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BMC Oral Health
Published in: BMC Oral Health 1/2020

01-12-2020 | Dental Injuries | Research article

Outcome of revascularization therapy in traumatized immature incisors

Authors: Carolina W. Mittmann, Eckehard Kostka, Husam Ballout, Mareike Preus, Robert Preissner, Murat Karaman, Saskia Preissner

Published in: BMC Oral Health | Issue 1/2020

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Abstract

Background

The aim of this retrospective analysis was to evaluate the clinical and radiological outcome of revascularization therapy in traumatized permanent incisors to determine whether this approach could be implemented into clinical routine.

Methods

A total of 16 traumatized incisors (either avulsion or severe luxation/intrusion) with open apices (> 1 mm) that underwent revascularization following a standardized protocol were analyzed with a mean follow-up of 22 months. Radiographs and clinical parameters (such as root length, pulp space, dentin wall width, apical foramen, alveolar bone loss, ankylosis/mobility, supra−/infraposition, discoloration, probing depth) were compared pre- and postoperatively and statistically analyzed.

Results

Over the follow-up period, 81.3% of the teeth survived revascularization and regained sensitivity, while 18.7% failed, as they had to be extracted due to serious root resorption. Regarding radiographic outcomes a significant difference could only be found in the decrease of apical foramina (p = 0.04). The other parameters showed no significant difference between pre- and postoperative measurements. More than half of the teeth (56.3%) developed root resorptions and 31.3% displayed signs of ankylosis and 92.9% developed discolorations during follow-up. However, 85.7% of the teeth maintained the bone level and outcomes of mobility showed a significant solidification.

Conclusions

Revascularization is a promising approach for the treatment of immature incisors to regain sensitivity and to enhance apical closure and at least to maintain alveolar bone in terms of a socket preservation. Further studies have to be performed to determine ideal conditions (type of trauma, age, width of apical foramen) for a revascularization.
Literature
1.
Trope M. Treatment of the immature tooth with a non-vital pulp and apical periodontitis. Dent Clin N Am. 2010;54(2):313–24.PubMed
2.
Rafter M. Apexification: a review. Dent Traumatol. 2005;21(1):1–8.PubMed
3.
Cvek M. Treatment of non-vital permanent incisors with calcium hydroxide. I. Follow-up of periapical repair and apical closure of immature roots. Odontol Revy. 1972;23(1):27–44.PubMed
4.
Witherspoon DE, Small JC, Regan JD, Nunn M. Retrospective analysis of open apex teeth obturated with mineral trioxide aggregate. J Endod. 2008;34(10):1171–6.PubMed
5.
Holden DT, Schwartz SA, Kirkpatrick TC, Schindler WG. Clinical outcomes of artificial root-end barriers with mineral trioxide aggregate in teeth with immature apices. J Endod. 2008;34(7):812–7.PubMed
6.
Nagy MM, Tawfik HE, Hashem AA, Abu-Seida AM. Regenerative potential of immature permanent teeth with necrotic pulps after different regenerative protocols. J Endod. 2014;40(2):192–8.PubMed
7.
Cvek M. Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with gutta-percha. A retrospective clinical study. Endod Dent Traumatol. 1992;8(2):45–55.PubMed
8.
Ostby BN. The role of the blood clot in endodontic therapy. An experimental histologic study. Acta Odontol Scand. 1961;19:324–53.PubMed
9.
Iwaya SI, Ikawa M, Kubota M. Revascularization of an immature permanent tooth with apical periodontitis and sinus tract. Dent Traumatol. 2001;17(4):185–7.PubMed
10.
Banchs F, Trope M. Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol? J Endod. 2004;30(4):196–200.PubMed
11.
Galler KM. Clinical procedures for revitalization: current knowledge and considerations. Int Endod J. 2016;49(10):926–36.PubMed
12.
Thibodeau B. Case report: pulp revascularization of a necrotic, infected, immature, permanent tooth. Pediatr Dent. 2009;31(2):145–8.PubMed
13.
Saoud TM, Zaazou A, Nabil A, Moussa S, Lin LM, Gibbs JL. Clinical and radiographic outcomes of traumatized immature permanent necrotic teeth after revascularization/revitalization therapy. J Endod. 2014;40(12):1946–52.PubMedPubMedCentral
14.
El Ashiry EA, Farsi NM, Abuzeid ST, El Ashiry MM, Bahammam HA. Dental pulp revascularization of necrotic permanent teeth with immature apices. The J Clin Pediatr Dent. 2016;40(5):361–6.PubMed
15.
Estefan BS, El Batouty KM, Nagy MM, Diogenes A. Influence of age and apical diameter on the success of endodontic regeneration procedures. J Endod. 2016;42(11):1620–5.PubMed
16.
Bassetti R, Kuttenberger J, Bassetti M. Regenerative endodontics after front tooth trauma. A case report. Swiss Dent J. 2018;128(5):393–9.PubMed
17.
Miller EK, Lee JY, Tawil PZ, Teixeira FB, Vann WF Jr. Emerging therapies for the management of traumatized immature permanent incisors. Pediatr Dent. 2012;34(1):66–9.PubMed
18.
Petrino JA, Boda KK, Shambarger S, Bowles WR, McClanahan SB. Challenges in regenerative endodontics: a case series. J Endod. 2010;36(3):536–41.PubMed
19.
Ding RY, Cheung GS, Chen J, Yin XZ, Wang QQ, Zhang CF. Pulp revascularization of immature teeth with apical periodontitis: a clinical study. J Endod. 2009;35(5):745–9.PubMed
20.
Wang X, Thibodeau B, Trope M, Lin LM, Huang GT. Histologic characterization of regenerated tissues in canal space after the revitalization/revascularization procedure of immature dog teeth with apical periodontitis. J Endod. 2010;36(1):56–63.PubMed
21.
Jadhav G, Shah N, Logani A. Revascularization with and without platelet-rich plasma in nonvital, immature, anterior teeth: a pilot clinical study. J Endod. 2012;38(12):1581–7.PubMed
22.
Nagaveni NB, Poornima P, Joshi JS, Pathak S, Nandini DB. Revascularization of immature, nonvital permanent tooth using platelet-rich fibrin in children. Pediatr Dent. 2015;37(1):1–6.PubMed
23.
Ulusoy AT, Turedi I, Cimen M, Cehreli ZC. Evaluation of blood clot, platelet-rich plasma, platelet-rich fibrin, and platelet pellet as scaffolds in regenerative endodontic treatment: a prospective randomized trial. J Endod. 2019;45(5):560–6.PubMed
24.
Bukhari S, Kohli MR, Setzer F, Karabucak B. Outcome of revascularization procedure: a retrospective case series. J Endod. 2016;42(12):1752–9.PubMed
25.
Bose R, Nummikoski P, Hargreaves K. A retrospective evaluation of radiographic outcomes in immature teeth with necrotic root canal systems treated with regenerative endodontic procedures. J Endod. 2009;35(10):1343–9.PubMed
26.
Alobaid AS, Cortes LM, Lo J, Nguyen TT, Albert J, Abu-Melha AS, Lin LM, Gibbs JL. Radiographic and clinical outcomes of the treatment of immature permanent teeth by revascularization or apexification: a pilot retrospective cohort study. J Endod. 2014;40(8):1063–70.PubMedPubMedCentral
27.
Mankani N, Chowdhary R, Patil BA, Nagaraj E, Madalli P. Osseointegrated dental implants in growing children: a literature review. J Oral Implantol. 2014;40(5):627–31.PubMed
28.
Kim ST, Abbott PV, McGinley P. The effects of Ledermix paste on discolouration of immature teeth. Int Endod J. 2000;33(3):233–7.PubMed
29.
Kim ST, Abbott P. The effects of Ledermix paste as an intracanal medicament on the discolouration of teeth. Aust Endod J. 2000;26(2):86–7.PubMed
30.
Bortoluzzi EA, Araujo GS, Guerreiro Tanomaru JM, Tanomaru-Filho M. Marginal gingiva discoloration by gray MTA: a case report. J Endod. 2007;33(3):325–7.PubMed
31.
Madani Z, Alvandifar S, Bizhani A. Evaluation of tooth discoloration after treatment with mineral trioxide aggregate, calcium-enriched mixture, and biodentine((R)) in the presence and absence of blood. Dent Res J (Isfahan). 2019;16(6):377–83.
32.
Lenherr P, Allgayer N, Weiger R, Filippi A, Attin T, Krastl G. Tooth discoloration induced by endodontic materials: a laboratory study. Int Endod J. 2012;45(10):942–9.PubMed
33.
Becerra P, Ricucci D, Loghin S, Gibbs JL, Lin LM. Histologic study of a human immature permanent premolar with chronic apical abscess after revascularization/revitalization. J Endod. 2014;40(1):133–9.PubMed
34.
Shimizu E, Ricucci D, Albert J, Alobaid AS, Gibbs JL, Huang GT, Lin LM. Clinical, radiographic, and histological observation of a human immature permanent tooth with chronic apical abscess after revitalization treatment. J Endod. 2013;39(8):1078–83.PubMed
35.
Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM. Replantation of 400 avulsed permanent incisors. 2. Factors related to pulpal healing. Endod Dent Traumatol. 1995;11(2):59–68.PubMed
36.
Andreasen JO: Textbook and color atlas of traumatic injuries to the teeth, 3. ed., 1. print. edn. Copenhagen: Munksgaard u.a.; 1994.
37.
Chen H, Teixeira FB, Ritter AL, Levin L, Trope M. The effect of intracanal anti-inflammatory medicaments on external root resorption of replanted dog teeth after extended extra-oral dry time. Dent Traumatol. 2008;24(1):74–8.PubMed
38.
Andreasen JO, Hjorting-Hansen E. Replantation of teeth. I. Radiographic and clinical study of 110 human teeth replanted after accidental loss. Acta Odontol Scand. 1966;24(3):263–86.PubMed
39.
Andreasen JO, Hjorting-Hansen E. Replantation of teeth. II. Histological study of 22 replanted anterior teeth in humans. Acta Odontol Scand. 1966;24(3):287–306.PubMed
40.
Andreasen JO. Relationship between cell damage in the periodontal ligament after replantation and subsequent development of root resorption. A time-related study in monkeys. Acta Odontol Scand. 1981;39(1):15–25.PubMed
41.
Andersson L. Dentoalveolar ankylosis and associated root resorption in replanted teeth. Experimental and clinical studies in monkeys and man. Swed Dent J Suppl. 1988;56:1–75.PubMed
42.
Fuss Z, Tsesis I, Lin S. Root resorption--diagnosis, classification and treatment choices based on stimulation factors. Dent Traumatol. 2003;19(4):175–82.PubMed
43.
Panzarini SR, Gulinelli JL, Poi WR, Sonoda CK, Pedrini D, Brandini DA. Treatment of root surface in delayed tooth replantation: a review of literature. Dent Traumatol. 2008;24(3):277–82.PubMed
44.
Kawanami M, Andreasen JO, Borum MK, Schou S, Hjorting-Hansen E, Kato H. Infraposition of ankylosed permanent maxillary incisors after replantation related to age and sex. Endod Dent Traumatol. 1999;15(2):50–6.PubMed
45.
Andersson L, Malmgren B. The problem of dentoalveolar ankylosis and subsequent replacement resorption in the growing patient. Aust Endod J. 1999;25(2):57–61.PubMed
46.
Andreasen JO. Experimental dental traumatology: development of a model for external root resorption. Endod Dent Traumatol. 1987;3(6):269–87.PubMed
47.
Andreasen JO. Relationship between surface and inflammatory resorption and changes in the pulp after replantation of permanent incisors in monkeys. J Endod. 1981;7(7):294–301.PubMed
48.
Andreasen JO. The effect of pulp extirpation or root canal treatment on periodontal healing after replantation of permanent incisors in monkeys. J Endod. 1981;7(6):245–52.PubMed
49.
Hecova H, Tzigkounakis V, Merglova V, Netolicky J. A retrospective study of 889 injured permanent teeth. Dent Traumatol. 2010;26(6):466–75.PubMed
50.
Souza BDM, Dutra KL, Kuntze MM, Bortoluzzi EA, Flores-Mir C, Reyes-Carmona J, Felippe WT, Porporatti AL, De Luca CG. Incidence of root Resorption after the replantation of avulsed teeth: a meta-analysis. J Endod. 2018;44(8):1216–27.PubMed
51.
Chueh LH, Ho YC, Kuo TC, Lai WH, Chen YH, Chiang CP. Regenerative endodontic treatment for necrotic immature permanent teeth. J Endod. 2009;35(2):160–4.PubMed
52.
Andreasen JO, Borum MK, Andreasen FM. Replantation of 400 avulsed permanent incisors. 3. Factors related to root growth. Endod Dent Traumatol. 1995;11(2):69–75.PubMed
53.
Zeichner-David M, Oishi K, Su Z, Zakartchenko V, Chen LS, Arzate H, Bringas P Jr. Role of Hertwig's epithelial root sheath cells in tooth root development. Dev Dyn. 2003;228(4):651–63.PubMed
Metadata
Title
Outcome of revascularization therapy in traumatized immature incisors
Authors
Carolina W. Mittmann
Eckehard Kostka
Husam Ballout
Mareike Preus
Robert Preissner
Murat Karaman
Saskia Preissner
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Dental Injuries
Published in
BMC Oral Health / Issue 1/2020
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-020-01193-5

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