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RESUMEN: Introducción: La pulpotomía parcial se utiliza para el tratamiento de caries con exposición pulpar en dientes permanentes inmaduros. El agregado de trióxido mineral (MTA) ha sido propuesto como uno de los biomateriales de elección para el tratamiento, pero existe incertidumbre en relación a su efectividad comparado con la del hidróxido de calcio. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Encontramos cinco revisiones sistemáticas, que incluyeron tres estudios primarios, de los cuales todos corresponden a ensayos aleatorizados. Concluimos que la pulpotomía parcial con agregado de trióxido mineral (MTA) podría resultar en poca o nula diferencia en la tasa de éxito comparado a la pulpotomía parcial con hidróxido de calcio, pero la certeza de la evidencia es baja.
ABSTRACT: Introduction: Partial pulpotomy is the treatment of choice following carious pulp exposure in immature permanent teeth. Mineral trioxide aggregate (MTA) has been suggested as the biomaterial first option for treatment, but there is still uncertainty regarding its effectiveness compared to calcium hydroxide. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified five systematic reviews including three studies overall, of which all were randomized trials. We conclude that partial pulpotomy with mineral trioxide aggregate (MTA) may make little or no difference to success rate compared to partial pulpotomy with calcium hydroxide, however, the certainty of the evidence has been assessed as low.
Subject(s)
Humans , Pulpotomy/methods , Calcium Hydroxide/administration & dosage , Silicates/administration & dosage , Calcium Compounds/administration & dosage , Aluminum Compounds/administration & dosage , Dental Caries/therapy , Oxides , Decision Making , Drug CombinationsABSTRACT
Objetivo: Presentar la terapia regenerativa como una al- ternativa para la resolución de un caso de traumatismo denta- rio en un diente permanente incompletamente desarrollado. Caso clínico: Se realizó el tratamiento de un incisivo central superior con mortificación pulpar y periodontitis api- cal aguda subsecuente a trauma dental en un paciente de 8 años de edad. Se aplicó el protocolo de regeneración pulpar recomendado por la Asociación Americana de Endodoncia. Se estimuló la formación de un coágulo en el interior del con- ducto a partir de los tejidos periapicales, previa desinfección con la pasta triple antibiótica, y finalmente se colocó mineral trióxido agregado coronal a este. Se obtuvo así una matriz es- teril que permitió el crecimiento de nuevo tejido y se realiza- ron controles periódicos durante 4 años. Se constató silencio clínico. Radiográficamente, se observó la formación de tejido sobre las paredes del conducto y el cierre apical. Conclusión: La terapia regenerativa como alternativa de tratamiento, en este caso, permitió la disminución de la luz del conducto por el depósito de tejidos calcificados y el cierre del foramen apical, mejorando el pronóstico de la pieza dentaria (AU)
Aim: To present pulp regeneration therapy as an alter- native to resolve dental trauma in immature permanent teeth. Clinical case: We report a clinical case of an immature central superior incisor with pulp mortification and acute api- cal periodontitis subsequent to dental trauma, in an 8 year old patient. The pulp Regeneration protocol recommended by the American Endodontics Association was applied. We stimulated a clot formation inside the duct from periapical tissues and after disinfection with a mixture of three antibi- otics mineral trioxide aggregated was finally place coronal to the clot. Thus a sterile matrix was obtained that allowed new tissue's growth. Periodic check-up visits were carried out over a 4 years period. Clinical silence was observed. Tissue formation on duct walls and apical closure were radiograph- ically detected (AU) Conclusion: Regenerative therapy is an alternative for the treatment of immature permanent teeth, in ths clinical case it allowed the reduction of the width of the duct by the opposition of hard tissues and the closure of the apical fora- men improving the forecast of these teeth.
Subject(s)
Regeneration , Dentition, Permanent , Incisor/injuries , Periapical Periodontitis , Argentina , Root Canal Filling Materials/therapeutic use , Wound Healing/physiology , Tooth Injuries/complications , Dental Pulp Necrosis , Tooth Apex/growth & development , Dental Service, HospitalABSTRACT
Objective: To compare the outcome of pulpotomy of immature permanent teeth using calcium hydroxide (CH) and mineral trioxide aggregate (MTA) as sealing materials. Methods: This randomized controlled trial was carried out in the Department of Pediatric Dentistry, Punjab Dental Hospital, Lahore. Duration of the study was 9 months: 6 months data collection (February 01, 2016 to May 31, 2016, and August 01, 2016 to September 09, 2016) and 3 months follow up period (October 01, 2016 to December 31, 2016). Total of 110 patients was included in this study. They were divided into 2 groups; A and B, each comprising of 55 patients. All cases were treated by the same operative team. Conventional access cavity was formed and coronal pulp was removed to the cervical level using a sharp spoon excavator and a sterile round diamond bur. Results: There were 25 males (45.4%) and 30 females (54.6%) in calcium hydroxide group, while in the mineral trioxide aggregate group, there were 26 males (47.2%) and 29 females (52.8%) with a male to female ratios 1:1.2 and 1:1.1 respectively. The mean ± SD ages were 8.93 ± 1.82 and 8.89 ± 1.97 years. Total 44 patients (80%) have success and 11 patients (20%) have a failure in calcium hydroxide group, while in mineral trioxide aggregate group, 48 patients (87.2%) have success and 7 patients (12.8%) have a failure. Statistically, there was no significant difference (p>0.05) between the two groups. Conclusion: Mineral trioxide aggregate showed good clinical and radiographic success as a pulpotomy agent in immature permanent teeth and seems to be a suitable alternative to calcium hydroxide.
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Objective: To evaluate the feasibility of immature permanent teeth pulp regeneration with a new method that utilizes the integration of concentrated growth factor (CGF) as a scaffold and stromal cell-derived factor-1 (SDF-1). Methods: Canine dental pulp cells (DPC) were isolated and cultured in vitro. Then the effects of SDF-1 and CGF were observed on DPC proliferation and differentiation. The pulpless model was established on the beagle’s immature incisors which were divided into four groups: natural pulp (A), empty cannel (B), CGF-filling (C) and SDF-1/CGF-filling (D). After 10 weeks, specimens were checked by imaging examination, RT-PCR and histological observation. Results: CGF extraction (CGFe) induced DPC proliferation while the combination of SDF-1 and CGFe enhanced this effect and also facilitated odontogenic and angiogenic differentiation of DPC. According to imaging examination, the apex growth of all four groups was in varying degrees. RT-PCR indicated the expressions of odontogenesis and angiogenesis related genes in group D were higher than those in group C. Besides, neonatal dentin and dental-pulp-like tissue were observed inside the canal of both group C and D, while only cementum-like tissue existed around root apex of group B. Conclusion:SDF-1 plays an important role in driving the process of pulp-like-tissue regeneration of immature permanent teeth by using CGF as an effective scaffold.
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Introdução: Dentes permanentes imaturos que evoluem para necrose pulpar representam um desafio para tratamento endodôntico. A endodontia regenerativa e técnicas de revascularização pulpar surgem como um campo dinâmico e potencialmente ideal para terapia clínica em dentes com desenvolvimento radicular incompleto. Objetivo: Revisar a literatura sobre as técnicas de revascularização pulpar no tratamento de dentes com ausência de vitalidade pulpar com ápice radicular imaturo. Métodos: Os descritores "pulp revascularization", "pulp necrosis", "immature permanent tooth", "revascularization", "revitalization", "dental pulp", "regeneration" foram utilizados para obtenção de artigos em língua inglesa, que apresentassem conteúdo disponibilizado na íntegra e publicados nos últimos 15 anos. Foram excluídos os trabalhos de relatos de caso e/ou séries de casos. Conclusão: Artigos revisados apresentaram uma heterogeneidade de resultados quanto à efetividade da técnica de revascularização pulpar, visto que os critérios estabelecidos para determinação do sucesso variavam entre os autores. O material mais comumente utilizado na técnica empregada consiste no Agregado Trióxido Mineral (MTA) em consistência pastosa aplicada sobre coágulo sanguíneo com formação induzida no interior do canal. Foi observada escassez de estudos laboratoriais e clínicos sobre as técnicas e materiais em revascularização pulpar, que suportem sua indicação, o que representa uma lacuna em potencial na literatura e requer cautela na indicação desta técnica.
Introduction: Immature permanent teeth that evolve to pulp necrosis represent a challenge for endodontic treatment. Regenerative endodontics and pulp revascularization techniques appear as a dynamic and potentially ideal field for clinical therapy in teeth with incomplete root development. Objective: To review the literature on pulpal revascularization techniques in the treatment of teeth with absence of pulp vitality with immature root apex. Methods: The descriptors "pulp revascularization", "pulp necrosis", "immature permanent tooth", "revascularization", "revitalization", "dental pulp" and "regeneration" were used to obtain articles in English that presented content available in full and published in the last 15 years. Works of case reports and/or series of cases were excluded. Conclusion: Reviewed articles presented a heterogeneity of results regarding the effectiveness of the pulp revascularization technique, since the established criteria for determining success varied among the authors. The material most commonly used in the technique used consists of the Mineral Trioxide Aggregate (MTA) in paste consistency applied on blood clot with induced formation inside the canal. A shortage of laboratory and clinical studies on pulp revascularization techniques and materials that support its indication has been observed, which represents a potential gap in the literature and requires caution in the indication of this technique.
Subject(s)
Dental Pulp Necrosis , Dental PulpABSTRACT
@#Tooth avulsion is one of the most serious case of all traumatic injuries, frequently found in the immature permanent teeth. The common treatment for avulsed permanent tooth is replantation and splint fixation. However it usually results in root inflammation, root absorption and ankylosis, eventually lead to extraction. The present report describes a 8-year-old boy with two immature mandibular central incisors avulsed three hours after the accident. Replantation was performed, and the teeth were splinted. Radiographic and clinical examinations were performed during 15 months follow-up. At present, the avulsed teeth have a favorable prognosis, and remained in a stable functional position and did not reveal root inflammation, root absorption and ankylosis.
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Objective: To evaluate the effects of calcium hydroxide [Ca(OH)2]in the treatment of immature permanent tooth pulp infection. Methods: 36 immature permanent teeth with pulp necrosis or periapical periodontitis were randomly divided into 2 groups (n = 18). The teeth in experimental group were treated with [Ca(OH)2]and in control group with triple antibiotic paste ciprofloxacin + metronidazole + minocycline(TAP). Then the periapical condition and root growth were evaluated by clinical follow up and Xray examination. Follow-up was conducted at 3rd, 6th, 12th, 18th and 24th month after operation. Results: The roots of 10 teeth were developed and 8 teeth apical foramen were reduced in experimental group. The roots of 13 teeth were developed and 5 teeth apical foramen were reduced in control group. There is no statistic difference between the groups. Conclusion: Calcium hydroxide is as effective as TAP in the treatment of immature permanent tooth pulp infection.
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<p><b>OBJECTIVE</b>The prevalence rate, distribution, and reasons of immature permanent-tooth trauma in Xi'an were investigated and described, and a scientific basis was provided for the decision-making of health-administration departments.</p><p><b>METHODS</b>Through cluster and simple random sampling survey, 4 013 pupils in schools from nine districts and four counties in Xi'an were sampled. All pupils and their parents were requested to complete a questionnaire. Oral examinations were conducted for children who had immature permanent teeth trauma. The number of trauma teeth and teeth were recorded. Survey data were analyzed statistically.</p><p><b>RESULTS</b>The prevalence rate of immature permanent dental trauma was 10.5% in Xi'an. No significant differences were observed between districts and counties (P>0.05). The peak age of permanent dental trauma was at 7-9 years old, and the most was at 8 years old (31.5%). The first reason of trauma was falling down (50.9%), and the second reason was crash (36.0%). The most common trauma teeth were maxillary incisors (75.4%).</p><p><b>CONCLUSIONS</b>The prevalence rate of immature permanent teeth trauma in Xi'an was in the middle of all international levels. Children, who are vulnerable to dental trauma at their age, should be provided with appropriate prevention measures to reduce the incidence of dental trauma.</p>
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<p><b>OBJECTIVE</b>This study aims to investigate the clinical visiting and prognosis of schoolchildren in Xi'an after immature permanent tooth trauma and explore the prognostic factors associated with this type of trauma.</p><p><b>METHODS</b>Through cluster and simple random sampling surveys, 4 013 pupils in schools from nine districts and four counties in Xi'an were sampled, respectively. All pupils and their parents were requested to complete a questionnaire, and children who had immature permanent tooth trauma answered a separate questionnaire and underwent oral examinations. The data of the survey were analyzed statistically.</p><p><b>RESULTS</b>The amount of valid questionnaire was 3 641. Clinical visiting rate related to immature permanent tooth trauma of Xi'an schoolchildren was low (38.2%). Gender and trauma type were the factors related to clinical visiting for dental trauma concerns. The incidence of poor prognosis was 29.7%. The incidence of poor prognosis of patients with clinical visiting (35.4%) was higher than that of patients without clinical visiting (20.6%).</p><p><b>CONCLUSIONS</b>Clinical visiting rate related to immature permanent tooth trauma in Xi'an schoolchildren is extremely low, and incidence of poor prognosis is high.</p>
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Objective:To evaluate the clinical effect of the revaseularization procedure for immature teeth with necrotic pulp and apical periodontitis.Methods:12 immature teeth with necrotic pulp and apical periodontitis in 12 patients(9-13 years old) were treated with revascularization protocol.The patients were followed up for 21-24 months.Results:All teeth were cured.4 types of responses were observed:①Increased thickening of the canal walls and continued root maturation;②Severe calcification of the canal space beneath MTA;③Partial pulp canal obliteration;④Continued root development with an open apex.Conclusion:Revascularization procedure may the formation of the root apex but not in all the cases.Excessive deposition of hard tissue might caused calcification in canal space.
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Objective@#To evaluate the treatment effectiveness of revascularization in immature permanent teeth with diffuse pulpitis and to provide an alternative approach for the treatment of these teeth.@*Methods@#Clinical and radiographic data were collected from 17 immature permanent teeth which were diagnosed as diffuse pulpitis and with their pulp extirpated at Emergency Department of Peking University School and Hospital of Stomatology. All these teeth were treated using pulp revascularization at Department of Pediatric Dentistry. Clinical success rate was then evaluated based on the clinical and radiographic findings. The increase of root length and dentin wall thickness of the revascularized teeth and the contralateral control teeth were measured and compared according to the preoperative and recall periapical radiographs.@*Results@#The average follow-uptime is (25.8±9.9) months (12-46 months). Totally 13 out of the 17 teeth showed normal clinical and radiographic manifestation and achieved the increasein root length and dentin wall thickness. They met criteria for success treatment. The rest 4 out of the 17 teeth also showed root length and dentin wall thickness increaseand apical foramen closure. However, periapical inflammations were observed during 12 to 36 monthfollow-ups. These cases were recognized as failed. In all the17 teeth, the increase of root length and dentin wall thickness was not significantly different between the revascularized teeth and the contralateral control teeth (P>0.05).@*Conclusions@#Pulp revascularization in young permanent teeth with diffuse pulpitis resulted in similar clinical outcomes in root development and root canal wall formation compared with the contralateral control teeth. However, reinfection might occur during long-term follow-up.
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Mineral trioxide aggregate appears to be a promising alternative to calcium hydroxide apexification because of its high biocompatibility, superior sealing ability and reduced treatment time.. Two case reports where the patients presented with fractured upper anterior teeth. Radiographic evaluation revealed open apices with blunderbuss canals. Apical stop was created with mineral trioxide aggregate by apexification and the root canals were obturated with thermoplasticized guttapercha.