Apexification or Regeneration? Repair in Endodontics

Year 2021, Volume: 5 Issue: 2, 85 - 90, 30.12.2021

Nimet Gençoğlu , Alev Eda Okutan , Ali Recai Menteş

https://doi.org/10.29228/erd.13

Abstract

Regenerative endodontics is a new concept for the management of the permanent immature teeth with necrotic pulps. This procedure enables to replace damaged dentine and pulp-dentin complex within the root structure with healthy tissue. Firstly, elimination of clinical symptoms of the infection then, thickening of the canal walls and continuing root maturation and finally filled with the host’s own vital tissue are the main goals of regenerative endodontics. However, apexification is another solution associated with traditional root canal treatment for the teeth with necrotic pulp and immature root development. It involves removal of necrotic and infected tissue from the wide and funnel shape of root canal in immature teeth. The purpose of this article is to review regenerative endodontics and apexification in conjunction within a case.

Keywords

regenerative endodontics, apexification, MTA, immature permanent teeth

Supporting Institution

Marmara University Research Fund

Project Number

5595

Apeksifikasyon mu Rejenerasyon mu? Endodontide Tamir

Abstract

Rejeneratif endodonti, apeksi açık nekrotik pulpalı daimî azı dişlerde uygulanan yeni bir tedavi konseptidir. Bu işlem, kök yapısındaki hasarlı dentin ve pulpa-dentin kompleksinin sağlıklı doku ile değiştirilmesini sağlar. İlk olarak enfeksiyonun klinik semptomlarının ortadan kaldırılması, ardından kanal duvarlarında kalınlaşma sağlanarak kök olgunlaşmasının devam etmesi ve son olarak da hastanın kendi vital dokusu ile kökün doldurulması rejeneratif endodontinin ana hedefleridir. Olgunlaşmamış dişlerde geniş ve huni şeklindeki kök kanalından nekrotik ve enfekte dokunun çıkarılmasını içeren apeksifikasyon işlemi, geleneksel kanal tedavisi ile ilişkili bir başka bir çözümdür. Bu makalede, aynı hasta üzerinde rejeneratif endodonti ve apeksifikasyon işlemleri farklı dişlerde uygulanarak tedavi prosedürü ve sonuçları gözden geçirilmiştir.

Keywords

rejeneratif endodonti, apeksifikasyon, MTA, olgunlaşmamış daimî dişler

Project Number

5595

References

• 1. Almutairi W, Yassen GH, Aminoshariae A, Williams KA, Mickel A. Regenerative Endodontics: A Systematic Analysis of the Failed Cases. J Endod. 2019 ;45(5):567-577.
• 2. Alobaid AS, Cortes LM, Lo J, Nguyen TT, Albert J, Abu-Melha AS, Lin LM, Gibbs JL. Radiographic and Clinical Outcomes of the Treatment of Immature Permanent Teeth by Revascularization or Apexification: A Pilot Retrospective Cohort Study. J Endod. 2014 ; 40(8): 1063–1070.
• 3. American Association of Endodontics. AAE Position Statement on the Scope of Endodontics: Regenerative Endodontics. 2013.
• 4. Andreasen JO, Andreasen FM. Textbook and color atlas of traumatic injuries to the teeth. 3rd ed. Munksgaard, 1994, 543.
• 5. Andreasen JO, Farik B, Munksgaard EC. Long-term calcium hydroxide as a root canal dressing may increase risk of root fracture. Dent Traumatol. 2002;18:134–137.
• 6. Banchs F, Trope M. Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol? J Endod. 2004 ;30(4):196-200.
• 7. Chaniotis A. The use of a single-step regenerative approach for the treatment of a replanted mandibular central incisor with severe resorption. Int Endod J. 2016 ;49(8):802-12.
• 8. Chueh LH, Ho YC, Kuo TC, Lai WH, Chen YH, Chiang CP. Regenerative endodontic treatment for necrotic immature permanent teeth. J Endod. 2009 Feb;35(2):160-4. doi: 10.1016/j.joen.2008.10.019. Epub 2008 Dec 12.
• 9. Cvek M. Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with gutta-percha. A retrospective clinical study. Endod Dent Traumatol 1992;8:45-55.
• 10. Harlamb SC. Management of incompletely developed teeth requiring root canal treatment, Aust Dent J. 2016 ;61 Suppl 1:95-106.
• 11. Hoshino E, Kurihara-Ando N, Sato I, Uematsu H, Sato M, Kota K, Iwaku M. In-vitro antibacterial susceptibility of bacteria taken from infected root dentine to a mixture of ciprofloxacin, metronidazole and minocycline. Int Endod J. 1996 ;29(2):125-30.
• 12. Iwaya SI, Ikawa M, Kubota M. Revascularization of an immature permanent tooth with apical periodontitis and sinus tract. Dent Traumatol. 2001 ;17(4):185-7.
• 13. Kahler B, Rossi-Fedele G, Chugal N, Lin LM. An Evidence-based Review of the Efficacy of Treatment Approaches for Immature Permanent Teeth with Pulp Necrosis. J Endod. 2017 Jul;43(7):1052-1057. doi: 10.1016/j.joen.2017.03.003. Epub 2017 May 13.
• 14. Kim JH, Kim Y, Shin SJ, Park JW, Jung IY. Tooth discoloration of immature permanent incisor associated with triple antibiotic therapy: a case report. J Endod. 2010 ;36(6):1086-91.
• 15. Kling M, Cvek M, Mejare I. Rate and predictability of pulp revascularization in therapeutically reimplanted permanent incisors. Endod Dent Traumatol. 1986 ;2(3):83-9.
• 16. McCabe P. Revascularization of an immature tooth with apical periodontitis using a single visit protocol: A case report. Int Endod J 2015;48(5):484-497.
• 17. Nygaard-Ostby B, Hjortdal O. Tissue formation in the root canal following pulp removal. Scand J Dent Res. 1971;79(5):333-49.
• 18. Ostby BN. The role of the blood clot in endodontic therapy. An experimental histologic study. Acta Odontol Scand. 1961 ;19:324-53.
• 19. Raldi DP, Mello I, Habitante SM, Lage-Marques JL, Coil J. Treatment options for teeth with open apices and apical periodontitis. J Can Dent Assoc. 2009 ;75(8):591-6.
• 20. Sato I, Ando-Kurihara N, Kota K, Iwaku M, Hoshino E. Sterilization of infected root-canal dentine by topical application of a mixture of ciprofloxacin, metronidazole and minocycline in situ. Int Endod J. 1996;29(2):118–24.
• 21. Shimizu E, Ricucci D, Albert J, Alobaid AS, Gibbs JL, Huang GT, Lin LM. Clinical, radiographic, and histological observation of a human immature permanent tooth with chronic apical abscess after revitalization treatment. J Endod. 2013 Aug;39(8):1078-83.
• 22. Shin SY, Albert JS, Mortman RE. One step pulp revascularization treatment of an immature permanent tooth with chronic apical abscess: a case report. Int Endod J. 2009 ;42(12):1118-26.
• 23. Silujjai J, Linsuwanont P. Treatment Outcomes of Apexification or Revascularization in Nonvital Immature Permanent Teeth: A Retrospective Study. J Endod. 2017 ;43(2):238-245.
• 24. Skoglund A, Tronstad L, Wallenius K. A microangiographic study of vascular changes in replanted and autotransplanted teeth of young dogs. Oral Surg Oral Med Oral Pathol. 1978 Jan;45(1):17-28.
• 25. Terranova VP, Odziemiec C, Tweden KS, Spadone DP. Repopulation of dentin surfaces by periodontal ligament cells and endothelial cells. Effect of basic fibroblast growth factor. J Periodontol. 1989; 60(6):293-301.
• 26. Torabinejad M, Walton RW. Endodontics Principles and Practice 4th ed. Saunders&Elsevier, 2009,p.33.
• 27. Yassen GH, Platt JA. The effect of nonsetting calcium hydroxide on root fracture and mechanical properties of radicular dentine: a systematic review. Int Endod J. 2013;46:112–118.
• 28. Yassen GH, Vail MM, Chu TG, Platt JA. The effect of medicaments used in endodontic regeneration on root fracture and microhardness of radicular dentine. Int Endod J. 2013 ;46(7):688-95.