTA apical plug, revascularization protocol, revascularization enhanced with injectable scaffold, MTA over empty canal. All root canals were disinfected with a triple antibiotic paste prior to revascularization with the exception of control subgroups. After disinfection, the root length, thickness and apical diameter were measured from radiographs. Histological evaluation was used to assess the inflammatory reaction, soft and hard tissue formation. In the absence of revascularization, the length and thickness of the root canals did not change over time. The injectable scaffold and growth factor was no more effective than a revascularization procedure to promote tooth development following root canal revascularization. The tissues formed in the root canals resembled periodontal tissues. The revascularization procedure allowed the continued development of roots in teeth with necrotic pulps.

Revascularization for a necrotic immature permanent lateral incisor: a case report and literature review

Revascularization is a valuable treatment in immature necrotic teeth that allows the continuation of root development. This article describes the successful revascularization treatment of an immature maxillary lateral incisor that was initially diagnosed with apical periodontitis. The tooth was asymptomatic and functional clinically and radiographically during the follow-up period of 5 years. The follow-up showed evidence of progressive thickening of the dentinal walls, development of root length and apical closure. The article also discusses the currently available literature regarding revascularization of immature permanent teeth.

Effect of sodium hypochlorite on human pulp cells: an in vitro study

The purpose of this study was to determine the effect of sodium hypochlorite (NaOCl) on human pulp cells to provide an aid in determining its optimum concentration in maintaining the viability of remaining pulp cells in the revascularization of immature permanent teeth with apical periodontitis. Human pulp tissue cells taken from extracted third molars were plated, incubated, and subjected to various concentrations of NaOCl (0.33%, 0.16%, 0.08%, and 0.04%) for 5-, 10-, and 15-minute time intervals to simulate possible contact times in vivo. The Cell Titer-Glo Luminescent Cell Viability Assay was used to determine the number of viable cells present in culture following treatment. The results showed an increase in cell viability with the lowering of NaOCl concentration. The use of 0.04% NaOCl was similar to the control, indicating nearly complete preservation of cell viability at all time intervals tested. As sodium hypochlorite concentration increased from 0.04% to 0.33%, cell viability decreased correspondingly. The results indicate that the lowest concentration of NaOCl tested did not affect the viability of cells. This may prove beneficial in developing a new treatment protocol to help preserve existing vital pulp cells in revascularization cases.