Dental Pulp Revascularization of Necrotic Permanent Teeth with Immature Apices.
OBJECTIVE
The treatment of immature necrotic teeth with apical periodontitis presents challenges in endodontic and pediatric dentistry. Revascularization is a recent treatment for such cases as an alternative to conventional apexification. The purpose is to examine the effect of a pulpal revascularization procedure on immature necrotic teeth with apical periodontitis.


METHODS
Twenty patients were enrolled for pulp revascularization procedure by root canal disinfection using a triple antibiotic mixture for 1-2 weeks, followed by creating a blood clot, sealing the root canal orifice using white mineral trioxide aggregate and a coronal seal of composite resin. Patients were recalled periodically for up to 24 months.


RESULTS
During follow-up, all patients were asymptomatic. Three cases of chronic apical periodontitis showed clinical disappearance of the sinus tract 2 weeks after treatment. Radiography revealed progressive periapical radiolucency resolution within the first 12 months. Within 12-24 months, the treated teeth showed progressive increases in dentinal wall thickness, root length and continued root development.


CONCLUSIONS
Clinical and radiographic evidence showed successful revascularization treatments of immature necrotic permanent teeth with apical periodontitis. More studies are necessary to understand the underlying mechanisms and to perform histopathology of the pulp space contents after revascularization procedures.
Eman A
EA
El Ashiry
Najat M
NM
Farsi
Sawsan T
ST
Abuzeid
Mohamed M
MM
El Ashiry
Hammam A
HA
Bahammam
D017607:Aluminum Compounds / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D056624:Apexification / Q000379:methods*; D001777:Blood Coagulation / Q000187:drug effects; D017610:Calcium Compounds / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000008:administration & dosage; D003188:Composite Resins / Q000737:chemistry; D003764:Dental Materials / Q000737:chemistry; D003790:Dental Pulp Necrosis / Q000628:therapy*; D003793:Dental Restoration, Permanent / Q000379:methods; D003804:Dentin / Q000473:pathology; D004203:Disinfection / Q000379:methods; D004338:Drug Combinations; D005500:Follow-Up Studies; D006801:Humans; D008795:Metronidazole / Q000008:administration & dosage; D008911:Minocycline / Q000008:administration & dosage; D010087:Oxides / Q000627:therapeutic use; D010485:Periapical Periodontitis / Q000628:therapy; D012387:Root Canal Filling Materials / Q000627:therapeutic use; D012388:Root Canal Irrigants / Q000008:administration & dosage / Q000627:therapeutic use; D018915:Root Canal Preparation / Q000379:methods; D017640:Silicates / Q000627:therapeutic use; D019227:Tooth Apex / Q000473:pathology*; D014092:Tooth Root / Q000473:pathology
D017607:Aluminum Compounds; D000900:Anti-Bacterial Agents; D017610:Calcium Compounds; D003188:Composite Resins; D003764:Dental Materials; D004338:Drug Combinations; D010087:Oxides; D012387:Root Canal Filling Materials; D012388:Root Canal Irrigants; D017640:Silicates; C086631:mineral trioxide aggregate; D008795:Metronidazole; D002939:Ciprofloxacin; D008911:Minocycline
Immature; necrosis; permanent teeth; revascularization