Regenerative therapy in young permanent tooth: Case report
DOI:
https://doi.org/10.33448/rsd-v12i1.39771Keywords:
Necrosis of the dental pulp; Regenerative endodontics; Permanent dentition.Abstract
Pulp necrosis in immature permanent teeth represents a challenge for clinical management. The dentin wall in immature teeth is thin and the root is short, leading to an unfavorable long-term prognosis due to the risk of root fracture. Regenerative endodontic procedures have been shown to be effective and improve the prognosis of the compromised immature tooth by re-establishing functional pulp tissue that promotes continued root development and immune competence. The objective of the study was to report a case of a young permanent molar, diagnosed with necrosis and incomplete rhizogenesis. A female patient, 08 years old, attended the clinic of the specialization course in Endodontics, Faculty of Dentistry São Leopoldo Mandic, Belo Horizonte Unit. Regenerative therapy was proposed, which involved the following steps: anesthesia, opening, odontometry, minimal instrumentation, disinfection with 2% chlorhexidine gel, irrigation with saline solution, intracanal medication with calcium hydroxide paste, induction of bleeding to form a blood clot, cervical sealing with mineral trioxide aggregate and composite resin. The patient remained symptom-free up to 5 months after treatment. However, radiographically, an increase in the periapical radiolucent area was noted, so it was decided to carry out the conventional endodontic treatment. Regenerative therapy can be an alternative to apexification in immature teeth in cases of irreversible pulpitis and pulp necrosis associated or not with a periapicalesionson. It is a simple treatment with advantageous results as it promotes an increase in the length and thickness of the dentin wall and apical closure as seen in the case described in this work.
References
Alipour M., Aghazadeh Z., Hassanpour M., Ghorbani M., Salehi R. & Aghazadeh M. (2022) MTA-Enriched Polymeric Scaffolds Enhanced the Expression of Angiogenic Markers in Human Dental Pulp Stem Cells. Stem Cells Int. 21:7583489.
Araújo P.R.S, Silva L.B., Neto A.P.D.S., Almeida de Arruda J.A., Álvares P.R., Sobral A.P.V., Júnior S.A., Leão J.C., Braz da Silva R., Sampaio G.C. (2017). Pulp Revascularization: A Literature Review. Open Dent .31;10:48-56.
Arshad S., Tehreem F., Rehab Khan M., Ahmed F., Marya A. & Karobari M.I. (2021). Platelet-Rich Fibrin Used in Regenerative Endodontics and Dentistry: Current Uses, Limitations, and Future Recommendations for Application. Int J Dent. 15;2021:4514598.
Bakhtiar H., Ashoori A., Rajabi S., Pezeshki-Modaress M., Ayati A., Mousavi M.R., Ellini M.R., Kamali A., Azarpazhooh A. & Kishen A. (2021). Human amniotic membrane extracellular matrix scaffold for dental pulp regeneration in vitro and in vivo. Int Endod J. 55(4):374-390.
Banchs F. & Trope M. (2004). Revascularization of immature permanente teeth with apical periodontitis: new treatment protocol. J Endod, 30:196-200.
Bassetti R., Kuttenberger J. & Bassetti M. (2018). Regenerative endodontische Therapie nach Frontzahntrauma. Ein Fallbericht [Regenerative endodontics after front tooth trauma. A case report]. Swiss Dent J. 14;128(5):393-399.
Bezgin T. & Sönmez H. (2015). Review of current concepts of revascularization/revitalization. Dent Traumatol. 31(4):267-73.
Brickhouse T.H., Unkel J.H., Porter A.S. & Lazar EL. (2007). Status do seguro e cárie dentária não tratada em escolares da Virgínia. Pediatr Dent. 29:493 - 9.
Caleza-Jiménez C., Ribas-Pérez D., Biedma-Perea M., Solano-Mendoza B. & Mendoza-Mendoza A. (2022). Radiographic differences observed following apexification vs revascularization in necrotic immature molars and incisors: a follow-up study of 18 teeth. Eur Arch Paediatr Dent. 7.
Cehreli Z.C., Erbas Unverdi G., Eymirli P., Mergen I., Arslan E. & Esenturk G. (2022). Combined conventional and regenerative treatment in molars with coexistent closed and open apices: A case series. Aust Endod J. 9.
Cehreli Z.C., Unverdi G.E. & Ballikaya E. (2022). Deciduous Tooth Pulp Autotransplantation for the Regenerative Endodontic Treatment of Permanent Teeth With Pulp Necrosis: A Case Series. J Endod. 1:S0099-2399(22)00068-1.
Chauhan R., Rasaratnam L., Alani A. & Djemal S. (2016). Adult Dental Trauma: What Should the Dental Practitioner Know. Prim Dent J. 1;5(3):70-81.
Chaves H.G.S., Moreira T.P.C., Figuereiro B., Macedo I.F.A, Maia I.C., Maia C.A., Ferreira I.C., Silva V.J.L, Nascimento W.M. (2022). Pulp calcification in traumatized teeth – a literature review. Research, Society and Development. 11(7).
Chaves H.G.S., Souza L.M.L, Macedo I.F.A., Maia C.A., Figuereiro B., Ferreira I.C., Maia G.C., Ferreira G.C., Silva V.J.L., Casadei B.A. (2022). Regenerative therapy in teeth with incomplete root formation after dental trauma to tooth 21: a case report. Research, Society and Development. v. 11(7).
Connert T., Weiger R. & Krastl G. (2022). Present status and future directions - Guided endodontics. Int Endod J. 25.
Deluca M.C.C., Scarparo R.K., Aspesi M., Matte B.F., Brand L.M., Grecca F.S., Casagrande L. & Kopper P.M.P. (2021). Cytotoxic, Migration, and Angiogenic Effects of Photodynamic Therapy and Photobiomodulation Associated with a Revascularization Protocol. J Endod. 47(1):69-77.
El-Tayeb M.M., Abu-Seida AM, E.l., Ashry S.H. & El-Hady S.A. (2019). Evaluation of antibacterial activity of propolis on regenerative potential of necrotic immature permanent teeth in dogs. BMC Oral Health. 6;19(1):174.
Eramo S., Natali A., Pinna R. & Milia E. (2018). Dental pulp regeneration via cell homing. Int Endod J. 51(4):405-419.
Faria L.V., Chaves H.G.D.S., Borges Silva E.A., Antunes L.S. & Antunes L.A.A. (2020). Minimally invasive treatment of an extruded deciduous tooth - Case report. Dent Traumatol. 36(3):303-306.
Flanagan T.A. (2014). What can cause the pulps of immature, permanent teeth with open apices to become necrotic and what treatment options are available for these teeth. Aust Endod J. 40:95–100.
Garcia-Godoy F. & Murray P.E. (2012). Recommendations for using regenerative endodontic procedures in permanent immature traumatized teeth. Dental Traumatology. 28(1):33-41.
Glynis A., Foschi F., Kefalou I., Koletsi D., Tzanetakis G.N. (2021). Regenerative Endodontic Procedures for the Treatment of Necrotic Mature Teeth with Apical Periodontitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Endod. 47(6):873-882.
Hameed M.H., Gul M., Ghafoor R. & Badar S.B. (2019). Management of immature necrotic permanent teeth with regenerative endodontic procedures - a review of literature. J Pak Med Assoc. 69(10):1514-1520.
He W.X. & Yu Q. (2022). New advances in vital pulp therapy and pulp regeneration for the treatment of pulpitis: from basic to clinical application. Zhonghua Kou Qiang Yi Xue Za Zhi. 9;57(1):16-22. Chinese.
Huang G.T.J. (2008). A paradigm shift in endodontic management of immature teeth: Conservation of stem cells for regeneration. Elsevier Ltd. All rights reserved. 36:379–386.
Jeeruphan T., Jantarat J., Yanpiset K., Suwannapan L., Khewsawai P. & Hargreaves K.M. (2012). Mahidol Study 1: Comparison of Radiographic and Survival Outcomes of Immature Teeth Treated with Either Regenerative Endodontic or Apexification Methods: A Retrospective Study. JOE. 38:1330-1336.
Jiménez C.C., Pérez R.D., Perea B.M., Mendonza S.B. & Mendonza M.A. (2022). Radiographic differences observed following apexification vs revascularization in necrotic immature molars and incisors: a follow-up study of 18 teeth. Eur Arch Paediatr Dent. 7.
Kontakiotis E.G., Filippatos C.G., Tzanetakis G.N. & Agrafioti A. (2015). Regenerative Endodontic Therapy: A Data Analysis of Clinical Protocols. JOE. 146-154.
Krasner P. & Rankow H. (1995). Nova filosofia para o tratamento de dentes avulsionados. Oral Surg Oral Med Oral Pathol. 79: 616
Law A.S. (2013). Considerations for Regeneration Procedures. Jornal Of Endodontics. 39(3).
Lenzi R. & Trope M. (2012). Revitalization Procedures in Two Traumatized Incisors with Different Biological Outcomes. Jornal Of Endodontics. 38(3).
Luz L.B., Vizzotto M.B., Xavier P.N.I., Vianna-Wanzeler A.M., Dias da Silveira H.L. & Montagner F. (2022). The Impact of Cone-beam Computed Tomography on Diagnostic Thinking, Treatment Option, and Confidence in Dental Trauma Cases: A Before and After Study. J Endod. 48(3):320-328.
Martins G., Ricucci, M.D., Jennifer L., Gibbs M.A.S., Louis M. & Lin B.D.S. (2013). Histological Findings of Revascularized/Revitalized Immature Permanent Molar with Apical Periodontitis Using Platelet-rich Plasma. JOE. 39:138-144.
Montero-Miralles P., Martín-González J., Alonso-Ezpeleta O., Jiménez-Sánchez M.C., Velasco-Ortega E., Segura-Egea J.J. (2018). Effectiveness and clinical implications of the use of topical antibiotics in regenerative endodontic procedures: a review. Int Endod J. 51(9):981-988.
Myers M.C & Fountain S.B. (1974). Dental pulp regeneration aided by blood and blood substitutes after experimentally induced periapical infection. Oral Surg Oral Med Oral Pathol. 37:441–50.
Nageh M., Ahmed G.M. & El-Baz A.A. (2018). Assessment of Regaining Pulp Sensibility in Mature Necrotic Teeth Using a Modified Revascularization Technique with Platelet-rich Fibrin: A Clinical Study. J Endod. 44(10):1526-1533.
Nageh M., Ibrahim L.A., AbuNaeem F.M. & Salam E. (2022). Management of internal inflammatory root resorption using injectable platelet-rich fibrin revascularization technique: a clinical study with cone-beam computed tomography evaluation. Clin Oral Investig. 26(2):1505-1516.
Namour M. & Theys S. (2014). Pulp Revascularization of Immature Permanent Teeth: A Review of the Literature and a Proposal of a New Clinical Protocol. Scientific World Journal. 01-09.
Namour M. & Theys S. (2014). Pulp revascularization of immature permanent teeth: a review of the literature and a proposal of a new clinical protocol. ScientificWorldJournal. 737503.
Natera M. & Mukherjee P.M. (2018). Regenerative Endodontic Treatment with Orthodontic Treatment in a Tooth with Dens Evaginatus: A Case Report with a 4-year Follow-up. J Endod. 44(6):952-55.
Neelamurthy P.S., Kumar R.A., Balakrishnan V., Venkatesan S.M., Narayan G.S. & I K. (2018). Revascularization in Immature and Mature Teeth with Necrotic Pulp: A Clinical Study. J Contemp Dent Pract. 1;19(11):1393-1399.
Nicoloso G.F., Goldenfum G.M., Pizzol T.D.S.D., Scarparo R.K., Montagner F., de Almeida Rodrigues J. & Casagrande L. (2019). Pulp Revascularization or Apexification for the Treatment of Immature Necrotic Permanent Teeth: Systematic Review and Meta-Analysis. J Clin Pediatr Dent. 43(5):305-313.
Nosrat A., Kolahdouzan A., Khatibi A.H., Verma P., Jamshidi D., NevinsA.J. & Torabinejad M. (2019). Clinical, Radiographic, and Histologic Outcome of Regenerative Endodontic Treatment in Human Teeth Using a Novel Collagen-hydroxyapatite Scaffold. J Endod. 45(2):136-143.
Nygaard-Ostby B. & Hjortdal O. (1971). Tissue formation in the root canal following pulp removal. Scand J Dent Res. 79:333–49.
Parhizkar A., Nojehdehian H. & Asgary S. (2018). Triple antibiotic paste: momentous roles and applications in endodontics: a review. Restor Dent Endod. 20;43(3):28.
Pereira A.C., Oliveira M.L., Cerqueira-Neto A.C.C.L., Gomes B.P.F.A., Ferraz C.C.R., Almeida J.F.A., Marciano M.A., DE-Jesus-Soares A. (2020). Treatment outcomes of pulp revascularization in traumatized immature teeth using calcium hydroxide and 2% chlorhexidine gel as intracanal medication. J Appl Oral Sci. 25;28:e20200217.
Pereira, J.C., Anauate-Netto C., Gonçalves S.M.A. (2014). Dentística: uma abordagem multidisciplinar. 1º ed. São Paulo: Artes médicas.
Ramezani M., Sanaei-Rad P. & Hajihassani N. (2019). Revascularization and vital pulp therapy in immature molars with necrotic pulp and irreversible pulpitis: A case report with two-year follow-up. Clin Case Rep.19;8(1):206-210.
Ravikumar K., Chakravarthy Y., Kumar A., Samynathan M. & Varshini R.J. (2021). Foreign Body Removal and Revascularization of Teeth with Periapical Radiolucency: 18 Months' Follow-Up. J Pharm Bioallied Sci.13(1):S886-S889.
Rombouts C, Giraud T, Jeanneau C, About I. (2017). Pulp Vascularization during Tooth Development, Regeneration, and Therapy. J Dent Res. 96(2):137-144.
Santos P.H.O., dos.; Aguiar K. S., Ogata L.I., & Ribeiro A.L.R. (2022). Revascularização pulpar como alternativa às terapias de apexificação comumente aplicadas em dentes jovens com raízes incompletas. Research, Society and Development. 11(15): 2525-3409.
Shah N., Logani A., Bhaskar U. & Aggarwal V. (2008). Efficacy of Revascularization to Induce Apexification/Apexogensis in Infected, Nonvital, Immature Teeth: A Pilot Clinical Study. J Endod. 34(8):919-25.
Shimizu E., Ricucci, M.D., Albert J., Alobaid A.S., Gibbs J.L., Huang G.T.J. & Lin L.M. (2013). Clinical, Radiographic, and Histological Observation of a Human Immature Permanent Tooth with Chronic Apical Abscess after Revitalization Treatment. JOE. 39:1078-1083.
Stambolsky C., Rodríguez-Benítez S., Gutiérrez-Pérez J.L., Torres-Lagares D., Martín-González J. & Segura-Egea J.J. (2016). Histologic characterization of regenerated tissues after pulp revascularization of immature dog teeth with apical periodontitis using tri-antibiotic paste and platelet-rich plasma. Arch Oral Biol. 71:122-128
Thomson A., Kahler B. (2010). Endodontia regenerativa - tratamento de base biológica para dentes permanentes imaturos: um relato de caso e revisão da literatura. Australian Dental Journal. 55 (4): 446–452.
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(2):265–68.
Viana F.L.P., Sampieri M.B.S., Viana P.P., Cruz S.M.L., Vivan R.R., Duaanin I.C.J., Vasconcelos B.C. (2021). Analise do pH e da atividade antimicrobiana de um novo medicamento intracanal bioceramico Bio-C temp. Research Society and Development. 10(7).
Wikström A., Brundin M., Lopes M.F., El Sayed M. & Tsilingaridis G. (2021). What is the best long-term treatment modality for immature permanent teeth with pulp necrosis and apical periodontitis? Eur Arch Paediatr Dent.22(3):311-340.
Xie Z., Shen Z., Zhan P., Yang J., Huang Q., Huang S., Chen L. & Lin Z. (2021). Functional Dental Pulp Regeneration: Basic Research and Clinical Translation. Int J Mol Sci. 20;22(16):8991.
Yang YQ, Wu BL, Zeng JK, Jiang C, Chen M. (2022). Pulp revascularization on an adult mandibular right second premolar: A case report. World J Clin Cases. 16;10(17):5833-5840.
Zanini M., Hennequin M. & Cousson P.Y. (2019). Which procedures and materials could be applied for full pulpotomy in permanent mature teeth? A systematic review. Acta Odontol Scand. 77(7):541-551.
Zhao Y., Liu B. & Zhao Y.F. (2019). Controversies Regarding the Management of Teeth Associated with Cystic Lesions of the Jaws. Chin J Dent Res. 22(2):81-92.
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