title: Challenges in regenerative endodontics: a case series.
abstract: BACKGROUND
  An immature tooth with pulpal necrosis and apical periodontitis presents a unique challenge to the endodontist. Endodontic treatment options consist of apexification, apical barriers, or more recently, revascularization. The purpose of this case series is to report three cases that used revascularization protocol as described by Banchs and Trope. Each case presented its own special circumstances and challenges. The lessons learned from each case provided guidance for more predictable outcomes on subsequent cases.
  
  
  METHODS
  Six immature teeth with apical periodontitis (in three patients) were treated via the revascularization protocol using irrigants, a triple antibiotic paste, and a coronal seal of mineral trioxide aggregate and composite.
  
  
  RESULTS
  For follow-up, all six teeth showed resolution of periapical radiolucencies, whereas three of six teeth showed continued root development. Two teeth displayed a positive response to vitality testing.
  
  
  CONCLUSIONS
  Results from this case series show that revascularization is a technically challenging but effective treatment modality for the immature tooth with apical periodontitis. Based on this case series, the following recommendations are made to help with the revascularization technique: (1) clinicians should consider the use of an anesthetic without a vasoconstrictor when trying to induce bleeding, (2) a collagen matrix is useful for the controlled placement of MTA to a desired and optimal level, (3) patients/parents should be informed about the potential for staining, especially in anterior teeth when the paste contains minocycline, and (4) patient/parent compliance with the necessary multiple appointment treatment plan may be significant for case selection.
authors.affiliation: Division of Endodontics, University of Minnesota School of Dentistry, Minneapolis, MN 55455, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Petrino
authors.forename: Kendra K
authors.initials: KK
authors.lastname: Boda
authors.forename: Sandra
authors.initials: S
authors.lastname: Shambarger
authors.forename: Walter R
authors.initials: WR
authors.lastname: Bowles
authors.forename: Scott B
authors.initials: SB
authors.lastname: McClanahan
mesh_terms: D000293:Adolescent; D002648:Child; D019140:Dental Care for Children / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D018919:Neovascularization, Physiologic; D010485:Periapical Periodontitis / Q000628:therapy*; D010486:Periapical Tissue / Q000098:blood supply; D044968:Regenerative Medicine / Q000379:methods*; D012390:Root Canal Therapy / Q000379:methods*; D019227:Tooth Apex / Q000098:blood supply / Q000254:growth & development / Q000473:pathology / Q000601:surgery*; D014094:Tooth, Deciduous / Q000473:pathology / Q000601:surgery*; D019553:Tooth, Nonvital / Q000628:therapy; D016896:Treatment Outcome