Continued root development of immature permanent teeth after regenerative endodontics with or without a collagen membrane: A randomized, controlled clinical trial.

BACKGROUND: Recent studies evaluated the efficacy of a collagen membrane (Bio-Gide) to promote root development in regenerative endodontics (REPs). However, the influence of etiology and tooth type on the results was not assessed. AIMS: To evaluate the quantitative and qualitative effect of a collagen membrane (Bio-Gide), with and without the effect of etiology and tooth type, in promoting root development in immature teeth after REPs. DESIGN: Eighty nonvital immature teeth were divided randomly into two groups (40 teeth in each group). REPs were performed with (experimental group) and without (control group) a collagen membrane. All teeth were subjected to regular clinical and radiographical follow-up. RESULTS: Seventy-six teeth were included in the final analyses. The average follow-up periods were 33.1 ± 21.8 months for the control group and 28.1± 18.6 months for the experimental group. Quantitative analysis of root development in the experimental group showed a greater increase in dentin wall thickness in the middle one-third of the root compared to the control group, with or without the effect of etiology and tooth type. Six types of root development were observed. There was no significant difference in the type of tooth development between the two groups. CONCLUSION: The use of a collagen membrane could promote an increase in dentin wall thickness in the middle one-third of the root, and it had no significant effect in terms of the type of subsequent root development.

Clinical and Radiographic Assessment of the Efficacy of a Collagen Membrane in Regenerative Endodontics: A Randomized, Controlled Clinical Trial.

INTRODUCTION: Recent reviews confirm a general lack of randomized, controlled clinical studies on the efficacy of regenerative endodontics in immature teeth affected by pulp and periapical diseases. Moreover, we have no evidence of the curative efficacy of collagen membranes used as scaffolds in regenerative endodontics. Here, we evaluated whether a Bio-Gide collagen membrane (Geistlich Pharma AG, Wolhusen, Switzerland) has efficacy in promoting dentin formation in regenerative endodontics. METHODS: Forty-three patients yielding a total of 46 nonvital immature teeth were divided randomly into 2 groups. Subsequent to chemomechanical preparation, regenerative endodontics with (the experimental group) and without (the control group) Bio-Gide were performed. All cases were followed up clinically and radiographically every 3 months for at least 6 months. Quantitative analyses using an imaging program yielded percentage changes in root dimensions based on a comparison between preoperative and recall radiographs. RESULTS: The results of 40 patients (43 teeth) were included in the final analyses. All patients from both groups showed clinical success with complete resolution of signs and symptoms. Radiographically, the thickness of the dentin wall at the middle third of the root was higher for the experimental group than the control group. However, other indicators were comparable between both groups. CONCLUSIONS: The use of the Bio-Gide collagen membrane promoted the development of the dentin wall in the middle third of the root in patients undergoing regenerative endodontic procedures. The convenience of operation and the assured positioning of the sealing material make the Bio-Gide collagen membrane especially suitable for handling wide root canals.

Histologic Findings of a Human Immature Revascularized/Regenerated Tooth with Symptomatic Irreversible Pulpitis.

INTRODUCTION: Pulp revascularization/regeneration in immature permanent teeth with necrotic pulp and/or apical periodontitis is an effective approach for inducing root maturation. Previous histologic studies showed cementoid/osteoid tissue and/or periodontal ligament-like tissue formed within the root canals. This case report describes the histologic findings of a human symptomatic irreversible pulpitis immature permanent tooth with most of the pulp removed after a revascularization/regeneration procedure. METHODS: A human immature permanent mandibular premolar (tooth #29) was diagnosed as symptomatic irreversible pulpitis with symptomatic apical periodontitis at the emergency department. Most of the pulp was removed. The tooth was treated with revascularization/regeneration. RESULTS: At the 12-month recall, the radiographic examination revealed thickening of the root canal wall, narrowing of the root apex, and lengthening of the root. The tooth was extracted at 12 months for orthodontic treatment. The specimens were processed for histologic examination. Histologically, the apical third of the root canal was filled with newly formed dentinlike and pulplike tissue. There was a layer of flattened odontoblastlike cells lining the dentinal wall. In the midportion of the root canal, the newly formed dentinlike tissue gradually changed to cementumlike tissue. In the upper third of the root canal, there was a presence of cementocytelike cells housed in the lacunae of cementumlike tissue around the loose connective tissue. CONCLUSIONS: In the present case, regeneration of the pulplike tissue and the periodontium existed after a revascularization/regeneration procedure in an immature permanent tooth clinically diagnosed as symptomatic irreversible pulpitis.

Long-term treatment outcomes in immature permanent teeth by revascularisation using MTA and GIC as canal-sealing materials: a retrospective study.

BACKGROUND: Pulp revascularisation with MTA sealing has been accepted as an alternative treatment for non-vital immature permanent teeth. Successful revascularisation cases with GIC sealing were also reported, but lack of long-term researches. AIM: To evaluate long-term outcomes of revascularisation using MTA and GIC as canal-sealing materials in non-vital immature permanent teeth. DESIGN: Clinical and radiographic data of 60 non-vital immature permanent teeth treated with revascularisation (36.8 ± 12.4 months of follow-up) were reviewed. Of these, 28 teeth were sealed with MTA, and 32 with GIC. Tooth survival, success rate, and increases in root length and dentine wall thickness were evaluated. RESULTS: Teeth in MTA group showed a similar survival rate (96%) to GIC group (100%). The success rate in MTA group (93%) was greater than that in GIC group (59%). Eight of fourteen failed teeth due to recurrent apical disease (seven teeth in GIC group and one in MTA group) achieved complete root development. There was no statistically significant difference in root length or dentine wall thickness increase between the groups. CONCLUSIONS: Long-term outcome of revascularisation in non-vital immature permanent teeth sealed with GIC was not as good as that with MTA. Although more recurrent apical disease developed, results on root development were acceptable in GIC sealed cases.

[Mineral trioxide aggragate pulpotomy for the treatment of immature permanent teeth with irreversible pulpitis: a preliminary clinical study].

OBJECTIVE: To evaluate the preliminary clinical effect of mineral trioxide aggragate (MTA) pulpotomy on immature permanent teeth with irreversible pulpitis. METHODS: Twenty-six immature permanent teeth with irreversible pulpitis were recuited from Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology. These teeth were treated with partial or full pulpotomy according to the condition of pulp bleeding. MTA was used as pulp capping material. Patients were recalled periodically after the treatment. Clinical and radiographic effects were evaluated. RESULTS: At one year follow-up, 20 teeth were evaluated as healed or healing, 2 teeth were evaluated as failure and 4 teeth were dropped out. The success rate was considered 91% (20/22). A dentinal bridge was radiographcally observed underneath the pulpotomy site in 13 teeth(65%, 13/20). CONCLUSIONS: MTA pulpotomy is an effective method for the treatment of immature permanent teeth with irreversible pulpitis. But further research with longer follow up period is required.

[Pulp revascularization of immature teeth with apical periodontitis: a clinical study].

OBJECTIVE: To evaluate the clinical effect of pulp revascularization procedure for immature teeth with apical periodontitis. METHODS: Nine immature permanent teeth diagnosed with chronic or acute apical periodontitis were recruited. According to a standard pulp revascularization procedure, the canal was disinfected with copious irrigation and a combination of three antibiotics, followed by a blood clot created in the canal. Patients were recalled periodically after the treatment. Clinical and radiographic evidence of healing was evaluated. RESULTS: Eighteen to 24 months after treatment, 6 teeth showed complete resolution of the radiolucency and closure of the apex and thickening of the dentinal walls. One tooth showed healing of periodontal lesion, but the root mature was not observed. Two teeth had recurrent apical periodontitis and no evidence of healing. Apexification was performed later. CONCLUSIONS: Pulp revascularization could be an effective treatment for immature permanent teeth with apical periodontitis, and root elongation and narrowing canal space were observed in appropriate cases. If the treatment failed, traditional apexification could be started instead.