Pulpal necrosis is a relatively common sequel following dental trauma which arrests the further root development in an immature permanent tooth resulting in wide open apices. The immature root with a necrotic pulp and apical periodontitis presents multiple challenges to successful treatment. Various treatment modalities for management such teeth include calcium hydroxide apexification, MTA apexification, and endodontic surgeries. Apexification using calcium hydroxide although shown some success but it is less popular nowadays due to limitations like multiple visits, formation of porous barrier. Mineral trioxide aggregate (MTA) apexification is a commonly used treatment option for management of immature non-vital teeth. However, it doesnot strengthen the remaining root structure and the tooth remains fracture prone and non-vital. Regenerative endodontic procedures are designed to replace damaged structures, including dentin and root structures, as well as cells of the pulp-dentin complex. Thickening of root dentin and reestablished tooth vitality are the significant outcome with revascularization which cannot be achieved with apexification procedure. Considering the advantages, if the proper case selection protocol is followed revascularization can be used as an alternative to apexification for management of immature non-vital teeth.
R Lam. Epidemiology and outcomes of traumatic dental injuries: a review of the literature. Australian Dental Journal 2016; 61:(1 Suppl): 4–20.
Martin trope. Treatment of the Immature Tooth with a Non– Vital Pulp and apical periodontitis. DCNA 2010.
Heithersay GS. Calcium hydroxide in the treatment of pulpless teeth with associated pathology. J Br Endod Soc 1962;8:74.
R after M. Apexification: a review. Dent Traumatol 2005;21:1- 8.
Ingle JI. Endodontics. Philadelphia: Lea and Febiger; 1965:504.
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.
Maroto M, Barberia E, Planells P, et al. Treatment of a nonvital immature incisor with mineral trioxide aggregate (MTA). Dent Traumatol 2003;19:16.
Katebzadeh N, Dalton BC, Trope M. Strengthening immature teeth during and after apexification. J Endod 1998;24:256.
Diogenes A, Henry MA, Teixeira FB, et al. An update on clinical regenerative endodontics. Endod Top 2013;28:2–23.
Nygaard-Østby B. The role of the blood clot in endodontic therapy. An experimental histological study. Acta Odontol Scand 1961: 19: 324–353.
Rule DC, Winter GB. Root growth and apical repair subsequent to pulpal necrosis in children. Br Dent J 1966: 120: 586–590.
Franklin Garcia-Godoy, Peter E. Murray. Recommendations for using regenerative endodontic procedures in permanent immature traumatized teeth. Dental Traumatology 2011.
Alam T, Nakazawa F, Nakajo K, Uematsu H, Hoshino E. Susceptibility of Enterococcus feacalis to combination of antibacterial drugs (3Mix) in vivo. J Oral Biosci 2005:47(4):315- 320.
A. R. Sánchez, R. S. Rogers III, and P. J. Sheridan, “Tetracycline and other tetracycline-derivative staining of the teeth and oral cavity,” International Journal of Dermatology, vol. 43, no. 10, pp. 709–715, 2004.
Belinda Kuan-Jung Chen, Roy George, and Laurence James Walsh, “Discoloration of Roots Caused by Residual Endodontic Intracanal Medicaments,” The Scientific World Journal, vol. 2014, Article ID 404676, 7 pages, 2014.
Sirtes G, Waltimo T, Schaetzle M, Zehnder M. The effect of temperature on sodium hypochlorite short term stability, pulp dissolution capacity and antimicrobial efficacy. JOE 2005; 31:669-671.
Trevino EG, Patwardhan AN, Henry MA, Perry G, Dybdal- Hargreaves N, Hargreaves KM, Diogenes A. Effect of irrigants on the survival of human stem cells of the apical papilla in a platelet-rich plasma scaffold in human root tips. J Endod 2011: 37: 1109–1115.
Galler KM, D'Souza RN, Federlin M, Cavender AC, Hartgerink JD, Hecker S, Schmalz G. Dentin conditioning codetermines cell fate in regenerative endodontics. J Endod 2011: 37: 1536– 1541.
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.
Ruparel NB, de Almeida JF, Henry MA, Diogenes A. Characterization of a stem cell of apical papilla cell line: effect of passage on cellular phenotype. J Endod 2013: 39: 357–363.
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.
H. S. Selden, “Apexification: an interesting case,” Journal of Endodontics, vol. 28, no. 1, pp. 44–45, 2002.
W. Sonoyama, Y. Liu, D. Fang, et al., “Mesenchymal stem cellmediated functional tooth regeneration in Swine,” PLoS One, vol. 1, no. 1, article e79, 2006.
S. Abe, S. Yamaguchi, A. Watanabe, K. Hamada, and T. Amagasa, “Hard tissue regeneration capacity of apical pulp derived cells (APDCs) from human tooth with immature apex,” Biochemical and Biophysical Research Communications, vol. 371, no. 1, pp. 90–93, 2008.
G. T.-J. Huang, W. Sonoyama, Y. Liu, H. Liu, S. Wang, and S. Shi, “The hidden treasure in apical papilla: the potential role in pulp/dentin regeneration and bioroot engineering,” Journal of Endodontics, vol. 34, no. 6, pp. 645–651,2008.
Thomson A, Kahler B. Regenerative endodontics— biologically-based treatment for immature permanent teeth: a case report and review of the literature. Aust Dent J 2010: 55: 446–452.
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 2009:42:1118–1126.
Windley W 3rd, Teixeira F, Levin L, Sigurdsson A, Trope M. Disinfection of immature teeth with a triple antibiotic paste. J Endod. 2005;31:439-43.
Greenstein G, Polson A. The role of local drug delivery in the management of periodontal diseases: a comprehensive review. J Periodontol. 1998;69:507-20.
Reynolds K, Johnson JD, Cohenca N. Pulp revascularization of necrotic bilateral bicuspids using a modified novel technique to eliminate potential coronal discolouration: a case report. Int Endod J. 2009;42:84-92.
Banchs F, Trope M. Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol? J Endod. 2004;30:196-200.
W. E. Andelin, S. Shabahang, K. Wright, and M. Torabinejad, “Identification of hard tissue after experimental pulp capping using dentin sialoprotein (DSP) as a marker,” Journal of Endodontics, vol. 29, no. 10, pp. 646–650, 2003.
K. Iohara, M. Nakashima, M. Ito, M. Ishikawa, A. Nakasima, and A. Akamine, “Dentin regeneration by dental pulp stem cell therapy with recombinant human bone morphogenetic protein 2,” Journal of Dental Research, vol. 83, no. 8, pp. 590– 595,2004.