Modified revascularization technique in permanent molars. A case series
DOI:
https://doi.org/10.33448/rsd-v10i5.14532Keywords:
Adolescent; Regeneration; Molar tooth; Dental pulp.Abstract
There are few reports of regenerative endodontic procedures in molars, and most using manual root canal preparation. This case series describes a modified revascularization technique used in permanent molars (five patients between 9 and 16 years old). Patients were referred by an emergency service and a diagnostic hypothesis was made based on the patient's reports. At the first appointment, coronal preparation was performed using Hedstroem files and Gates Glidden drills, followed by complete root canal preparation with rotary NiTi files. Calcium hydroxide (Ca(OH)2) paste was used as intracanal medication. At the second appointment, intracanal medication was removed, followed by final irrigation with EDTA under ultrasonic agitation, and the clot was promoted. The entrances of the canals were sealed using a mineral trioxide aggregate sealer (MTA) and provisionally restored with a light-cured glass ionomer. All teeth were finally restored using direct composite resin restoration and were followed for up to 18 months, checking pain, edema, and fistula during clinical evaluation. Radiographic examinations were performed to assess apical repair until 15 months, where root apex closure and canal reduction were observed. After 6 months, evidence of healing was observed in all cases. It was possible to confirm that endodontic regeneration after mechanized root canal preparation, use of a MTA sealer, and direct composite resin restoration in molars is a promising option for maintaining permanent molars in adolescents.
References
Ajram, J., Khalil, I., Gergi, R & Zogheib, C. (2019) Management of an Immature Necrotic Permanent Molar with Apical Periodontitis Treated by Regenerative Endodontic Protocol Using Calcium Hydroxide and MM-MTA: A Case Report with Two Years Follow Up. Dent J (Basel), 7:1.
Althumairy, R. I., Teixeira, F. B. & Diogenes, A. (2014) Effect of dentin conditioning with intracanal medicaments on survival of stem cells of apical papilla. J. Endod, 40: 521–5.
American Association of Endodontists. (2020) Considerations for Regenerative Procedures. Available at: https://www.aae.org/specialty/publications-research/research/regenerative-database/ Accessed October 14, 2020.
Antunes, L. S., Salles, A. G., Gomes, C.C., Andrade, T. B., Delmindo, M. P. & Antunes, L. A. A. (2015). The effectiveness of pulp revascularization in root formation of necrotic immature permanent teeth: A systematic review. Acta Odontologica Scandinavica,74:161-9.
Berkhoff, J. A., Chen, P. B., Teixeira, F. B. & Diogenes, A. (2014). Evaluation of triple antibiotic paste removal by different irrigation procedures. J Endod, 40:1172-7.
Dhaimy, S., Dhoum, S., Amarir, H., El Merini, H., Nadifi, S. & Ouazzani, A. E. (2017). Pulpo-Periodontal Regeneration: Management of Partial Failure Revascularization. Case Rep Dent, 2017:8302039.
Diogenes, A., Ruparel, N.B., Shiloah, Y. & Hargreaves, K. M. (2016). Regenerative endodontics: A way forward. J Am Dent Assoc, 147:372-80.
Diogenes, A. & Ruparel, N. B. (2017). Regenerative Endodontic Procedures: Clinical Outcomes. Dent Clin North Am, 61:111-5. 1.
Duggal, M., Tong, H. J., Al-Ansary, M., Twati, W., Day, P. F. & Nazzal, H. (2017) Interventions for the endodontic management of non-vital traumatised immature permanent anterior teeth in children and adolescents: a systematic review of the evidence and guidelines of the European Academy of Paediatric Dentistry. Eur Arch Paediatr Dent, 18:139-151.
Galler, K. M. (2016). Clinical procedures for revitalization: current knowledge and considerations. Int Endod J. Oct;49(10):926-36.
Galler, K. M., D’Souza, R. N., Federlin, M., Cavender, A. C., Hartgerink, J. D., Hecker, S. & Schmalz, G. (2011). Dentin conditioning codetermines cell fate in regenerative endodontics. J Endod, 37:1536–41.
Huang, G. T., Yamaza, T., Shea, L. D., Djouad, F., Kuhn, N. Z., Tuan, R. S. & Shi, S. (2010). Stem/progenitor cell-mediated de novo regeneration of dental pulp with newly deposited continuous layer of dentin in an in vivo model. Tissue Eng, 6:605-15.
Kontakiotis, E. G., Filippatos, C. G., Tzanetakis, G. N. & Agrafioti, A. (2015). Regenerative endodontic therapy: a data analysis of clinical protocols. J Endod, 41:146-54.
Law, A. S. Considerations for regeneration procedures. (2013). J Endod, 39:44–56.
Lin, L. M., Shimizu, E., Gibbs, J. L., Loghin, S. & Ricucci, D. (2014). Histologic and histobacteriologic observations of failed revascularization/revitalization therapy: A case report. J Endod, 40:291-25.
Martin, D. E., De Almeida, J. F., Henry, M. A., Khaing, Z. Z., Schmidt, C. E., Teixeira, F. B. & Diogenes, A. (2014). Concentration-dependent effect of sodium hypochlorite on stem cells of apical papilla survival and differentiation. J Endod, 40:51-5.
Martin, G., Ricucci, D., Gibbs, J. L. & Lin, L. M. (2013). Histological findings of revascularized/revitalized immature permanent molar with apical periodontitis using platelet-rich plasma. J Endod, 39:138-44.
Orstavik, D., Kerekes, K. & Eriksen, H. M. (1986). The periapical index: a scoring system for radiographic assessment of apical periodontitis. Endodontics & Dental Traumatology, 2:20-3.
Paryani, K. & Kim, S. G. (2013). Regenerative endodontic treatment of permanent teeth after completion of root development: a report of 2 cases. J Endod, 39:929-34.
Rodrigues, M. P., Soares, P. B. F., Gomes, M. A. B., Pereira, R. A., Tantbirojn D., Versluis A. & Soares C. J. (2020). Direct resin composite restoration of endodontically-treated permanente molars in adolescents: bite force and patient-specific finite element analysis. J Applied Oral Scienc.
Ruparel, N. B., Teixeira, F. B., Ferraz, C.C. & Diogenes, A. (2012). Direct effect of intracanal medicaments on survival of stem cells of the apical papilla. J Endod, 38:1372-5.
Saoud, T. M., Martin,G., Chen, Y. H., Chen, K. L., Chen, C. A., Songtrakul, K., Malek, M., Sigurdsson, A. & Lin L. M. (2016). Treatment of Mature Permanent Teeth with Necrotic Pulps and Apical Periodontitis Using Regenerative Endodontic Procedures: A Case Series. J Endod, 42:57-65.
Saoud, T. M., Zaazou, A., Nabil, A., Moussa, S., Lin, L. M. & Gibbs, J. L. (2014). Clinical and radiographic outcomes of traumatized immature permanent necrotic teeth after revascularization/revitalization therapy. J Endod, 40:1946-52.
Song, M., Cao, Y., Shin, S. J., Shon, W. J., Chugal, N., Kim, R. H., Kim, E. & Kang, M. K. (2017). Revascularization-associated Intracanal Calcification: Assessment of Prevalence and Contributing Factors. J Endod, 43:2025-33.
Sonoyama, W., Liu, Y., Fang, D., Yamaza, T., Seo, B. M., Zhang, C., Liu, H., Gronthos, S., Wang, C. Y., Wang, S. & Shi, S. (2006). Mesenchymal stem cell-mediated functional tooth regeneration in swine. PLoS One, 20;1:e79.
Topçuoğlu, G. & Topçuoğlu, H. S. (2016). Regenerative Endodontic Therapy in a Single Visit Using Platelet-rich Plasma and Biodentine in Necrotic and Asymptomatic Immature Molar Teeth: A Report of 3 Cases. J Endod, 42:1344-6.
Torabinejad, M. & Turman, M. (2011). Revitalization of tooth with necrotic pulp and open apex by using platelet-rich plasma: a case report. J Endod, 37:265–8.
Trevino, E. G., Patwardhan, A. N., Henry, M. A., Perry, G., Dybdal-Hargreaves, N., Hargreaves, K. M. & Diogenes, A. (2011). Effect of irrigants on the survival of human stem cells of the apical papilla in a platelet-rich plasma scaffold in human root tips. J Endod, 37:1109-15.
Zhujiang, A. & Kim, S. G. (2016). Regenerative Endodontic Treatment of an Immature Necrotic Molar with Arrested Root Development by Using Recombinant Human Platelet-derived Growth Factor: A Case Report. J Endod, 42:72-5.
Wigler, R., Kaufman, A. Y., Lin, S., Steinbock, N., Hazan-Molina, H. & Torneck, C. D. (2013). Revascularization: a treatment for permanent teeth with necrotic pulp and incomplete root development. J Endod, 39:319-26.
Yang, S. F., Rivera, E. M., Baumgardner, K. R., Walton, R. E. & Stanford, C. (1995). Anaerobic tissue-dissolving abilities of calcium hydroxide and sodium hypochlorite. J Endod, 21:613–6.
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Copyright (c) 2021 Lilian Vieira Oliveira; Anahi de Paula Melo; Priscilla Barbosa Ferreira Soares; Juliane Maria Guerreiro Tanomaru; Carlos José Soares; Camilla Christian Gomes Moura
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