恒牙牙髓炎的活髓保存治疗

活髓保存治疗是尽最大限度保留健康牙髓组织、提高患牙远期保存率的方法,但其被认为适应范围有限,疗效不确定。牙髓组织的病理学改变是决定临床治疗方案和评估疗效的组织学基础,而常用的检查方法无法全面反映牙髓的病理学改变。随着对牙髓生物学研究的深入、现代诊疗技术及盖髓材料的革新,活髓保存治疗越来越多地被应用在以往被认为需要摘除牙髓的患牙上。本文根据循证文献,就牙髓炎病理改变、恒牙牙髓炎活髓保存治疗的临床研究等方面进行分析讨论和总结。在活髓保存治疗的过程中综合运用包括激光多普勒血流仪、组织氧检测仪、核磁共振成像、牙科显微镜等技术与方法准确判断牙髓炎症状态,并依此决定牙髓的去留程度;结合严格的感染控制与高生物相容性盖髓材料的使用,活髓保存治疗可运用在部分龋源性露髓患牙与出现不可复性牙髓炎症状的恒牙上。未来的研究则需从牙髓修复再生机制、牙髓炎诊断精准化、盖髓材料的升级等方面提高恒牙牙髓炎活髓保存治疗的成功率。     

年轻恒牙活髓保存治疗

年轻恒牙活髓保存的目的是为了保护冠部或根部剩余牙髓组织的活性和功能,促进牙根生理性发育。传统观点认为,活髓保存只适用于牙髓正常或可逆性牙髓炎、无根尖病变的患牙,以保留患牙剩余未被感染的健康牙髓组织。但迄今为止,并没有可靠的手段能准确判断牙髓状态。此外,多个研究显示龋源性露髓、伴有不可逆性牙髓炎及根尖周感染的患牙活髓保存治疗成功。临床上应充分利用年轻恒牙牙髓组织再生修复能力强的组织学特点,对年轻恒牙牙髓治疗采取更为保守的方法,以期获得更好的预后。     

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?? The purpose of vital pulp therapy for immature permanent tooth is to protect activity and function of the crown or root residual pulp tissue?? and promote the root physiological development. It has been recommended that vital pulp therapy should be performed only to preserve the healthy pulp tissue in teeth with normal pulp or teeth with reversible pulpitis or teeth without periapical lesions. But up to now?? there is no reliable means that can precisely reflect the pulp condition. Currently?? several studies have reported successful outcome of vital pulp therapy in vital teeth with cariously exposed pulp??or with signs and symptoms of irreversible pulpitis or with periapical lesions. In clinics?? we should make full use of the fact that pulp tissue in immature permanent teeth has strong ability of tissue repair and regeneration. So a more conservative pulp therapy should be taken for young permanent teeth in order to obtain a better prognosis.     

Regeneration of Pulp-Dentin Complex in a Tooth with Symptomatic Irreversible Pulpitis and Open Apex Using Regenerative Endodontic Procedures

Regenerative endodontic procedures are undertaken on permanent teeth with necrotic pulps and open apices in an attempt to resolve symptoms, to allow the continued development of the root(s), and to reestablish vitality. The available histologic analysis of these teeth has, in the majority of studies, shown that true regeneration of the pulp-dentin complex is not achieved. A recent investigation using an animal model outlined a procedure wherein pulpal amputation a few millimeters short of the apex followed by evoked bleeding allowed the complete regeneration of the normal pulp-dentin complex in immature vital teeth of ferrets. By implementation of this procedure, we report successful pulp regeneration outcome evidenced by continued root development and a positive response to pulp vitality tests in a maxillary central incisor with an open apex diagnosed with symptomatic irreversible pulpitis.     

Direct pulp capping with mineral trioxide aggregate: an observational study

BACKGROUND: Pulp capping in carious teeth has been considered unpredictable and therefore contraindicated. A recently developed material, mineral trioxide aggregate (MTA), resists bacterial leakage and may provide protection for the pulp, allowing repair and continued pulp vitality in teeth when used in combination with a sealed restoration. METHODS: Forty patients aged 7 to 45 years accepted pulp-capping treatment when they received a diagnosis no more severe than reversible pulpitis after undergoing cold testing and radiographic examination. The primary author removed caries using a caries detector dye and sodium hypochlorite solution for hemostasis and placed MTA over the exposures and all surrounding dentin. The operator then restored the teeth provisionally with unbonded Clearfil Photocore (Kuraray Medical, Okayama, Japan). During a second visit, the operator restored the teeth with bonded composite after sensibility testing and confirmed MTA curing. At recall appointments, patients were evaluated for reparative dentin formation, pulpal calcification, continued normal root development and evidence of pathosis. RESULTS: Over an observation period of nine years, the authors followed 49 of 53 teeth and found that 97.96 percent had favorable outcomes on the basis of radiographic appearance, subjective symptoms and cold testing. All teeth in younger patients (15/15) that initially had open apexes showed completed root formation (apexogenesis). CONCLUSIONS: MTA can be a reliable pulp-capping material on direct carious exposures in permanent teeth when a two-visit treatment protocol is observed. PRACTICE IMPLICATIONS: Vital pulp therapy using MTA is a treatment option for teeth diagnosed with a condition no more severe than reversible pulpitis.     

Calcitonin gene-related peptide receptor expression in healthy and inflamed human pulp tissue

AIM: To use radioreceptor analysis for comparing calcitonin gene-related peptide (CGRP) receptor expression in human pulp tissue samples collected from teeth having a clinical diagnosis of acute irreversible pulpitis, healthy pulps and teeth with induced inflammation. METHODOLOGY: Six pulp samples were obtained from teeth having a clinical diagnosis of acute irreversible pulpitis. Another eight pulp samples were obtained from healthy premolars where extraction was indicated for orthodontic purposes. In four of these premolars, inflammation was induced prior to pulp collection. All the samples were processed and labelled with 125I-CGRP. Binding sites were identified by 125I-CGRP and standard CGRP competition assays. RESULTS: CGRP receptor expression was found in all human pulp tissue samples. Most receptors were found in the group of pulps from teeth having a clinical diagnosis of acute irreversible pulpitis, followed by the group of pulps having induced inflammation. The least number of receptors was expressed in the group of healthy pulps. The Kruskal-Wallis and Mann-Whitney (post-hoc) tests showed statistically significant differences between the groups (P < 0.05). CONCLUSION: CGRP receptor expression in human pulp tissue is significantly increased during inflammatory phenomena such as acute irreversible pulpitis.     

Maturogenesis of a cariously exposed immature permanent tooth using MTA for direct pulp capping: a case report

Abstract –  Successful direct pulp capping of cariously exposed permanent teeth with reversible pulpitis and incomplete apex formation can prevent the need for root canal treatment. A case report is presented which demonstrates the use of mineral trioxide aggregate (MTA) as a direct pulp capping material for the purpose of continued maturogenesis of the root. Clinical and radiographic follow-up demonstrated a vital pulp and physiologic root development in comparison with the contralateral tooth. MTA can be considered as an effective material for vital pulp therapy, with the goal of maturogenesis.     

Indirect pulp treatment: in vivo outcomes of an adhesive resin system vs calcium hydroxide for protection of the dentin-pulp complex

PURPOSE: The purpose of this prospective and randomized in vivo study was to compare the clinical and radiographic outcomes of an adhesive resin system vs a calcium hydroxide liner for protection of the dentin-pulp complex of primary molars treated with indirect pulp treatment. METHODS: Forty-eight primary molars with deep occlusal caries, but without preoperative signs and symptoms of irreversible pulpitis, received indirect pulp treatment and were restored with a composite resin (Z100). The teeth were randomly divided into 2 groups according to the material used for protection of the dentin-pulp complex: (1) adhesive resin system (Scotchbond MultiPurpose); and (2) calcium hydroxide liner (Dycal). These teeth were evaluated clinically and radiographicaly for 2 years. RESULTS: After 2 years, 83% (19/23) of the teeth treated with calcium hydroxide and 96% (24/25) of teeth treated with only the adhesive resin system presented a successful outcome, as determined by clinical and radiographic examination. Interradicular and/or periapical lesions were the most predominant signs of treatment failure, since 3 out of 23 teeth treated with calcium hydroxide and 1 out of 25 teeth treated with only adhesive resin presented this outcome. One tooth treated with the calcium hydroxide liner was diagnosed with internal root resorption at the 18-month examination. Of the 5 teeth diagnosed from radiographs as a failure of the indirect pulp treatment, none presented clinical signs/symptoms of pulpitis or necrosis such as the presence of fistula, enhanced tooth mobility, or pain. CONCLUSIONS: This study demonstrates that protection of the dentin-pulp complex of primary molars with an adhesive resin system results in similar clinical and radiographic 2-year outcomes as compared to calcium hydroxide when indirect pulp treatment is performed in Class I composite restorations.     

Substance P receptor expression in healthy and inflamed human pulp tissue

AIM: To use radioreceptor analysis for comparing substance P (SP) receptor expression in human pulp tissue samples collected from teeth having a clinical diagnosis of acute irreversible pulpitis, healthy pulps and teeth with induced inflammation. METHODOLOGY: Five pulp samples were obtained from teeth having a clinical diagnosis of acute irreversible pulpitis. Another 10 pulp samples were obtained from healthy premolars where extraction was indicated for orthodontic purposes. In five of these premolars inflammation was induced prior to pulp collection. All of the samples were processed and labelled with 125I-SP. Binding sites were identified by 125I-SP and standard SP competition assays. Kruskal-Wallis and Mann-Whitney (post-hoc) tests were used to establish statistically significant differences between the groups. RESULTS: Substance P receptor expression was found in all human pulp tissue samples. Most receptors were found in the group of pulps from teeth having a clinical diagnosis of acute irreversible pulpitis, followed by the group of pulps having induced inflammation. The least number of receptors was expressed in the group of healthy pulps. Statistical analysis revealed significant differences between the group of healthy pulp and both inflamed pulp groups (P < 0.01). CONCLUSION: Substance P receptor expression in human pulp tissue is significantly increased during inflammatory phenomena such as acute irreversible pulpitis.     

Outcome of Partial Pulpotomy in Cariously Exposed Posterior Permanent Teeth: A Systematic Review and Meta-analysis

IntroductionThe current systematic review and meta-analysis aimed to evaluate the success rate of partial pulpotomy in treating permanent posterior teeth with carious vital pulp exposure. A secondary aim was to assess the prognostic factors using a meta-regression.MethodsAn electronic search was performed for studies from January 1950 to November 2018 in the following databases: PubMed, ScienceDirect, and Cochrane. All searches were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Clinical studies evaluating the success rate of cariously exposed vital human permanent posterior teeth treated with a partial pulpotomy were selected. Only randomized clinical trials and prospective clinical studies were included for evaluation. The Newcastle-Ottawa Scale and the Cochrane Collaboration’s tool were used to evaluate risk assessment.ResultsFrom the 218 studies identified through the initial search, 11 studies qualified for the final analysis (5 randomized clinical trials and 6 prospective studies). The results of the meta-analysis indicate a success rate of 98% (confidence interval [CI]: 0.94–1), 96% (CI: 0.92–0.99), and 92% (CI: 0.83–0.97) after 6 months and 1 and 2 years of follow-up. Examining the probable prognostic factors using meta-regression analysis, only preoperative pulp status (P = .001) was identified as a significant factor, with studies including teeth with the presumptive diagnosis of irreversible pulpitis displaying significantly lower results. The final solution, pulp capping material, apex closure, and the age of the patient did not affect the treatment success rate (P > .05).ConclusionsThe available data suggest that a partial pulpotomy results in high success rates in treating cariously exposed permanent posterior teeth up to 2 years. Six months of monitoring can be considered an appropriate period when evaluating the success of a partial pulpotomy although more clinical and radiographic controls are essential to ensuring success.     

Tissue levels of immunoreactive substance P are increased in patients with irreversible pulpitis

Odontogenic pain often involves inflammation of dental pulp tissue. Dental pulp is highly innervated with a subpopulation of sensory neurons containing neuropeptides. Substance P, released from afferent fibers (e.g. nociceptors) is associated with the development of neurogenic inflammation. In this study, we tested the hypothesis that irreversible pulpitis is associated with increased activity of peptidergic neurons, as measured by increased pulpal levels of immunoreactive substance P (iSP). We determined in vivo pulpal levels of immunoreactive substance P in human teeth with a diagnosis of normal pulp or irreversible pulpitis using CMA/20 microdialysis probes inserted into vital pulps of 24 teeth from 21 patients. Probes were perfused with a modified Locke-Ringer's buffer and immunoreactive substance P levels in the dialysate were measured using a radioimmunoassay. Mean extracellular levels of immunoreactive substance P were significantly higher (>8-fold) in teeth diagnosed with irreversible pulpitis than immunoreactive substance P levels in dental pulp diagnosed as normal (147.7 +/- 34.0 pM versus 18.2 +/- 6.2 pM). These observations suggest that biochemical measures of inflammatory mediators exhibit significant change during irreversible pulpitis and may contribute to clinical signs and symptoms.     

Bacterial Invasion of Pulp Blood Vessels in Teeth with Symptomatic Irreversible Pulpitis

IntroductionThis study described the degenerative changes and infection patterns of the pulp tissue associated with symptomatic irreversible pulpitis.MethodsThe material consisted of 32 extracted teeth with untreated deep caries that were clinically and histologically diagnosed with irreversible pulpitis and were part of the histopathologic collection of 1 of the authors. The controls consisted of intact teeth with normal uninflamed pulps and teeth with reversible pulpitis. Teeth were processed for histopathologic and histobacteriologic analyses.ResultsAll teeth with irreversible pulpitis showed areas of severe acute inflammation, necrosis, microabscesses, and bacterial infection in the pulp chamber. These areas were surrounded by a chronic inflammatory infiltrate, and, at the distance, the pulp tissue was often uninflamed. Bacteria were also observed in the areas surrounding the necrotic foci, both as scattered cells through the extravascular space and at varying numbers within the blood vessel lumen. The number of bacteria and the density of the intravascular bacterial aggregations varied considerably. In one third of the cases, bacteria occurred in the lumen of venules in areas at a considerable distance from the necrotic focus in the coronal third of the root. No intravascular bacteria were noted in the middle and apical segments of the canal. No bacteria were found in the pulps of any of the control specimens.ConclusionsBacterial invasion and colonization of necrotic areas were observed in the pulp of all teeth with caries exposure and symptomatic irreversible pulpitis. Bacterial penetration of blood vessels occurred in all cases, suggesting that this may be an important mechanism of spread of bacterial infection through the pulp tissue in an endodontic infection.     

TheraCal LC和Dycal两种盖髓剂用于乳牙和恒牙直接盖髓的疗效比较

目的 比较TheraCal LC和Dycal两种盖髓剂用于乳、恒牙直接盖髓术的临床疗效。方法 选择深龋意外露髓的乳牙180颗和恒牙243颗做直接盖髓术,乳、恒牙均按单双数就诊顺序采用半随机方法分为两组,乳牙TheraCal LC组81例患者（90颗牙）;乳牙Dycal组76例患者（90颗牙）。恒牙TheraCal LC组102例患者（122颗牙）;恒牙Dycal组109例患者（121颗牙）。术后12个月,比较两种材料的治疗成功率。结果 治疗12个月后,恒牙TheraCal LC组成功率为95.1%,恒牙Dycal组成功率为93.3%,两组之间差异无统计学意义（P>0.05）。乳牙TheraCal LC组成功率为87.7%,乳牙Dycal组成功率为46.9%,两组之间有显著差异（P<0.05）。结论 TheraCal LC盖髓剂更适合乳、恒牙的盖髓剂,乳牙的优势可能更为明显。     

Partial pulpotomy as a treatment alternative for exposed pulps in crown-fractured permanent incisors

Abstract Sixty-three vital permanent incisors with complicated crown fractures were treated by partial pulpotomy and assessed clinically and radiographically for healing. Healing of the pulp was considered to have taken place when the following criteria were fulfilled: absence of clinical symptoms, radiographic evidence of dentin bridge formation, no intrapulpal or periapical pathosis, continued root development in immature teeth, and a positive response to electrical pulp testing. The treatment was successful in 59 teeth (94%). In the remaining 4 teeth, necrosis of the pulp was diagnosed clinically and radiographically 3 weeks to 6 months after treatment. The high frequency of healing in both the present and previous studies seems to justify recommending partial pulpotomy as the treatment of choice in crown-fractured teeth with pulp exposure.     

Irreversible but not reversible pulpitis is associated with up-regulation of tumour necrosis factor-alpha gene expression in human pulp

AIM: To analyse the gene expression of tumour necrosis factor-alpha (TNF-alpha) in human dental pulps, under normal and inflammatory conditions and to examine the association between any observed alterations in the expression of this cytokine with the severity of the clinical symptoms. METHODOLOGY: Eighteen pulpal samples were obtained from single-rooted human teeth. Six of the teeth were normal (group A), six had been diagnosed with reversible pulpitis (group B), and the remaining six were from teeth diagnosed with irreversible pulpitis (group C). TNF-alpha gene expression was semi-quantitatively analysed in each sample with RT-PCR, and the results from each group of teeth were compared with the Kruskal-Wallis and Mann-Whitney tests. RESULTS: Tumour necrosis factor-alpha was detected in all three groups of dental pulp. Statistical analysis provided evidence of a significant increase of TNF-alpha gene expression associated with irreversible inflammation compared with healthy controls (P = 0.002). No such difference was detected in reversibly inflamed pulp in comparison to healthy teeth (P = 0.699). CONCLUSION: Tumour necrosis factor-alpha gene expression in inflamed human dental pulp tissue is positively associated with the severity of clinical symptoms.     

Evaluation of Complete Pulpotomy With Biodentine on Mature Permanent Molars With Signs and Symptoms of Symptomatic Irreversible Pulpitis: 12-months Follow-up

IntroductionComplete pulpotomy is the removal of the coronal portion of a vital pulp and is a means of preserving the vitality of the remaining root portion. The objective of this study was to evaluate the 12-months success rate of complete pulpotomy with Biodentine on mature permanent molars with signs and symptoms of symptomatic irreversible pulpitis.Materials and methodsA total of 68 molars diagnosed with symptomatic irreversible pulpitis in 68 patients aged 20 years and older were included in this study. The exclusion criteria were intraoperative clinical signs of pulp necrosis on the molar to be treated such as no bleeding, or uncontrollable pulp hemorrhage (more than 5 minutes of hemostasis) on at least 1 canal. A complete pulpotomy with Biodentine was performed on molars with symptomatic irreversible pulpitis by the same operator and with the same protocol. A 12-months postoperative follow-up was conducted to evaluate clinical and radiologic success.ResultsA total of 66 patients received complete pulpotomy; 52 could be examined 12 months postoperatively. Clinical and radiologic analysis at 12 months postoperatively revealed a success rate of 87% (45 of 52 molars) and a failure rate of 13% (7 of 52 molars). There was a relationship between age, tooth type, and preoperative periapical condition and treatment success with P < .05.ConclusionCompliance with the indications and protocol for complete pulpotomy with Biodentine on mature permanent molars with symptomatic irreversible pulpitis gives positive results at the 12-month follow-up.     

Response to Pulp Sensibility Tests after Full Pulpotomy in Permanent Mandibular Teeth with Symptomatic Irreversible Pulpitis: A Retrospective Data Analysis

IntroductionThis retrospective study analyzed the 12-month pulp sensibility (cold and electric) test response after mineral trioxide aggregate (MTA) full pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis.MethodsThe records of 120 subjects from 3 completed and 1 ongoing clinical study on MTA full pulpotomy were retrieved. Ninety-six first and second mandibular molar teeth with a diagnosis of symptomatic irreversible pulpitis that underwent a single-visit MTA full pulpotomy and had completed a 12-month clinical, radiographic, and pulp sensibility (cold and electric) test follow-up were included. The data were analyzed using the Fisher exact test, the Pearson chi-square test, and the McNemar test. The significance level was predetermined at P < .05.ResultsA higher percentage of teeth (94.7%) responded to the electric pulp test in comparison with the cold test (13.5%) (P < .05). Sex-based responses to the electric pulp test (P > .05) and the cold test were similar (P > .05). The age-based response was similar for the electric pulp test (P > .05) but was significant for the cold test (P < .05). The tooth quadrant (left and right), the tooth (mandibular first and second molar), and the location of restoration (proximal or occlusal) did not influence the response of either the electric pulp test (P > .05) or the cold test (P > .05). At the 1-year follow-up, all the teeth that were classified as clinically and radiographically successful responded to the electric pulp test; however, only 13 teeth responded to the cold test (P = .00).ConclusionsThe majority (94.7%) of the teeth that underwent MTA full pulpotomy responded to the electric pulp test at a 1-year time interval.     

Bradykinin levels in dental pulp by microdialysis

Bradykinin is a potent mediator of pain and inflammation. To examine extracellular levels of bradykinin in human dental pulp, CMA/20 microdialysis probes were inserted into the pulp tissue of 22 teeth diagnosed with normal pulp or with irreversible pulpitis before their extraction or endodontic therapy. Probes were perfused with a modified Locke-Ringer's buffer and bradykinin levels in the dialysate evaluated using a radioimmunoassay. Mean extracellular levels of bradykinin within pulp tissue diagnosed with irreversible pulpitis were significantly higher (262.26 +/- 83.79 fmol/ml) than that found within normal pulp (19.41 +/- 6.47 fmol/ml). Highest levels of bradykinin were detected in pulp tissue diagnosed with irreversible pulpitis when the patient had reported pain in the past, compared with patients who were in pain just before their visit. These observations suggest that the bradykinin system is activated during pulpitis and may contribute to pain and inflammation.     

Effect of full pulpotomy using a calcium silicate–based bioactive ceramic in adult permanent teeth with symptoms indicative of irreversible pulpitis: A retrospective study

BackgroundThe authors studied the treatment effect of full pulpotomy using a calcium silicate–based bioactive ceramic in adult permanent teeth with symptoms indicative of irreversible pulpitis.MethodsEighty-one adult permanent teeth with symptoms indicative of irreversible pulpitis in 78 patients aged 18 through 72 years were evaluated for inclusion in the study. After caries excavation, the pulp was amputated to the level of the canal orifices. After hemostasis was achieved, calcium silicate–based bioactive ceramic was placed as the capping agent. The cavity was sealed temporarily with a glass ionomer cement and then restored with flowable resin and composite resin after 2 weeks if no positive symptoms were reported or detected. Postoperative evaluation was performed by means of clinical and radiographic examination at 2 weeks and 3, 6, and 12 months.ResultsOverall success rates of the procedure were 96.3% (78 of 81), 93.8% (76 of 81), 92.6% (75 of 81), and 92.6% (75 of 81) at the 2-week, 3-month, 6-month, and 12-month recall visits, respectively. Six of the 81 teeth failed and required root canal therapy. In these 6 teeth, 3 exhibited severe cold stimuli pain and spontaneous pain at the 2-week follow-up, 2 had no response to electric pulp testing with apical percussion pain and periapical rarefaction at the 3-month follow-up, and 1 tooth exhibited periapical rarefaction and labial mucosal fistula at the 6-month follow-up.ConclusionsUnder the conditions of this study, full pulpotomy using a calcium silicate–based bioactive ceramic was a successful option for the treatment of adult permanent teeth with carious originated symptoms indicative of irreversible pulpitis.Practical ImplicationsVital pulp therapy is no longer impossible for adult permanent teeth with carious originated symptoms indicative of irreversible pulpitis.     

Treatment of a Large Cystlike Inflammatory Periapical Lesion Associated with Mature Necrotic Teeth Using Regenerative Endodontic Therapy

Introduction

Regenerative endodontic therapy is currently used to treat immature permanent teeth with necrotic pulp and/or apical periodontitis. However, mature teeth with necrotic pulp and apical periodontitis have also been treated using regenerative endodontic therapy. The treatment resulted in resolution of apical periodontitis, regression of clinical signs and symptoms but no apparent thickening of the canal walls, and/or continued root development. A recent study in an animal model showed that the tissues formed in the canals of mature teeth with apical periodontitis after regenerative endodontic therapy were cementumlike, bonelike, and periodontal ligament–like tissue with numerous blood vessels. These tissues are similar to the tissues observed in immature permanent teeth with apical periodontitis after regenerative endodontic therapy.

Methods

A 23-year-old woman had a history of traumatic injury to her upper anterior teeth when she was 8 years old. Subsequently, #8 developed pulp necrosis and an acute apical abscess and #7 symptomatic apical periodontitis. The apex of #8 was slightly open, and the apex of #7 was completely formed. Instead of nonsurgical root canal therapy, regenerative endodontic therapy was attempted, including complete chemomechanical debridement on #8 and #7. This was based on the premise that filling of disinfected root canals with the host's biological vital tissue might be better than filling with foreign materials.

Results

After regenerative endodontic therapy of #8 and #7, there was radiographic evidence of periapical osseous healing and regression of clinical signs and symptoms. The pulp cavity of #8 decreased in size, and the apex closed. The pulp cavity of #7 appeared to be obliterated by mineralized tissue. These indicated ingrowth of new vital tissue into the chemomechanically debrided canals.

Conclusions

Regenerative endodontic therapy of mature teeth with apical periodontitis and apical abscess can result in the regression of clinical signs and/or symptoms and healing of apical periodontitis but no apparent thickening of the canal walls or continued root development. Filling of the disinfected canals with the host's vital tissue may be better than with foreign materials because vital tissue has innate and adaptive immune defense mechanisms.