Elsevier

Journal of Endodontics

Volume 40, Issue 2, February 2014, Pages 192-198
Journal of Endodontics

Clinical Research
Regenerative Potential of Immature Permanent Teeth with Necrotic Pulps after Different Regenerative Protocols

https://doi.org/10.1016/j.joen.2013.10.027Get rights and content

Abstract

Introduction

Regenerative endodontics is a promising alternative treatment for immature teeth with necrotic pulps. The present study was performed to assess the regenerative potential of young permanent immature teeth with necrotic pulp after the following treatment protocols: (1) a mineral trioxide aggregate (MTA) apical plug, (2) the regenerative endodontic protocol (blood clot scaffold), and (3) the regenerative endodontic protocol with a blood clot and an injectable scaffold impregnated with basic fibroblast growth factor.

Methods

Immature necrotic permanent maxillary central incisors (n = 36) of patients 9–13 years old were divided into 3 groups according to the treatment protocol: the MTA group (MTA apical plug), the REG group (regenerative endodontic protocol [blood clot]), and the FGF group (regenerative endodontic protocol [blood clot + injectable scaffold]). Follow-up was done up to 18 months. Standardized radiographs were digitally evaluated for an increase in root length and thickness, a decrease in the apical diameter, and a change in periapical bone density.

Results

After a follow-up period of 18 months, most of the cases showed radiographic evidence of periapical healing. Groups 2 and 3 showed a progressive increase in root length and width and a decrease in apical diameter.

Conclusions

The regenerative endodontic procedure allowed the continued development of roots in teeth with necrotic pulps. The use of artificial hydrogel scaffold and basic fibroblast growth factor was not essential for repair.

Section snippets

Materials and Methods

Thirty-six patients with immature, nonvital maxillary anterior teeth presenting with or without signs and/or symptoms of periapical pathology were included in this study from the outpatient clinic of the Faculty of Dentistry, Ain Shams University, Cairo, Egypt. A detailed medical and dental history was obtained from each patient's parents or guardians. Only medically free patients were included in this research. The clinical and radiographic exclusion criteria were teeth with vertical

Results

Patients' demographic data are summarized in Table 1. A total of 7 patients were excluded from the study because of inadequate compliance and failure to recall. Three cases were excluded from the MTA group, 2 cases were excluded from the REG group, and 2 cases were excluded from the FGF group. The percentages of recall for the MTA, REG, and FGF groups were 75%, 83%, and 83% respectively. Clinical and radiographic examination during the follow-up period showed signs and symptoms of failure in 3

Discussion

The management of immature necrotic teeth has been considered a great challenge in endodontics. Historically, the treatment of such cases was performed using calcium hydroxide apexification. However, the long-term use of calcium hydroxide has several drawbacks (21), including multiple patient visits, low patient compliance, probability of canal contamination between visits, and increased dentin brittleness, which increase the risk of fracture (21).

The technique of an immediate apical plug has

Conclusions

Under the circumstances of this study, it can be concluded that both treatment protocols (ie, an MTA apical plug and the regenerative endodontic procedure) were successful treatment options with regard to the closure of open apices. Regenerative endodontic procedures induced an increase in root length, thickness, and apical closure. The use of an artificial hydrogel scaffold and bFGF was not essential for repair.

Acknowledgments

The authors thank Professor Yasuhiko Tabata for providing the hydrogel gel scaffold and bFGF used in this study.

The authors deny any conflict of interest related to this study.

References (34)

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