Late term complications of intruded permanent incisors: 2 case reports

This report describes 2 cases of intrusive luxation injuries of maxillary immature permanent central incisors. In both cases, intruded teeth were left for spontaneous re-eruption. During periodic follow-ups for up to 2 years the teeth did not show any sign, clinically or radiographically, of pulp necrosis with apical periodontitis. However, in the first case tenderness to percussion and periapical radiolucency developed after 2.5 years and endodontic treatment was started. In the second case, the patient returned after 2 years 9 months with complaint and periapical radiolucency was observed radiographically. Endodontic therapy was performed. These late-term complications highlight the need for regular long-term follow-up in cases of intrusive luxation in permanent teeth.     

MTA apical plugs in the treatment of traumatized immature teeth with large periapical lesions

Abstract – This case report describes the management of a late‐referral case of periapically involved, traumatized immature permanent incisors by endodontic treatment and the use of mineral trioxide aggregate (MTA) apical plugs. A 10‐year‐old boy was referred to the clinic with a chief complaint of pain in his maxillary central incisors, which had experienced subluxation trauma 2 years earlier. Periapical radiograph of the teeth showed incomplete root development with wide‐open apices and large periradicular lesions. The canals were gently debrided using K‐files in conjunction with 2.5% NaOCl irrigation and 2% chlorhexidine for final flush. The root canals became asymptomatic after employing the same endodontic regimen for three visits. MTA plugs were placed in the apical area of the root canals, and the rest of the canal space was obturated by warm compaction of gutta‐percha and AH Plus sealer. Resolution of the large periapical lesions was observed 2 months after treatment. At 18 months, the periapical areas revealed radiographic evidence of bone healing. Following successful removal of the toxic content of the root canal, placement of MTA plugs resulted in both healing of the periradicular radiolucency and regeneration of the periapical tissue.     

年轻恒前牙感染根管内血管再生的动物实验研究

目的通过建立根尖周炎模型观察年轻恒前牙根管内血管再生的组织学状况。方法选择4个半月龄杂种犬1只,建立上颌未发育完成的恒前牙根尖周炎模型,将6颗上颌恒前牙随机分组,对照组3颗采用根尖诱导成形术,实验组3颗采用根管内血管再生术。将术后1、4、8周的X线片分别与术前X线片进行对比,观察牙根继续发育及根尖炎症的愈合情况。术后8周处死动物,利用苏木精-伊红（HE）染色观察根尖闭合情况及根管内容物的构成。结果X线观察,术后1、4周,2组牙根的根尖孔大小及根尖透射区范围未见明显改变。术后8周,实验组根尖透射区范围缩窄较明显,并出现根尖孔缩窄的趋势,但管壁厚度无明显变化;而对照组根尖透射区变化不一。组织学检查,实验组管腔内可见肉芽组织,其中包含有大量的不规则的类牙本质、类牙骨质和类骨质样钙化物,钙化物以根尖部和管腔内侧壁尤为明显。对照组管腔未见软组织,根尖部有少量的硬组织沉积。结论血管再生术可促使年轻无髓恒前牙的慢性根尖周炎症消退,根管内再生的肉芽组织中有硬组织沉积。     

Characterization of Histopathology and Microbiota in Contemporary Regenerative Endodontic Procedures: Still Coming up Short

IntroductionThis study aimed to investigate microbiota and the histopathology of infected immature teeth microenvironments after disinfection with calcium hydroxide, triple antibiotic paste, and a synthetic antimicrobial peptide (synthetic human beta-defensin-3-C15) for regenerative endodontic procedures (REPs). The null hypothesis was that there is no difference among intracanal medications on disinfection in REPs.MethodsPulp necrosis and periapical lesions were induced in immature beagle dog premolars. Block randomized teeth were uninfected (negative control, n = 6), left infected (positive control, n = 6), or medicated with a disinfectant (n = 6/group). After disinfection (2 weeks), teeth were reaccessed, irrigated with 17% EDTA, blood clot induced, sealed with ProRoot MTA (Dentsply Tulsa Dental, Tulsa, OK), and restored with resin-modified glass ionomer. Animals were monitored radiographically and euthanized (12 weeks) for histopathologic and metagenomic analyses.ResultsREP-treated roots showed radiographic repair of periapical radiolucency (67.65%, 23/34), continued root development (73.53%, 25/34), and apical closure (70.59%, 24/34) regardless of the disinfectant used (P > .05). Canal microenvironments histologically devoid of bacteria contained new mineralized and pulp-like tissues in characteristic patterns that varied by disinfectant. Next-generation sequencing (16S ribosomal RNA) identified Firmicutes, Proteobacteria, Actinobacteria, and Bacteroidetes as dominant phyla of microbiota in immature teeth. Infection-induced teeth showed changes in diversity and richness of microbiota from negative controls. Compared with positive controls, all treated teeth exhibited depleted operational taxonomic units, with lower phylogenic diversity from synthetic human beta-defensin-3-C15–treated teeth.ConclusionsThere were no differences among the medicaments investigated in radiologic treatment outcomes, but disinfectants in REPs showed altered microbiota from normal and diseased immature teeth with different histologic patterns of regeneration.     

Regenerative Endodontic Treatment as a Biologically Based Approach for Non-Surgical Retreatment of Immature Teeth

IntroductionThe goal of regenerative endodontic treatment (RET) is to regenerate the pulp-dentin complex in immature teeth with pulp necrosis. There is no consensus in using RET in previously treated teeth. This article reports on long-term outcomes of RET in previously treated immature teeth.MethodsPreviously treated immature teeth with signs/symptoms of failure were included. After local anesthesia and rubber dam isolation, the root canal filling material was removed without the use of chemical solvents. The root canals were irrigated with 6% sodium hypochlorite using an EndoVac (Kerr Endodontics, Culver City, CA), and a creamy mix of metronidazole and ciprofloxacin was placed in the canals for 4 weeks. At the second visit, the antibiotic dressing was removed using 17% EDTA. Bleeding was induced into the root canal space, and SynOss Putty (Collagen Matrix Inc, Oakland, NJ) was placed. Bioceramic putty was placed over the SynOss Putty, and the teeth were restored at a subsequent visit.ResultsFive teeth in 4 patients were included. The patients’ ages ranged from 14–46 years. Recall examinations were performed from 20 to 72 months with an average of 54.4 months. The apical openings of the teeth ranged from 1–3.7 mm. All teeth were functional and asymptomatic at the recall visits. All periapical lesions resolved with partial or complete mineralization of the root canals, and all teeth showed partial to complete apical closure at the follow-up visits.ConclusionsRET can be a viable option for nonsurgical retreatment of immature teeth. This article adds a new perspective to the field of regenerative endodontics.     

Pulp revascularization for immature replanted teeth: a case report

Immature avulsed teeth are not usually treated with pulp revascularization because of the possibility of complications. However, this therapy has shown success in the treatment of immature teeth with periapical lesions. This report describes the case of an immature replanted tooth that was successfully treated by pulp revascularization. An 8‐year‐old boy suffered avulsion on his maxillary left lateral incisor. The tooth showed incomplete root development and was replanted after 30 minutes. After diagnosis, revascularization therapy was performed by irrigating the root canal and applying a calcium hydroxide paste and 2% chlorhexidine gel for 21 days. In the second session, the intracanal dressing was removed and a blood clot was stimulated up to the cervical third of the root canal. Mineral trioxide aggregate was placed as a cervical barrier at the entrance of the root canal and the crown was restored. During the follow‐up period, periapical repair, apical closure and calcification in the apical 4 mm of the root canal was observed. An avulsed immature tooth replanted after a brief extra‐alveolar period and maintained in a viable storage medium may be treated with revascularization.     

Conservative Endodontic Treatment Of A Large Periapical Lesion

A 60-year-old female presented with a large periapical radiolucency associated with a previously root filled 1.3 and suspected involvement of the 1.2. Endodontic treatment of 1.2 had been commenced by the referring dentist. Following a differential diagnosis, conservative endodontic treatment was instituted. A post was removed from 1.3 and long term calcium hydroxide intracanal dressings placed in both teeth. The lesion showed good repair over a period of 12 months. This case report supports the view that the treatment of choice for periapical lesions associated with failed conventional endodontic treatment is orthograde re-treatment with regular follow-up to confirm bony healing.     

Revascularization Outcomes: A Prospective Analysis of 16 Consecutive Cases

Introduction

Recent reviews lament the lack of evidence on the efficacy of regenerative procedures to induce further root maturation despite claims of a paradigm shift in the way infected, necrotic immature teeth with arrested root development can be endodontically treated. The majority of reports are either case series or successful case reports where nonstandardized images may make interpretation uncertain.

Methods

This prospective clinical study reports on preliminary outcomes of regenerative endodontic procedures carried out on 16 teeth, 3 mandibular premolars and 13 traumatized central incisors, after 18-month reviews. Qualitative analysis of resolution of periapical radiolucencies and apical closure was undertaken. Quantitative analysis compared preoperative and recall radiographs by using a geometrical imaging program that calculated percentage changes in root length and dentin wall thickness.

Results

Qualitative assessment showed 90.3% resolution of the periapical radiolucency. Apical closure was assessed as incomplete in 47.2% and complete apical closure in 19.4% of cases. Quantitative assessment showed change in root length varying from −2.7% to 25.3% and change for root dentin thickness of −1.9% to 72.6%.

Conclusions

Patterns of continued root maturogenesis were variable at 18-month review. Reviews at 36 months showed continued root maturogenesis for 2 cases. Quantitative analysis can control for changes in angulation but may introduce other measurement errors. However, not all anterior teeth were suitable for TurboReg assessment because overlapping of the cementoenamel junctions and/or further eruption of teeth often precluded stable landmark positioning. Discoloration of the crown was a common consequence, with unaesthetic results in 10 of the 16 cases.     

Factors affecting the long-term results of endodontic treatment

The influence of various factors that may affect the outcome of root canal therapy was evaluated in 356 patients 8 to 10 yr after the treatment. The results of treatment were directly dependent on the preoperative status of the pulp and periapical tissues. The rate of success for cases with vital or nonvital pulps but having no periapical radiolucency exceeded 96%, whereas only 86% of the cases with pulp necrosis and periapical radiolucency showed apical healing. The possibility of instrumenting the root canal to its full length and the level of root filling significantly affected the outcome of treatment. Of all of the periapical lesions present on previously root-filled teeth, only 62% healed after retreatment. The predictability from clinical and radiographic signs of the treatment-outcome in individual cases with preoperative periapical lesions cases was found to be low. Thus, factors which were not measured or identified may be critical to the outcome of endodontic treatment.     

Effect of QMix as final irrigation protocol on periapical healing after single-visit root canal treatment: A randomised controlled clinical trial

The aim of this study was to evaluate radiographic periapical repair after endodontic treatment using QMix or NaOCl irrigation in single-rooted teeth with apical periodontitis. In this randomised clinical trial, 60 patients were selected and randomised into two groups (n = 30). After instrumentation of root canals, QMix or NaOCl was used as a final irrigation and the canals obturated with gutta-percha and AH Plus sealer. All the participants were recalled after 12 months and 15 patients were lost to the study so 45 patients were evaluated radiographically according to periapical index (PAI) scores. A significant decrease was seen in PAI scores after 1 year in all patients (p < 0.001). In the QMix and NaOCl group, absence or reduction of radiolucency was observed in 23 of 25 teeth (92%) and 20 of 20 teeth (100%), respectively. There was no significant difference between two groups according to the decrease in PAI score (p = 0.508). Root canal treatments with or without QMix irrigation contributed equally to periapical healing.     

Langerhans Cell Histiocytosis Mimicking Periapical Pathology in a 39-year-old Man

Langerhans cell histiocytosis (LCH) is a clonal neoplastic proliferation of Langerhans-type dendritic cells, with more than 50% of cases of LCH seen in children younger than 15 years of age. The most common clinical presentation of LCH is solitary or multiple bony lesions. The jaws are affected in approximately 10%–20% of cases, with a strong predilection for the mandible. The maxilla is involved in only 1% of head and neck cases. When the jaws are involved, lesions of LCH may mimic periapical pathology as seen in patients requiring endodontic therapy or bone loss as seen in periodontal disease. We report the case of a 39-year-old man with LCH involving the posterior maxilla. This is a rare presentation of LCH with respect to both location and patient age. Clinicians should consider LCH when developing a differential diagnosis of an apical radiolucency of vital teeth or teeth that fail to respond to endodontic therapy and be aware of its clinical and radiographic mimics.     

Calcium hydroxide induced apexification with apical root development: a clinical case report

Aim  To report the induction of apical root development by calcium hydroxide in teeth with pulp necrosis and periapical radiolucency.
Summary  A 10-year-old male patient was admitted to the clinic complaining of an intense pain and oedema on the anterior facial region, compatible with an acute dentoalveolar abscess. There was a previous history of dental trauma; only tooth 11 was negative to pulp sensitivity tests. Radiographically, tooth 11 exhibited incomplete root formation, characterized by a wide root canal, thin and fragile dentinal walls, and an extensive, divergent foraminal opening associated with an apical radiolucency. The first appointment focused on urgent local and systemic treatment. Apexification treatment commenced at the second session after 7 days, by means of chemo-mechanical debridement throughout the entire root canal, using K-files and irrigation with a 2.5% sodium hypochlorite solution. Subsequently, a calcium hydroxide paste was applied and changed four times over 8 months, when radiographic examination revealed complete closure of the foraminal opening, resulting in resolution of the periapical radiolucency and associated with 5 mm of additional root development. The root canal was filled by thermomechanical compaction of gutta-percha and sealer. A 3-year follow-up revealed normal periapical tissues and the absence of symptoms.
Key learning points • In young patients, dental trauma may cause pulp necrosis and arrest of root formation.
• Under certain circumstances, chemo-mechanical debridement, including the use of a calcium hydroxide paste, is a valid alternative to mineral trioxide aggregate and or surgery for root-end closure.
• In teeth with incompletely formed roots associated with periapical lesions, calcium hydroxide can induce periapical repair through the closure of the foramen and apical root development.     

Outcome of Regenerative Endodontic Procedures in Nonvital Immature Permanent Teeth Using 2 Intracanal Medications: A Prospective Randomized Clinical Study

IntroductionThis randomized clinical trial aimed to assess and compare the long-term clinical and radiographic outcomes of regenerative endodontic procedures (REPs) in treating nonvital immature permanent teeth using 2 intracanal medicaments.MethodsForty-five patients yielding a total of 50 anterior and posterior nonvital immature teeth were randomly divided into 2 groups. REPs using either nonsetting calcium hydroxide (Ca[OH]₂) (n = 25) or modified triple antibiotic paste (TAP) (n = 25) as intracanal medicaments were performed. NeoMTA Plus (Avalon Biomed Inc) was applied for coronal sealing. Cases were followed up clinically and radiographically for 36 months. The survival rate, success rate, and clinical outcome measures were analyzed. Preoperative and recall radiographs were evaluated for dimensional changes in root length, dentin thickness, apical diameter, and periapical radiolucency.ResultsAt the 36-month follow-up, the success and survival rates were 81.6% and 100%, respectively, in which 79.4% of cases showed complete resolution of periapical radiolucency with no significant difference between the nonsetting Ca(OH)₂ and modified TAP groups (P > .050). The cumulative changes in root length, root dentin thickness, and apical diameter throughout the study period were observed in 47.9%, 77.1%, and 89.6% of cases, respectively, with no significant differences between groups (P ≥ .39). Intracanal calcifications were detected in 60% of cases with no significant difference between groups (P = .77).ConclusionsREPs, using either nonsetting Ca(OH)₂ or modified TAP as the intracanal medicament, exhibited high success and survival rates over a follow-up period of 36 months with equally favorable clinical and radiographic outcome data.     

Four-year Outcome of Nonsurgical Root Canal Retreatment Using Cone-beam Computed Tomography: A Prospective Cohort Study

IntroductionThe purpose of this prospective study was to investigate the 4-year outcome and prognostic factors of nonsurgical root canal retreatment determined by measuring the volumetric change of periapical radiolucencies on cone-beam computed tomographic (CBCT) scans.MethodsNinety-seven endodontically treated teeth from 80 patients diagnosed as apical periodontitis and indicated for root canal retreatment were included. Retreatment was performed by 7 endodontic specialists using a standardized treatment protocol. The teeth were reexamined clinically and radiographically 48–67 months after retreatment. The volume of preoperative and postoperative periapical radiolucencies on CBCT images was independently measured by 2 examiners. Radiographic outcome is presented in 4 categories: absence, reduction, enlargement, or unchanged. Reduction or enlargement was determined when the volumetric change of radiolucency was 20% or more. Multivariate logistic regression was performed for predictor analysis.ResultsSixty-two teeth (63.9%) from 50 patients returned for follow-up. Fifty-eight teeth were included in the prognostic analysis, all of which were symptom free. The 4 remaining teeth that had been extracted because of fracture were excluded. The total volume of periapical radiolucencies at 4 years postoperatively decreased by 94.6% compared with that preoperatively (P < .001), with an average reduction of 83.4% (95% confidence interval, 69.2%–97.5%). The periapical radiolucencies were determined as absence in 44 teeth (75.9%), reduction in 10 teeth (17.2%), unchanged in 1 tooth (1.7%), and enlargement in 3 teeth (5.2%). Tooth type was identified as an outcome predictor (P < .05).ConclusionsThe 4-year outcome of endodontic retreatment is predictable, with a significant volumetric reduction in periapical radiolucencies.     

Mineral Trioxide Aggregate as Apical Plug in Teeth with Necrotic Pulp and Immature Apices: A 10-year Case Series

Introduction

This 10-year study evaluated the clinical and radiologic outcomes of teeth with necrotic pulp, immature apices, and periapical lesions treated with the mineral trioxide aggregate (MTA) apical plug technique.

Methods

Seventeen single-rooted immature teeth with necrotic pulp and periapical lesion from 17 patients treated between January 2001 and December 2001 were included in this study. Apical obturation on all teeth included in the study was completed in 2 visits: first using calcium hydroxide as an interappointment intracanal medication and a second visit for the creation of the artificial apical barrier with MTA. The outcome, based on clinical and radiographic criteria, was assessed by 2 calibrated investigators using the periapical index (PAI). The Friedman test was used to verify the differences between baseline and the 1-, 5-, and 10-year PAI scores.

Results

Of the 17 patients treated, 1 patient dropped out at 5 years. At the 10-year follow-up, 15 teeth were healed (PAI ≤2), and 1 tooth had been extracted because of the presence of a longitudinal root fracture. The PAI score exhibited a significant decrease between baseline and 1 year and between 1 and 5 years. The difference between 5 and 10 years was not significant.

Conclusions

The apical plug with MTA was a successful and effective technique for long-term management of this group of teeth with necrotic pulps with immature root development and periapical lesions.     

Endodontic treatment and immunopathology of periapical granuloma in an AIDS patient

Abstract The complications of endodontic treatment in an AIDS patient are described and related to the immunopathological findings in a periapical granuloma. The lesion contained abundant polyclonal immunoglobulin-producing plasma cells but was virtually devoid of CD4-positive T cells (putative “helper” phenotype), indicating compromised local immune function. Delayed healing of apical periodontitis after endodontic treatment of teeth with periapical lesions was found in several teeth in this case. Root canal treatment of teeth with vital pulps was performed successfully. Extraction of teeth and endodontic treatment in combination with root resection were uneventful.     

Apexogenesis after initial root canal treatment of an immature maxillary incisor – a case report

Aim To present a case where a traumatized, immature tooth still showed capacity for continued root development and apexogenesis after root canal treatment was initiated based on an inaccurate pulpal diagnosis. Summary Traumatic dental injuries may result in endodontic complications. Treatment strategies for traumatized, immature teeth should aim at preserving pulp vitality to ensure further root development and tooth maturation. A 9‐year‐old boy, who had suffered a concussion injury to the maxillary anterior teeth, was referred after endodontic treatment was initiated in tooth 21 one week earlier. The tooth had incomplete root length, thin dentinal walls and a wide open apex. The pulp chamber had been accessed, and the pulp canal instrumented to size 100. According to the referral, bleeding from the root made it difficult to fill the root canal with calcium hydroxide. No radiographic signs of apical breakdown were recorded. Based on radiographic and clinical findings, a conservative treatment approach was followed to allow continued root development. Follow‐up with radiographic examination every 3rd month was performed for 15 months. Continued root formation with apical closure was recorded. In the cervical area, a hard tissue barrier developed, which was sealed with white mineral trioxide aggregate (MTA). Bonded composite was used to seal the access cavity. At the final 2 years follow‐up, the tooth showed further root development and was free from symptoms. Key learning points

• ? Endodontic treatment of immature teeth may result in a poor long‐term prognosis.
• ? The pulp of immature teeth has a significant repair potential as long as infection is prevented.
• ? Treatment strategies of traumatized, immature permanent teeth should aim at preserving pulp vitality to secure further root development and tooth maturation.
• ? Radiographic interpretation of the periapical area of immature teeth may be confused by the un‐mineralized radiolucent zone surrounding the dental papilla.

     

Detection of bacteria in endodontic samples by polymerase chain reaction assays and association with defined clinical signs in Italian patients

BACKGROUND/AIMS: The presence of selected bacteria (Enterococcus faecalis, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythensis, Treponema denticola) in infected root canals was studied using polymerase chain reaction (PCR) assays, and the association of bacteria with clinical signs of endodontic disease was assessed. The null hypothesis, that no difference could be observed between clinical signs of apical periodontitis and a specific bacterial strain, was tested. METHODS: Microbial samples were obtained from 62 teeth in 54 patients with endodontic disease. For each tooth, clinical data including patient symptoms were collected. Teeth were categorized by diagnosis as having acute apical periodontitis (AAP, teeth with clinical symptoms but no periapical radiolucency, n=22), chronic apical periodontitis (CAP, teeth with radiolucency but no clinical symptoms, n=15) or exacerbated apical periodontitis (EAP, teeth with symptoms and radiolucency, n=25). Seventy-one percent of cases were primary endodontic infections, and 29% were recurrent ('secondary') endodontic infections (failing cases). PCR assays were used to detect the presence of the selected bacteria. RESULTS: T. denticola and E. faecalis were each detected in 15 of 62 samples (24%), P. gingivalis in 8 samples (13%), P. intermedia in 5 samples (8%), and T. forsythensis in 4 samples (7%). T. denticola was detected in 56% of teeth with EAP. E. faecalis was found in 60% of teeth with CAP and in 72% of teeth with secondary infection. Statistical analysis demonstrated an association of CAP and secondary endodontic infection with the presence of E. faecalis. (P<0.01). EAP was associated with the presence of T. denticola (P<0.01). CONCLUSION: T. denticola was associated with symptomatic endodontic disease in the presence of apical bone resorption. E. faecalis was associated with treatment failures. We suggest that these species may play critical roles in endodontic pathology.     

Radiographic Healing after a Root Canal Treatment Performed in Single-rooted Teeth with and without Ultrasonic Activation of the Irrigant: A Randomized Controlled Trial

Introduction

The aim of this study was to compare the outcome of a root canal treatment with and without additional ultrasonic activation of the irrigant.

Methods

Single-rooted teeth with radiographic evidence of periapical bone loss were randomly assigned to 2 treatment groups. In both groups syringe irrigation was performed, and in one group the irrigant was also activated by ultrasound. Ten to 19 months after treatment, the teeth were examined by using periapical radiography (PA) and cone-beam computed tomography (CBCT). Area and volume of the periapical lesions were measured, and the outcome was presented in 4 categories: absence, reduction or enlargement of the radiolucency, or uncertain. Lesions were classified as reduced or enlarged when the change in size of the radiolucency was 20% or more.

Results

The recall rate was 82%, and 84 teeth were analyzed. CBCT detected significantly more post-treatment lesions than PA (P = .038), but the percentages of absence and reduction of the radiolucency together revealed by CBCT and PA were similar (P = .383). The CBCT results showed that absence of the radiolucency was observed in 16 of 84 teeth (19%) and reduction of the radiolucency in 61 of 84 teeth (72.6%), but there was no significant difference between the results of the 2 groups (P = .470). Absence and reduction of the radiolucency together were observed in the ultrasonic group in 39 of 41 teeth (95.1%) and in the syringe group in 38 of 43 teeth (88.4%).

Conclusions

Root canal treatments with and without additional ultrasonic activation of the irrigant contributed equally to periapical healing.     

Regenerative Potential of Immature Permanent Teeth with Necrotic Pulps after Different Regenerative Protocols

Introduction

Regenerative endodontics is a promising alternative treatment for immature teeth with necrotic pulps. The present study was performed to assess the regenerative potential of young permanent immature teeth with necrotic pulp after the following treatment protocols: (1) a mineral trioxide aggregate (MTA) apical plug, (2) the regenerative endodontic protocol (blood clot scaffold), and (3) the regenerative endodontic protocol with a blood clot and an injectable scaffold impregnated with basic fibroblast growth factor.

Methods

Immature necrotic permanent maxillary central incisors (n = 36) of patients 9–13 years old were divided into 3 groups according to the treatment protocol: the MTA group (MTA apical plug), the REG group (regenerative endodontic protocol [blood clot]), and the FGF group (regenerative endodontic protocol [blood clot + injectable scaffold]). Follow-up was done up to 18 months. Standardized radiographs were digitally evaluated for an increase in root length and thickness, a decrease in the apical diameter, and a change in periapical bone density.

Results

After a follow-up period of 18 months, most of the cases showed radiographic evidence of periapical healing. Groups 2 and 3 showed a progressive increase in root length and width and a decrease in apical diameter.

Conclusions

The regenerative endodontic procedure allowed the continued development of roots in teeth with necrotic pulps. The use of artificial hydrogel scaffold and basic fibroblast growth factor was not essential for repair.