Revascularization Outcomes: A Prospective Analysis of 16 Consecutive Cases

By Kahler B, Mistry S, Moule A, Ringsmuth AK, Case P, Thomson A, Holcombe T.

Date: 01/2014
Journal: JOE

Purpose:

  • Present a preliminary prospective analysis of 16 teeth in 12 consecutive patients where a standardized protocol for regenerative endodontic procedure was undertaken for the treatment of immature infected teeth.

Materials/Methods:

  • N= n=16 teeth (13 incisors, 3 PM’s) – Ave age 10 yo.
  • Exclusion criteria: Closed apex and any longitudinal fracture of the root.
  • Inclusion criteria: Open apex that was considered as greater than 1.1 mm in diameter.
  • Positive/negative control: N/A
  • Control & Design: Tooth accessed, WL confirmed w/apex locator and radiograph. Irrigation w/1% NaOCl2 mm short of WL. Canal dried w/paper points. TAP (metro, cipro, amox – mixed w/1mL sterile water) placed with lentulo. Canal filled below CEJ. 4 mm Cavit w/Fuji IX placed as temp.
  • Teeth reviewed 4 wks later. Re-access, irrigated, dried w/paper points. Where possible, blood was allowed to clot to a level 3mm below the CEJ. 3mm white MTA placed onto clot. Access sealed w/3mm GI.
  • The teeth were reviewed 6 months after access closure for at least 18 months.
  • Qualitative and Quantitative analyses used to determine change in root, dentin thickness.
  • Criteria of evaluation: TurboReg plug-in used to evaluate change in root length, width

Results:

  • Qualitative assessment:
    • 90.3% resolution of PA radiolucency
    • Apical closure assessed as incomplete in 47.2% and complete apical closure in 19.4%
  • Quantitative assessment:
    • Change in root length: -2.7% to 25.3%
    • Change in dentin thickness: -1.9% to 72.6%
    • Discoloration was common result, w/unaesthetic results in 10/16 cases
    • 2 cases continued root development through 36 mo’s

Clinical Significance:

The results of this study have showed that the pattern for further root maturation of roots after regenerative procedures was variable when assessed at 18 months, although in almost all cases, periapical pathology appeared to resolve completely.