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      Revitalisation endodontic treatment of traumatised immature teeth: a prospective long-term clinical study

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          Abstract

          Purpose

          Continuation of root development following revitalisation endodontics (RET) has been shown to be unpredictable with lower success rates in traumatised teeth. This study reports the outcomes for RET in traumatised teeth over a review period of 4 years.

          Methods

          A prospective uncontrolled study, where RET was performed on traumatised upper immature anterior teeth with necrotic pulps in 15 children (mean age = 8.3 years), was conducted. Patients were reviewed at 3, 9, 12, 24, and 48 months, where clinical and radiographic assessments were performed. At the last review appointment, patients and parents answered questions assessing their perception and acceptance of tooth colour change over time. McNemar’s Exact test and linear mixed model assessment were used to assess changes in pulpal electrical response and radiographic evidence of continuation of root development over time, respectively.

          Results

          There was 83.3% healing with no significant changes in EPT responses, and no significant changes in root lengths, while significant changes in root widths ( p < 0.05) and root apex widths ( p < 0.001) were found over time. Twenty-five percent of patients and 33% of parents felt that there were changes in tooth colour following RET over time.

          Conclusion

          Within the limitations of this study, traumatised teeth treated using RET showed no significant root lengthening, however, acceptable periapical healing, slow thickening of root dentinal walls, and rapid development of apical closure were evident over a period of 43 months. Using Portland cement and omitting minocycline, did not eliminate crown colour change following RET.

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          Most cited references27

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          Regenerative endodontics: a comprehensive review

          The European Society of Endodontology and the American Association for Endodontists have released position statements and clinical considerations for regenerative endodontics. There is increasing literature on this field since the initial reports of Iwaya et al. (Dental Traumatology, 17, 2001, 185) and Banchs & Trope (Journal of Endodontics, 30, 2004, 196). Endogenous stem cells from an induced periapical bleeding and scaffolds using blood clot, platelet rich plasma or platelet-rich fibrin have been utilized in regenerative endodontics. This approach has been described as a 'paradigm shift' and considered the first treatment option for immature teeth with pulp necrosis. There are three treatment outcomes of regenerative endodontics; (i) resolution of clinical signs and symptoms; (ii) further root maturation; and (iii) return of neurogenesis. It is known that results are variable for these objectives, and true regeneration of the pulp/dentine complex is not achieved. Repair derived primarily from the periodontal and osseous tissues has been shown histologically. It is hoped that with the concept of tissue engineering, namely stem cells, scaffolds and signalling molecules, that true pulp regeneration is an achievable goal. This review discusses current knowledge as well as future directions for regenerative endodontics. Patient-centred outcomes such as tooth discolouration and possibly more appointments with the potential for adverse effects needs to be discussed with patients and parents. Based on the classification of Cvek (Endodontics and Dental Traumatology, 8, 1992, 45), it is proposed that regenerative endodontics should be considered for teeth with incomplete root formation although teeth with near or complete root formation may be more suited for conventional endodontic therapy or MTA barrier techniques. However, much is still not known about clinical and biological aspects of regenerative endodontics.
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            Responses of immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscess to revascularization procedures.

            To report several types of response of immature permanent teeth with infected necrotic pulp tissue and either apical periodontitis or abscess to revascularization procedures. Twenty immature permanent teeth with infected necrotic pulp tissue and either apical periodontitis or abscesses from 20 patients were included. The teeth were isolated with rubber dam, and pulp chambers was accessed through the crowns. The canals were gently irrigated with 5.25% sodium hypochlorite with minimal mechanical debridement. Calcium hydroxide was used as an inter-appointment intracanal medicament and placed into the coronal half of the canal space. After resolution of clinical signs and symptoms, bleeding was induced into the canal space from the periapical tissues using K-files. The coronal canal space was sealed with a mixture of mineral trioxide aggregate (MTA) and saline solution. The access cavity was filled with composite resin. These immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscesses were followed up from 6 to 26 months. Five types of responses of these immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscess to revascularization procedures were observed: type 1, increased thickening of the canal walls and continued root maturation; type 2, no significant continuation of root development with the root apex becoming blunt and closed; type 3, continued root development with the apical foramen remaining open; type 4, severe calcification (obliteration) of the canal space; type 5, a hard tissue barrier formed in the canal between the coronal MTA plug and the root apex. Based on this case series, the outcome of continued root development was not as predictable as increased thickening of the canal walls in human immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscess after revascularization procedures. Continued root development of revascularized immature permanent necrotic teeth depends on whether the Hertwig's epithelial root sheath survives in case of apical periodontitis/abscess. Severe pulp canal calcification (obliteration) by hard tissue formation might be a complication of internal replacement resorption or union between the intracanal hard tissue and the apical bone (ankylosis) in revascularized immature permanent necrotic teeth. © 2011 International Endodontic Journal.
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              Concentration-dependent effect of sodium hypochlorite on stem cells of apical papilla survival and differentiation.

              Intracanal disinfection is a crucial step in regenerative endodontic procedures. Most published cases suggest the use of sodium hypochlorite (NaOCl) as the primary irrigant. However, the effect of clinically used concentrations of NaOCl on the survival and differentiation of stem cells is largely unknown. In this study, we tested the effect of various concentrations of NaOCl on the stem cells of the apical papilla (SCAPs) survival and dentin sialophosphoprotein (DSPP) expression.
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                Author and article information

                Contributors
                haninazzal@hotmail.com
                Journal
                Eur Arch Paediatr Dent
                Eur Arch Paediatr Dent
                European Archives of Paediatric Dentistry
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                1818-6300
                1996-9805
                6 December 2019
                6 December 2019
                2020
                : 21
                : 5
                : 587-596
                Affiliations
                [1 ]GRID grid.9909.9, ISNI 0000 0004 1936 8403, Department of Paediatric Dentistry, School of Dentistry, , University of Leeds, ; Clarendon Way, Leeds, LS2 9LU UK
                [2 ]GRID grid.413548.f, ISNI 0000 0004 0571 546X, Paediatric Dentistry Section, Department of Dentistry, Hamah Dental Centre, , Hamad Medical Corporation, ; P.O. Box: 21954, Doha, Qatar
                [3 ]GRID grid.415970.e, ISNI 0000 0004 0417 2395, Department of Orthodontics, , Royal Liverpool University Dental Hospital, ; Liverpool, UK
                [4 ]GRID grid.9909.9, ISNI 0000 0004 1936 8403, Department of Oral Biology, School of Dentistry, , University of Leeds, ; Clarendon Way, Leeds, LS2 9LU UK
                [5 ]GRID grid.410759.e, ISNI 0000 0004 0451 6143, Discipline of Orthodontics and Paediatric Dentistry, , National University Health System, ; Singapore, Singapore
                Author information
                http://orcid.org/0000-0002-6220-8873
                Article
                501
                10.1007/s40368-019-00501-0
                7518998
                31808111
                10f5980c-774c-42ef-b131-12ef125b64a8
                © The Author(s) 2019

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 6 September 2019
                : 28 November 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100012536, Leeds Hospital Charitable Foundation;
                Award ID: 9R11/1207
                Award Recipient :
                Categories
                Original Scientific Article
                Custom metadata
                © European Academy of Paediatric Dentistry 2020

                revitalisation endodontic technique,immature non vital teeth,crown discolouration

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