ABSTRACT
Abstract This case report discusses the endodontic treatment of a 7-year-old girl who suffered trauma (intrusion) to the immature upper central incisors secondary to a fall from a bicycle. Thirty days after the accident the patient was brought by her mother for clinical and radiographic assessment with a chief complaint of swelling and tenderness to percussion and palpation. Acute apical abscess associated with immature teeth were diagnosed. A decision was made to perform regenerative endodontic treatment. Access cavities were made and the root canals were disinfected by irrigation with 2.5% sodium hypochlorite. Final irrigation was performed with 17% EDTA. Due to pain and presence of secretions, 2% chlorhexidine gel was applied as an intracanal medicament. Seven days later, at the second visit, the root canals were once again disinfected and the canals of the right and left permanent upper central incisors were filled with double antibiotic paste (metronidazole/ciprofloxacin) and calcium hydroxide paste, respectively. Zinc oxide was mixed in both pastes. At the third visit, after 21 more days, the pastes were removed and the periapical areas were stimulated with a #80 K-file to encourage clot formation within the pulp cavities. A mineral trioxide aggregate (MTA) paste cervical plug was placed and the teeth were restored with glass ionomer cement. Radiographs and CBCT scans demonstrated complete root formations. The patient has been followed for 12 years, with evidence of clinical success throughout.
Resumo Este relato de caso discute o tratamento endodôntico de uma menina de 7 anos que sofreu trauma nos incisivos centrais superiores imaturos, após queda de bicicleta. Trinta dias após o acidente, a paciente foi levada pela mãe para avaliação clínica e radiográfica com queixa principal de inchaço e sensibilidade à percussão e palpação. Foram diagnosticados abscessos apicais agudos em ambos os dentes. Foi decidido por realizar o tratamento endodôntico regenerativo. Após acessos coronários, os canais radiculares foram submetidos à protocolos de antissepsia com auxílio de irrigação com hipoclorito de sódio a 2,5% e EDTA 17%. Devido à dor e presença de secreções, foi utilizada medicação intracanal com clorexidina gel 2% por 7 dias. Na segunda sessão, os canais radiculares foram novamente submetidos aos procedimentos de antissepsia e os canais dos incisivos centrais superiores permanentes direito e esquerdo foram preenchidos com pasta antibiótica dupla (Metronidazol / Ciprofloxacina) e pasta de hidróxido de cálcio, respectivamente. Em ambas as pastas foi adicionado o óxido de zinco. Na terceira sessão, após mais 21 dias, as pastas foram removidas e as regiões periapicais foram estimuladas com lima K nº 80 para incentivar a formação de coágulos sanguíneos no interior das cavidades pulpares. Tampões cervicais de MTA foram adaptados e os dentes restaurados com cimento de ionômero de vidro resinoso. Radiografias e tomografias computadorizadas demonstraram formações radiculares completas. A paciente é acompanhada há 12 anos, com evidências clínicas e radiográficas de sucesso.
Subject(s)
Humans , Female , Child , Regenerative Endodontics , Incisor , Oxides , Follow-Up Studies , Silicates , Calcium Compounds , Dental Pulp Necrosis , Abscess , Drug CombinationsABSTRACT
Objetivo: O objetivo deste artigo é apresentar o relato de um caso clínico de luxação extrusiva de dente permanente com rizogênese incompleta, onde não foi necessária a realização de intervenção endodôntica. Relato de caso: Paciente de 6 anos de idade compareceu ao serviço de urgência da Policlínica Odontológica da Universidade do Estado do Amazonas (UEA) para atendimento após queda durante atividade de lazer, apresentando traumatismo direto na boca. Foi informado durante a consulta inicial que o incidente havia ocorrido há cerca de três dias, e que o atendimento imediato logo após o trauma foi realizado em um Serviço de Pronto Atendimento, porém, nenhum tipo de procedimento na cavidade oral foi realizado. Após exames clínico e radiográfico observou-se que o dente 21 apresentava deslocamento parcial para fora do alvéolo dentário no sentido axial, com alteração da oclusão, dor local à palpação e mobilidade dentária. Foi realizada profilaxia da área afetada, e anestesia do dente luxado e tecidos adjacentes. O reposicionamento do dente foi realizado em seguida, pressionando-o e tracionando-o de forma suave e contínua até a sua correta posição dentro do alvéolo. A área afetada foi limpa com gaze estéril embebida em soro fisiológico, e foi instalada uma contenção rígida confeccionada com fio ortodôntico e resina composta. Conclusão: O reposicionamento da maneira adequada do dente traumatizado dentro do alvéolo dentário, num período de tempo hábil, seguido de sua proservação, permitiram a manutenção da vitalidade do tecido pulpar, e consequentemente, o desenvolvimento do segmento radicular.
Objective: The objective of this article is to present a clinical case of extrusive luxation of an immature permanent tooth, with no endodontic management. Case report: A 6-year-old patient was provided to emergency treatment at the State University of Amazonas, as a result of a fall, with a direct trauma to the mouth. It was informed during the initial consultation that the incidente has occurred three days after. Emergency examination had been carried out by an Emergency Service; however, any type of procedure in the oral cavity was performed in ths occasion. After clinical and radiographic examinations, it was observed that tooth 21 presented partial displacement from the alveolar socket in the axial direction, with occlusion alteration, local pain to palpation and dental mobility. Cleaning of the affected area and anesthesia of the dislocated tooth and adjacent tissues were performed. Then, tooth repositioning was performed by pressing and tracing it smoothly and continuously until its correct position within the alveolar socket. The affected area was cleaned with sterile gauze soaked in saline solution, and a rigid containment made of orthodontic wire and composite resin was installed. Conclusion: A proper repositioning of the traumatized tooth within the alveolar socket, followed by its clinical followup, allowed the pulp tissue to remain vital, and consequently, the complete development of the root portion
ABSTRACT
Objective@#To evaluate the effect of exogenous stem cells from apical papillae (SCAP) in the pulp revascularization treatment for the immature permanent tooth with periapical periodontitis in animal model.@*Methods@#After the SCAP were isolated and cultured from the Beagle dogs, stem cell properties of these cells were characterized by analyzing their colony-forming ability, the expression of mesenchymal stem cell markers and the multidifferentiation characteristics including osteogenic, adipogenic, and chondrogenic potentials. Models of young permanent tooth with periapical periodontitis were established in dogs and the infection in each of the model tooth was eliminated by root canal irrigation and intracanal medication. After that, all of the model teeth were randomly divided into 4 groups: Group 1: normal developing teeth with no treatment applied;Group 2: teeth that periapical tissues were irritated to induce blood flowing into the root canals;Group 3: teeth that peripheral blood was delivered into the root canals;Group 4: teeth that SCAP were resuspended in peripheral blood and delivered into the root canals. In Group 2-4, firm coronal seal was performed after revascularization procedure and radiographs were taken periodically in order to observe the development of roots. After a 12-week-period, alveolar samples were collected and observed histologically.@*Results@#The isolated SCAP showed clonogenic ability and multilineage differentiation ability including osteogenic, adipogenic and chondrogenic potentials. These cells also expressed the mesenchymal stem cell markers such as STRO-1 and CD146, while no cytokeratin was detected. The thickening of canal wall was observed radiographically 12 weeks after procedures of infection control and revascularization. Histologically, the newly formed tissues on the inner canal wall were found bone lacuna like structure in Group 2 and 3, and the new tissue formed in the Group 3 seemed easy to separate from the canal wall. The newly formed tissues in Group 4 were much thicker compare to those in the Group 2 and 3, and the dentine tubule like structure instead of bone lacuna was noticed although the orientation of these tubules were various.@*Conclusions@#SCAP seem to play an important role in the tissue regeneration procedure when infection is well controlled in young permanent teeth with periapical periodontitis. It is difficult to achieve real tissue regeneration due to the lack of endogenous SCAP in apical area, therefore delivering adequate exogenous SCAP isolated and cultured in vitro could be a promising approach to overcome the challenge.
ABSTRACT
The purpose of this study was to analyze the ratio and rate of apical closure when inducing root growth of necrotic immature permanent teeth using alternative triple antibiotics. 24 permanent teeth in the treatment group and 27 premolars in the control group were retrospectively studied using periapical radiographs for more than 300 days after the first visit. The difference in the growth rate between the two groups was statistically compared using the Mann-Whitney test at a significance level of 0.05. There were no statistically significant differences between the two groups in the first month and during months 1 – 3, 3 – 6, and 6 – 12. After 12 months, the cumulative rate of decrease in the apical foramen width in the treatment group was 50.59% and that in the control group was 71.82%, which revealed a significant difference between the two groups. There were significant differences in the rates of decrease in the apical foramen width after 3, 6 months, and later period in the treatment group, respectively. The cumulative rate of increase in the root dentin area presented no statistically significant differences between the treatment group and control group during the entire period of examination.
Subject(s)
Anti-Bacterial Agents , Bicuspid , Dentin , Retrospective Studies , Tooth Apex , ToothABSTRACT
Mineral trioxide aggregate (MTA) is widely used in endodontic therapy as a pulp-capping material, root or furcal perforation repair material, and for apexification and obturation of the root canal system. The purpose of this study was to formally document cases of MTA application in South Korean children and adolescents. Through this research, the practice of using MTA will be introduced and familiarized to the clinical practitioners. This study involved endodontic treatment using MTA for fractured crowns in 11- and 12-year-old. The children were followed up for 12 months until the pulp vitality was confirmed; in young permanent teeth with immature roots, the pulp is integral to the process of apexogenesis. These observational results regarding the use of MTA as an apexification material in non-vital immature permanent incisors appear to provide promising results in the search for new materials to meet existing endodontic needs.
Subject(s)
Adolescent , Child , Humans , Apexification , Crowns , Dental Pulp Cavity , Incisor , Miners , Pemetrexed , ToothABSTRACT
Abstract: Treatment of non-vital immature teeth with apical periodontitis has always been a challenge in Endodontics. Regenerative endodontic treatment (RET) has been successfully used for the management of these cases. The aim of this study is to present a case of RET used for the retreatment of a previously endodontically treated permanent tooth with an open apex. A 14-year-old boy with a poor endodontic treatment done on his maxillary right central incisor developed symptomatic apical periodontitis. Radiographically, incomplete root development with thin dentinal walls and an open apex were evident. After accessing and removing previous filling materials, the canal was copiously irrigated with 2.5% sodium hypochlorite. A triple antibiotic paste was placed inside the canal and left for 15 days. After removal of the antibiotic mixture, bleeding was induced into the canal by passing a hand file out of the apex. A collagen membrane barrier was placed over the blood clot, followed by sealing with mineral trioxide aggregate. Access was sealed with permanent filling materials. Clinical examination at 12, 24 and 36 months revealed no symptoms. Radiographic examination showed resolution of the periapical lesion and apical closure. Sensitivity tests with cold and an electric pulp test elicited a negative response at all recall periods. On the basis of long-term results, RET may be an effective option for the retreatment of an immature permanent tooth with a failed previous treatment and periapical periodontitis.
Subject(s)
Humans , Adolescent , Adult , Root Canal Therapy , Tooth Apex/surgery , Aluminum Compounds/administration & dosage , Anti-Bacterial Agents/administration & dosage , Calcium Compounds/administration & dosage , Drug Combinations , Oxides/administration & dosage , Root Canal Filling Materials , Silicates/administration & dosageABSTRACT
This study describes the treatment of an immature permanent tooth with periapical lesion which was treated with regenerative approach using platelet rich plasma (PRP). The root canal of immature human permanent tooth with periapical lesion was gently debrided of necrotic tissue and disinfected with 2.5% NaOCl, and then medicated with triple antibiotic paste comprised of ciprofloxacin, metronidazole, and tetracycline. When the tooth was asymptomatic, PRP and mineral trioxide aggregate (MTA) were placed into the root canal. Six months after PRP treatment, radiographical examination revealed resolution of the radiolucency and progressive thickening of the root wall and apical closure. Our findings suggest that PRP can be used for the treatment of immature permanent teeth with periapical lesion, as part of a regenerative endodontic treatment procedure.
Subject(s)
Humans , Ciprofloxacin , Dental Pulp Cavity , Metronidazole , Platelet-Rich Plasma , Tetracycline , ToothABSTRACT
This study describes the treatment of an immature permanent tooth with periapical lesion which was treated with regenerative approach using platelet rich plasma (PRP). The root canal of immature human permanent tooth with periapical lesion was gently debrided of necrotic tissue and disinfected with 2.5% NaOCl, and then medicated with triple antibiotic paste comprised of ciprofloxacin, metronidazole, and tetracycline. When the tooth was asymptomatic, PRP and mineral trioxide aggregate (MTA) were placed into the root canal. Six months after PRP treatment, radiographical examination revealed resolution of the radiolucency and progressive thickening of the root wall and apical closure. Our findings suggest that PRP can be used for the treatment of immature permanent teeth with periapical lesion, as part of a regenerative endodontic treatment procedure.
Subject(s)
Humans , Ciprofloxacin , Dental Pulp Cavity , Metronidazole , Platelet-Rich Plasma , Tetracycline , ToothABSTRACT
O tratamento de dentes com rizogênese incompleta e necrose pulpar representa grande desafio para a terapia endodôntica. O panorama atual recai no conceito de regeneração do tecido pulpar. A endodontia regenerativa propõe o controle da infecção do sistema de canais radiculares, com o mínimo de ação dos instrumentos, farta irrigação. Vários protocolos têm sido propostos com variáveis pequenas, sem um consenso entre os autores. O presente artigo descreve e discute os três principais protocolos e suas variáveis, especificando os pontos mais obscuros de uma terapia que é o mais excitante novo campo da Endodontia e cujos avanços proporcionarão benefícios inestimáveis para toda a população. Importa considerar que o sucesso da regeneração deve atender três principais objetivos: primeiro aeliminação dos sintomas e a evidenciação de reparo dos tecidos periapicais; segundo promover espessamento das paredes do canal e/ou a continuidade da formação radicular (desejável, mas não essencial) e terceiro, obter resposta positiva aos testes de vitalidade, que, se alcançado certamente indicará a presença de um tecido pulpar mais organizado.
Treatment of immature permanent teeth with pulpal necrosis presents a unique challenge to the endodontists. The current panorama lies in the concept of pulpal tissue regeneration. Endodontic regeneration is based on the control of endodontic infection with minimal instrumentation and plentiful irrigation of the root canal system. Different protocols have been suggested with very little differences. The aim of this article is to present the main three basic protocols and their variables, specifying the darkest points of a therapy that is the most exciting new of Endodontics and advances will provide invaluable benefits to the entire population. It considers that the success of regeneration must meet three main goals: primary: the elimination of the symptoms and the evidence of bony healing; secondary: increased root wall thickness and/or increased root length (desirable but perhaps not essential); tertiary: positive response to vitality testing (wich, if achieved, could indicate a more organized vital pulp tissue).