American Journal of Clinical and Experimental Medicine
Volume 6, Issue 2, March 2018, Pages: 40-45
Received: Mar. 3, 2018;
Accepted: Mar. 19, 2018;
Published: Apr. 10, 2018
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Christian Holscher, Integra, Department of Integra Medical Research, Luxemburg, Luxembourg
Kerstin Galler, Department of Conservative Dentistry and Periodontology, University Medical Center, Regensburg, Germany
In addition to caries, dental trauma is one of the most common causes of damage to permanent teeth and pulp. Pulp necrosis or damage to Hertwig’s epithelial root sheath (HERS) leads to arrested tooth root development in immature teeth. Pulp necrosis can be treated by revitalization, a biology-based treatment alternative to apexification. Induction of a blood clot inside the root canal can lead to healing of periapical lesions and increased root length and thickness. Traumatic impact as the cause of pulp necrosis may affect the treatment outcome negatively, depending on the severity of damage to HERS. Revitalization procedures in four teeth with pulp necrosis following dental trauma were performed using a standardized treatment protocol. Three teeth were dislocated, the fourth tooth was avulsed. Each patient exhibited at least two clinical signs of pulp necrosis as well as radiographic evidence of apical periodontitis. X-rays were taken using individualized film holders (IFH) to reliably assess the treatment outcome. Revitalization treatment was performed without instrumentation of the canal walls, but disinfection with sodium hypochlorite and intracanal dressing with triple antibiotic paste (TAP) for three weeks. Provocation of bleeding was induced in a second visit, the blood clot was covered with collagen followed by calcium silicate cement, and teeth were sealed with resin composite. Clinical and radiographic follow-ups were performed after 1, 3, 6 and 12 months. An increase of root length and thickness was evident in the three teeth with dislocation injuries. In one case, formation of mineralized tissue below the calcium silicate cement was observed. The tooth which had been avulsed and replanted showed resorption of the apical root area. The observations made in this study support the assumption that a separation of HERS and the cells that form pulp and dentin during tooth root development may negatively affect the outcome after a standardized revitalization procedure. The consistent implementation of standardized treatment protocols and the use of IFH are helpful receiving a reliable treatment outcome.
Revitalization Teeth: A Prospective Case Series, American Journal of Clinical and Experimental Medicine.
Vol. 6, No. 2,
2018, pp. 40-45.
D’Souza R. Development of the pulpodentin complex. In: Goodis HE, ed: Seltzer and Bender’s Dental Pulp. Carol Stream, IL: Quintessence Publishing Co, Inc; 2002.
Diekwisch TG. The developmental biology of cementum. Int J Dev Biol. 2001; 45:695-706.
Nanci A (2003). Development of the tooth and its supporting tissues. In: Ten Cate’s oral histology: development, structure, and function. 6th ed. St. Louis: Mosby, pp. 79–110.
Huang GT, Sonoyama W, Liu Y, Liu H, Wang S, Shi S. The hidden treasure in apical papilla: the potential role in pulp/dentin regeneration and bioroot engineering. J Endod. 2008; 34:645-651.
Luder HU. Malformations of the tooth root in humans. Front Physiol. 2015; 27:307.
Lovelace TW, Henry MA, Hargreaves KM, Diogenes A. Evaluation of the delivery of mesenchymal stem cells into the root canal space of necrotic immature teeth after clinical regenerative endodontic procedure. J Endod. 2011; 37:133-138.
Galler KM, Krastl G, Simon S, Van Gorp G, Meschi N, Vahedi B, Lambrechts P. European Society of Endodontology position statement: Revitalization procedures. Int Endod J. 2016; 49:717-723.
Hargreaves KM, Diogenes A, Teixeira FB. Treatment options: biological basis of regenerative endodontic procedures. J Endod. 2013; 39:30-43.
Wigler R, Kaufman AY, Lin S, Steinbock N, Hazan-Molina H, Torneck CD. Revascularization: a treatment for permanent teeth with necrotic pulp and incomplete root development. J Endod. 201339:319-326.
Jung IY, Kim ES, Lee CY, Lee SJ. Continued development of the root separated from the main root. J Endod. 2011; 37:711-714.
AAE Position Statement (2013). Scope of Endodontics: Regenerative Endodontics. Available at: https://www.aae.org/specialty/wp-content/uploads/sites/2/2017/06/scopeofendo_regendo.pdf.
Glendor U. Epidemiology of traumatic dental injuries--a 12 year review of the literature. Dent Traumatol. 2008; 24:603-611.
Oginni AO, Adekoya-Sofowora CA. Pulpal sequelae after trauma to anterior teeth among adult Nigerian dental patients. BMC Oral Health 2007; 7:11.
Jarvinen S. Fractured and avulsed permanent incisors in Finnish children. A retrospective study. Acta Odontol Scand. 1979; 37:47-50.
Lauridsen E, Hermann NV, Gerds TA, Ahrensburg SS, Kreiborg S, Andreasen JO. Combination injuries 3. The risk of pulp necrosis in permanent teeth with extrusion or lateral luxation and concomitant crown fractures without pulp exposure. Dent Traumatol. 2012; 28:379-385.
Viduskalne I, Care R. Analysis of the crown fractures and factors affecting pulp survival due to dental trauma. Stomatologija. 2010; 12:109-115.
Bhaskar S, Rappaport H. Dental vitality tests and pulp status. J Am Dent Assoc. 1973; 86:409-411.
Andreasen J, Andreasen F (1994). Textbook and Color Atlas of Traumatic Injuries to the Teeth, 3rd edn. Copenhagen: Munksgaard.
Lin LM, Shimizu E, Gibbs JL, Loghin S, Ricucci D. Histologic and histobacteriologic observations of failed revascularization/revitalization therapy: a case report. J Endod. 2014; 40:291-295.
Ricucci D, Pascon EA, Pitt Ford TR, Langeland K. Epithelium and bacteria in periapical lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 101:239-249.
Tronstad L, Andreasen JO, Hasselgren G, Kristerson L, Riis I. pH changes in dental tissues after root canal filling with calcium hydroxide. J Endod. 1981; 7:17-21.
Meadow D, Lindner G, Needleman H. Oral trauma in children. Pediatr Dent. 1984; 6:248-251.
Ruparel NB, Teixeira FB, Ferraz CC, Diogenes A. Direct effect of intracanal medicaments on survival of stem cells of the apical papilla. J Endod. 2012; 38:1372-1375.
Banchs F, Trope M. Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol? J Endod. 2004; 30:196-200.
Torabinejad M, Nosrat A, Verma P, Udochukwu O. Regenerative endodontic treatment or mineral trioxide aggregate apical plug in teeth with necrotic pulps and open apices: a systematic review and meta-analysis. J Endod. 2017; 43:1806-1820.
Chan EKM, Desmeules M, Cielecki M, Dabbagh D, Ferraz dos Santos B. Longitudinal cohort study of regenerative endodontic treatment for immature necrotic permanent teeth. J Endod. 2017; 43:395-400.
Phumpatrakom P, Srisuwan T. Regenerative capacity of human dental pulp and apical papilla cells after treatment with a 3-antibiotic mixture. J Endod. 2014; 40:399-405.
Chuensombat S, Khemaleelakul S, Chattipakorn S, Srisuwan T. Cytotoxic effects and antibacterial efficacy of a 3-antibiotic combination: an in vitro study. J Endod. 2013; 39:813-819.
Bezgin T, Sönmez H. Review of current concepts of revascularization/ revitalization. Dent Traumatol. 2015; 31:267-273.
Thibodeau B, Teixeira F, Yamauchi M, Caplan DJ, Trope M. Pulp revascularization of immature dog teeth with apical periodontitis. J Endod. 2007; 33:680-699.
Miller EK, Lee JY, Tawil PZ, Teixeira FB, Vann WF Jr. Emerging therapies for the management of traumatized immature permanent incisors. Pediatr Dent. 2012; 34:66-69.
Montero-Miralles P, Martín-González J, Alonso-Ezpeleta O, Jiménez-Sánchez MC, Velasco-Ortega E, Segura-Egea JJ. Effectiveness and clinical implications of the use of topical antibiotics in regenerative endodontic procedures: a review. Int Endod J. 2018; 26. [in press].
Mehrvarzfar P, Abbott PV, Akhavan H, Savadkouhi ST. Modified Revascularization in Human Teeth Using an Intracanal Formation of Treated Dentin Matrix: A Report of Two Cases. J Int Soc Prev Community Dent. 2017; 7:218-221.
Wang X, Jong G, Lin LM, Shimizu E. EphB-EphrinB interaction controls odontogenic/osteogenic differentiation with calcium hydroxide. J Endod. 2013; 39:1256-1260.
Andreasen JO, Bakland LK. Pulp regeneration after non-infected and infected necrosis, what type of tissue do we want? A review. Dental Traumatol. 2012; 28:13-18.
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; 40:1063-1070.
Saoud TM, Zaazou A, Nabil A, Moussa S, Lin LM, Gibbs JL. Clinical and radiographic outcomes of traumatized immature permanent necrotic teeth after revascularization/revitalization therapy. J Endod. 2014; 40:1946-1952.
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; 43:1052-1057.