Histologic and histobacteriologic observations of failed revascularization/revitalization therapy: a case report.
BACKGROUND
Mechanical debridement plays an important role in eliminating intracanal bacteria, such as biofilm on the canal walls and bacteria in the dentinal tubules. Mechanical debridement is not recommended for root canal disinfection in revascularization/revitalization therapy. Here we report a failed revascularization/revitalization case, which could be due to inadequate root canal disinfection without mechanical removal of biofilm and bacteria in dentinal tubules.


METHODS
A 6-year-old boy had a traumatic injury to tooth #9, which was avulsed and replanted within 40 minutes. The tooth subsequently developed a local swelling in the periapical area. The patient was referred to the Postgraduate Endodontic Clinic for revascularization/revitalization therapy on tooth #9. The treated tooth remained asymptomatic for 16 months and then developed pain and local periapical swelling. The oral surgeon extracted the revascularized/revitalized tooth. On request, the extracted tooth was processed for histologic and histobacteriologic examination.


RESULTS
The tissue in the canal was completely destroyed. Most bacteria were observed in the apical portion and not in the coronal portion of the canal and formed biofilm on the canal walls and penetrated into the dentinal tubules.


CONCLUSIONS
On the basis of histobacteriologic observations, the failure of revascularized/revitalized tooth could be due to inadequate root canal disinfection without mechanical debridement. It may be important to perform mechanical debridement as part of the revascularization/revitalization therapy to disrupt the biofilm on the canal walls and remove bacteria in the dentinal tubules because revascularization/revitalization therapy is able to increase thickening of the canal walls.
Department of Endodontics, New York University College of Dentistry, New York, New York.
Louis M
LM
Lin
Department of Endodontics, New York University College of Dentistry, New York, New York.
Emi
E
Shimizu
Department of Endodontics, New York University College of Dentistry, New York, New York.
Jennifer L
JL
Gibbs
Private practice, Cetraro, Italy.
Simona
S
Loghin
Private practice, Cetraro, Italy. Electronic address: dricucci@libero.it.
Domenico
D
Ricucci
D017607:Aluminum Compounds / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D056624:Apexification / Q000379:methods*; D018441:Biofilms; D017610:Calcium Compounds / Q000627:therapeutic use; D002126:Calcium Hydroxide / Q000627:therapeutic use; D002648:Child; D002710:Chlorhexidine / Q000627:therapeutic use; D003786:Dental Pulp Cavity / Q000382:microbiology; D003804:Dentin / Q000382:microbiology; D004338:Drug Combinations; D005500:Follow-Up Studies; D006801:Humans; D007180:Incisor / Q000293:injuries*; D008297:Male; D008768:Methylmethacrylates / Q000627:therapeutic use; D018919:Neovascularization, Physiologic / Q000502:physiology; D010087:Oxides / Q000627:therapeutic use; D010485:Periapical Periodontitis / Q000628:therapy; D012387:Root Canal Filling Materials / Q000627:therapeutic use; D012388:Root Canal Irrigants / Q000627:therapeutic use; D017640:Silicates / Q000627:therapeutic use; D012973:Sodium Hypochlorite / Q000627:therapeutic use; D019227:Tooth Apex / Q000382:microbiology; D014084:Tooth Avulsion / Q000628:therapy*; D014090:Tooth Replantation / Q000379:methods*; D017211:Treatment Failure; D015035:Zinc Oxide-Eugenol Cement / Q000627:therapeutic use
D017607:Aluminum Compounds; D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D017610:Calcium Compounds; D004338:Drug Combinations; D008768:Methylmethacrylates; D010087:Oxides; D012387:Root Canal Filling Materials; D012388:Root Canal Irrigants; D017640:Silicates; D015035:Zinc Oxide-Eugenol Cement; C086631:mineral trioxide aggregate; C031667:IRM cement; D012973:Sodium Hypochlorite; D002126:Calcium Hydroxide; D002710:Chlorhexidine
Immature permanent tooth; reinfection; revascularization/revitalization; root canal disinfection