REVASCULARIZATION IN MATURE PERMANENT TEETH WITH NECROTIC PULP AND APICAL PERIODONTITIS: CASE SERIES | ||||
| Alexandria Dental Journal | ||||
| Article 2, Volume 43, Issue 2, August 2018, Page 7-12 PDF (441.48 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/adjalexu.2018.57617 | ||||
 View on SCiNiTO | ||||
| Authors | ||||
| Rasha A. Abou Samra1; Rania M. El Backly2; Hanaa M. Aly3; Samir R. Nouh4; Sybel M. Moussa5 | ||||
| 1MSc, Conservative Dentistry Department. Faculty of Dentistry, Alexandria University, Alexandria, Egypt. | ||||
| 2Lecturer of Endodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt | ||||
| 3Professor of Oral Biology, Faculty of Dentistry, Alexandria University. Alexandria, Egypt | ||||
| 4Professor of Veterinary Surgery, Faculty of Veterinary Medicine. Alexandria, Egypt | ||||
| 5Professor of Endodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt. | ||||
| Abstract | ||||
| INTRODUCTION: Revascularization procedures have been limited to immature teeth but application to mature teeth should be clinically investigated as an alternative to conventional root canal treatment. The translation of regenerative endodontic procedures into treating mature teeth is challenging and depends on efficient root canal disinfection, proper size of the apical foramen, the availability and delivery of stem cells into the root canal system. OBJECTIVES: Evaluation of revascularization in mature teeth after enlargement of the apical foramen to size 35 K-file. MATERIALS AND METHODS: Three necrotic incisors with mature roots and apical periodontitis in three patients ranging from 20–30 years old were treated by revascularization procedures. Access opening was performed. The canal was mechanically instrumented to the radiographic apex. The apical foramen was enlarged with a size 35 K-file. Triple antibiotic paste (0.1 mg/ml) was applied in the canal using a syringe. After three weeks, the medication was removed with 20 ml of 1.5% sodium hypochlorite followed by final irrigation with 20 ml of 17% EDTA. Bleeding was induced in the root canal and mineral trioxide aggregate (MTA) was placed approximately 3-4 mm below the CEJ. The tooth was restored with a layer of glass ionomer followed by composite resin. The patient was scheduled for follow up and evaluation of healing after 3 months, 6 months and 9 months. Resolution of apical periodontitis and regression of clinical signs and symptoms were observed during the follow up periods. RESULTS: After a follow-up period of 9 months, the three teeth demonstrated radiographic evidence of periapical healing with absence of clinical signs and symptoms. CONCLUSIONS: The present cases demonstrated a favorable outcome of the revascularization procedure in mature necrotic incisors with chronic apical periodontitis | ||||
| Keywords | ||||
| Mature teeth; necrotic pulp; apical periodontitis; Periapical healing; pulp tissue regeneration | ||||
| References | ||||
|
1.Murray PE, Garcia-Godoy F, Hargreaves KM. Regenerative endodontics: A review of current status and a call for action. J Endod. 2007; 33: 377-90.
2. Shah N. and Logani A. SealBio: A novel, non-obturation endodontic treatment based on concept of regeneration. J Conserv Dent. 2012; 15: 328-32.
3. Saoud TM, Ricucci D, Lin LM, Gaengler P. Regeneration and Repair in Endodontics—A Special Issue of the Regenerative Endodontics—A New Era in Clinical Endodontics. Dent. J. 2016; 4: 1-15.
4.Trope M. Regenerative Potential of Dental Pulp. J Endod. 2008; 34: 13-17.
5. Gupta P, Sneha S, Shetty H. Regenerative Endodontics: An Evidence Based Review. J Cont Med A Dent. 2015; 3: 12- 19.
6. Ahmed HM, Abbott PV. Discoloration potential of endodontic procedures and materials: a review. Int Endod J. 2012; 45: 883-97.
7. Paryani K, Kim SG. Regenerative endodontic treatment of permanent teeth after completion of root development: A Report of 2 Cases. J Endod. 2013; 39: 929–34.
8. Diogenes A, Henry MA, Teixeira FB, Hargreaves KM. An update on clinical regenerative endodontics. Endod Topics. 2013; 28: 2-23.
9.Liao J, Al Shahrani M, Al-Habib M, Tanaka T, Huang GT. Cells isolated from inflamed periapical tissue express mesenchymal stem cell markers and are highly osteogenic. J Endod. 2011; 37:1217-24.
10.Chrepa V, Henry MA, Daniel J, and Diogenes A. Delivery of Apical Mesenchymal Stem Cells into Root Canals of Mature Teeth. J. Dent. Res. 2015; 94: 1-7.
11.Galler KM, Buchalla KA, Federlin M, Eidt A, Schiefersteiner M, Schmalz G. Influence of root canal disinfections on growth factor release from dentin. J Endod. 2015; 41: 363–68.
12.Laureys WG, Cuvelier CA, Dermaut LR, De Pauw GA. The critical apical diameter to obtain regeneration of the pulp tissue after tooth transplantation, replantation, or regenerative endodontic treatment. J Endod. 2013; 39: 759-63.
13.Yang J, Yuan G, Chen Z. Pulp Regeneration: Current Approaches and Future Challenges. Front Physiol. 2016; 7: 1-8.
14.Vemuri S, Rkotha S, Raghunath RG, Kandregula C.R. Root canal revascularization via blood clotting in regenerative endodontics: Essentials and expectations. J Dr NTR Univ Health Sci. 2013; 2: 235-38.
15.Borlina SC, de Souza V, Holland R, Murata SS, GomesFilho JE, Dezan Junior E, et al. Influence of apical foramen widening and sealer on the healing of chronic periapical lesions induced in dogs’ teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109: 932-40
16.Iwaya SI, Ikawa M, Kubota M. Revascularization of an immature permanent tooth with apical periodontitis and sinus tract. Dent Traumatol. 2001; 17:185-7.
17.Banchs F, Trope M. Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol? J Endod. 2004; 30:196-200.
18.Lin LM, Shimizu E, Gibbs JL. Histologic and histobacteriologic observations of failed revascularization/revitalization therapy: a case report. J Endod. 2014; 40: 291-295.
19.Fouad AF. Microbial factors and antimicrobial strategies in dental pulp regeneration. J Endod. 2017; 43:46–50.
20.Galler KM, Souza RN, Federlin M, Cavender AC, Hartgerink J.D., Hecker S. Dentin Conditioning Codetermines Cell Fate in Regenerative Endodontics. J Endod. 2011; 37:1536-41.
21.Park HB, Na Lee B, Hwang YC, Hwang IM, Oh WM, Chang HS. Treatment of non-vital immature teeth with amoxicillin-containing triple antibiotic paste resulting in apexification. Restor Dent Endod. 2015; 40:322-27.
22.Ruparel NB, Teixeira FB, Ferraz CC, Diogenes A. Direct Effect of Intracanal Medicaments on Survival of Stem Cells of the Apical Papilla. J Endod. 2012; 38:1-4.
23.Sabrah AH, Yassen GH, Wai CL, Goebel WS, Gregory RL, Platt JF. The effect of diluted triple and double antibiotic pastes on dental pulp stem cells and established Enterococcus faecalis biofilm. Clin Oral Invest. 2015; 19:2059–66.
24.Althumairy RI, Teixeira FB, Diogenes A. Effect of Dentin Conditioning with Intracanal Medicaments on Survival of Stem Cells of Apical Papilla. J Endod. 2014; 40: 521–25.
25.Reyhani MF, Rahimi S, Fathi Z, Shakouie S, Milani AS, Barhaghi MH, Shokri J. Evaluation of Antimicrobial Effects of Different Concentrations of Triple Antibiotic Paste on Mature Biofilm of Enterococcus faecalis. JODDD. 2015; 9: 138-143.
26.AAE Clinical Considerations for a Regenerative Procedure. Revised 6-8-2016. (Internet). Available at: http://www.aae.org/. Accessed on 10-10-2017.
27.Kim JH, Kim Y, Shin SJ, Park JW. Tooth Discoloration of Immature Permanent Incisor Associated with Triple Antibiotic Therapy: A Case Report. J Endod. 2010; 36:1086-91.
28.Fang Y, Wang X, Zhu J, Su C, Yang Y, Meng L. Influence of apical diameter on the outcome of regenerative endodontic treatment in teeth with pulp necrosis: a review. J Endod 2017; 1–18.
29.Cruz EV, Kota K, Huque J, Iwaku M, Hoshino E. Penetration of propylene glycol into dentine. Int Endod J. 2002; 35: 330-6.
30.Petrino JA, Boda K, Shambarger S. Challenges in Regenerative Endodontics: A Case Series. J Endod. 2010; 36:536- 41.
31.Ding RY, Cheung GS, Chen J, Yin YZ, and Wang Q. Pulp Revascularization of immature teeth with apical periodontitis: A Clinical Study. J Endod. 2009; 35:745-9.
32.Banchs F, Trope M. Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol? J Endod. 2004; 30:196-200.
33.Torabinejad M, Parirokh M. Mineral trioxide aggregate: a comprehensive literature review—part II: leakage and biocompatibility investigations. J Endod 2010; 36: 190- 202.
34.Wang X, Thibodeau B, Trope M, Lin L, Huang G. Histologic characterization of regenerated tissue in canal space after the revitalization/revascularization procedure of immature dog teeth with apical periodontitis. J Endod. 2010; 36:56-63.
35.Seo BM, Miura M, Gronthos S, Bartold PM, Batouli S, Brahim J et al. Investigation of multipotent postnatal stem cells from human periodontal ligament. The Lancet. 2004; 364: 149–155.
36.Song M, Cao Y, Shin SJ, Shon WJ, Chugal N, Kim RH et al. Revascularization-associated intracanal calcification: Assessment of prevalence and contributing factors. J Endod .2017;43:2025–33 | ||||
|
Statistics Article View: 2,302 PDF Download: 3,330 |
||||
