Limited evidence suggests benefits of single visit revascularization endodontic procedures - a systematic review

Abstract Revascularization endodontic procedures commonly require multiple treatment sessions. However, single visit procedures may be advantageous from the clinical and patient management standpoints. The purpose of this review was to evaluate the outcomes of single-visit revascularization endodontic procedures for the management of immature permanent teeth with non-vital pulp. Two electronic databases (Scopus and PubMed) were searched, from their inception to July 2018, for studies that assessed clinical and/or radiographic and/or histologic outcomes of single-visit revascularization endodontic procedures performed in immature permanent teeth with non-vital pulp. Case reports, animal studies and clinical trials were included. The quality of case reports was appraised by Joanna Briggs Institute Critical Appraisal Checklist for Case Reports. The quality of randomized clinical trials was assessed by the revised Cochrane risk of bias tool for randomized trials. The risk of bias for animal studies was assessed using SYRCLE's risk of bias tool. Tabulation followed by narrative synthesis was used to draw conclusions. Seven studies satisfied the selection criteria. Five were classified as case reports, one as a randomized clinical trial and one as animal study. The latter presented with a high risk of bias, whilst the remaining showed a low risk. The evidence supporting the potential use of single-visit revascularization endodontic procedures is scarce. Successful single-visit revascularization endodontic procedures commonly include the use of high concentrations of sodium hypochlorite and EDTA combined with the use of agitation systems. Further clinical trials with long term follow up are needed to confirm the results of the current review.

Resumo Os protocolos clínicos de procedimentos endodônticos de revascularização comumente requerem múltiplas sessões. Entretanto, procedimentos em única sessão podem apresentar vantagens clínicas relacionadas ao paciente. O objetivo desta revisão sistemática foi avaliar os resultados clínicos dos procedimentos endodônticos de revascularização para o manejo de dentes permanentes imaturos realizados em única visita. Duas bases de dados eletrônicas (Scopus e PubMed) foram utilizadas, do seu início à julho de 2018, buscando estudos que avaliaram resultados de procedimentos endodônticos clínicos e/ou radiográficos, e/ou histológicos da revascularização em sessão única realizados em dentes permanentes imaturos com necrose pulpar. Relatos de casos, estudos em animais e estudos clínicos foram incluídos e avaliados quanto à qualidade e risco de viés. A qualidade dos relatos de casos foi avaliada utilizando-se a ferramenta própria de análise crítica do Instituto Joanna Briggs. A qualidade dos estudos clínicos randomizados controlados foi analisada pela ferramenta de risco de viés da Cochrane. O risco de viés para os estudos em animais foi mensurado utilizando-se a ferramenta SYRCLE. Os dados foram tabulados e a síntese narrativa foi utilizada para análise dos mesmos. Sete estudos satisfizeram os critérios de inclusão. Cinco foram classificados como relatos de casos, um como ensaio clínico randomizado e um outro como estudo em modelo animal. Este último apresentou alto risco de viés, enquanto o restante dos estudos mostrou baixo risco. A evidência que apoia a utilização potencial de procedimentos endodônticos de revascularização em sessão única é escassa. Os procedimentos endodônticos de revascularização em sessão única geralmente incluem o uso de altas concentrações de hipoclorito de sódio e EDTA, combinadas com o uso de sistemas de agitação. Assim, estudos clínicos com longos períodos de acompanhamento são necessários para confirmação dos resultados do presente estudo.

Tissue characterization following revascularization of immature dog teeth using different disinfection pastes

Abstract Revascularization of immature teeth with necrotic pulps traditionally involves the use of triple antibiotic paste, which may sometimes lead to undesirable complications. The objective of this study was to assess tissue repair in immature dog teeth with apical periodontitis subjected to revascularization, comparing two different pastes used for root canal disinfection. Apical periodontitis was induced in 30 dog premolars. Teeth were randomly divided into three experimental groups: root canals filled with triple antibiotic paste (n = 10); root canals filled with 1% propolis paste (n = 10); and no medication (n = 10). An additional group (n = 10, no intervention) was used as control. After 7 months, the jaws were histologically evaluated for the following variables: newly formed mineralized tissue (present/absent); vital tissue in the canal space (absent/periodontal ligament-like/pulp-like); apical extension of root (present/absent); and severity of inflammatory process (absent/mild/moderate/severe). There were no statistically significant differences among the experimental groups in new mineralized tissue formation and apical root development. The formation of vital tissue in the canal space, in turn, was statistically different between the triple paste and propolis groups: vital tissues were present in all revascularized teeth disinfected with propolis paste (100%), compared to 71% of those disinfected with the triple paste. Severity of inflammatory process was different between the triple paste and no medication groups. The new tissues formed onto canal walls and in the root canal space showed characteristics of cementum and periodontal ligament, respectively. Propolis may have some advantages over the triple paste for the revascularization of immature teeth.