1
|
Alsofi L, Almarzouki S. Failed Regenerative Endodontic Case Treated by Modified Aspiration-irrigation Technique and Apexification. J Contemp Dent Pract 2024; 25:92-97. [PMID: 38514438 DOI: 10.5005/jp-journals-10024-3601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
AIM This report addresses the management of a large persistent discharging lesion in an 11-year-old boy. The report describes the use of aspiration-irrigation technique for the management of immature necrotic tooth with persistent discharge after a failed regenerative procedure. BACKGROUND Regenerative endodontics aim to provide an increase in root canal width, length, and in apical closure. Alternative procedures, such as apexification, should be attempted when regeneration fails. If the canal cannot be dried to persistent discharge, the aspiration-irrigation technique can be used. The technique relies on using aspiration along with irrigation to remove pus from the periapical area. CASE DESCRIPTION This is a case for an 11-year-old patient who had trauma to tooth #11, which resulted in the complicated crown fracture. He had an emergency management that included pulpectomy and intracanal medication at another clinic. Two years later, the patient was presented to our clinic. Upon examination, the diagnosis was previously initiated therapy with asymptomatic apical periodontitis in immature tooth #11. Regeneration was attempted first but failed. The mineral trioxide aggregate (MTA) plug was removed, and the canal had persistent pus discharge. The canal was filled with intracanal medication, and then 2 weeks later, the canal was filled with triple antibiotic paste (TAP). Next visit, and due to continuous discharge, tooth #11 was treated conservatively with an intracanal aspiration-irrigation technique. An IrriFlex needle attached to a high-volume suction was used to aspirate the cystic fluid. Mineral trioxide aggregate plug apexification was performed in a later visit and the tooth was restored. CONCLUSION During the 3-month and 16-month follow-up, there was resolution of the symptoms, a decrease in the periapical lesion size, and soft tissues appeared within normal limits. CLINICAL SIGNIFICANCE Regenerative procedures are a good option for immature necrotic teeth. These procedures may fail due to persistent pus discharge from the root canals. The aspiration-irrigation technique is a good treatment option in cases of consciously discharging canals. How to cite this article: Alsofi L, Almarzouki S. Failed Regenerative Endodontic Case Treated by Modified Aspiration-irrigation Technique and Apexification. J Contemp Dent Pract 2024;25(1):92-97.
Collapse
Affiliation(s)
- Loai Alsofi
- Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia, Phone: +966 555318481, e-mail:
| | - Sara Almarzouki
- Department of Endodontics, University Dental Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
2
|
Impact of Platelet-rich Plasma in the Healing of Through-and-through Periapical Lesions Using 2-dimensional and 3-dimensional Evaluation: A Randomized Controlled Trial. J Endod 2020; 46:1167-1184. [DOI: 10.1016/j.joen.2020.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/28/2020] [Accepted: 06/07/2020] [Indexed: 12/11/2022]
|
3
|
Metlerska J, Fagogeni I, Nowicka A. Efficacy of Autologous Platelet Concentrates in Regenerative Endodontic Treatment: A Systematic Review of Human Studies. J Endod 2018; 45:20-30.e1. [PMID: 30446403 DOI: 10.1016/j.joen.2018.09.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/26/2018] [Accepted: 09/09/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The latest research concerns the use of platelet concentrates, which are introduced into the root canal. The aim of this study was to examine the effectiveness of platelet-rich fibrin and platelet-rich plasma in regenerative endodontics. METHODS This literature review was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The literature search included all publications without a year limit. The last search was performed on January 31, 2018. An electronic search was performed using MEDLINE (PubMed), Cochrane, and Scopus. Articles were selected that addressed the following research question: Is the use of platelet concentrates effective in regenerative endodontics? The necessary information was extracted by 2 authors independently using a standardized form. RESULTS The search resulted in 426 titles from all databases, and 26 studies met the inclusion criteria. Five were randomized trials, and the others were case reports. All described cases were asymptomatic. Only 3 cases from randomized trials were unsuccessful. Ten of the case reports found positive results for pulp vitality. In randomized trials, the teeth treated with platelet concentrates showed better results for pulp vitality. In almost all cases, they also described thickening and lengthening of the root wall and closure of the apical foramen, which are important for successful treatment of permanent teeth. CONCLUSIONS This review showed that procedures using autologous platelet concentrates were successful in treating permanent teeth with root development. However, more long-term clinical studies are needed.
Collapse
Affiliation(s)
- Joanna Metlerska
- Doctoral Studies of the Faculty of Dentistry, Pomeranian Medical University in Szczecin, Szczecin, Poland.
| | - Irini Fagogeni
- Doctoral Studies of the Faculty of Dentistry, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Alicja Nowicka
- Department of Conservative Dentistry and Endodontics, Pomeranian Medical University in Szczecin, Szczecin, Poland
| |
Collapse
|
4
|
Kim JH, Woo SM, Choi NK, Kim WJ, Kim SM, Jung JY. Effect of Platelet-rich Fibrin on Odontoblastic Differentiation in Human Dental Pulp Cells Exposed to Lipopolysaccharide. J Endod 2018; 43:433-438. [PMID: 28231982 DOI: 10.1016/j.joen.2016.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/11/2016] [Accepted: 11/02/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Platelet-rich fibrin (PRF), as an autologous fibrin matrix, is known to contain platelets, leukocytes, and growth factors to control inflammation and to facilitate the healing process. The purpose of this study was to investigate the effects of PRF on odontoblastic differentiation in human dental pulp cells (HDPCs) treated with lipopolysaccharide (LPS). METHODS Gene expression of inflammatory cytokines and adhesion molecules on the HDPCs cultured with or without LPS and PRF extract (PRFe) were evaluated by reverse-transcription polymerase chain reaction and Western blot analysis. In addition, odontoblastic differentiation was determined by measuring alkaline phosphatase (ALP) activity using ALP staining, the expression of odontogenesis-related genes, and the extent of mineralization using alizarin red S staining. RESULTS Treatment with PRFe significantly attenuated the LPS-stimulated expression of interleukin (IL)-1β, IL-6, and IL-8 in HDPCs. In addition, PRFe inhibited the up-regulation of vascular cell adhesion molecule 1 and the production of intracellular adhesion molecule 1 in HDPCs exposed to LPS. Expression of dentin sialophosphoprotein and dentin matrix acidic phosphoprotein 1, ALP activity, and mineralization were enhanced by PRFe in LPS-treated HDPCs. CONCLUSIONS These results suggest that PRF has effects associated not only with inhibition of inflammation in HDPCs exposed to LPS but also stimulation of odontoblastic differentiation.
Collapse
Affiliation(s)
- Jae-Hwan Kim
- Department of Pediatric Dentistry, Dental Science Research Institute, School of Dentistry, Chonnam National University, Gwangju, South Korea
| | - Su-Mi Woo
- Department of Oral Physiology, Dental Science Research Institute, School of Dentistry, Chonnam National University, Gwangju, South Korea; Research Center for Biomineralization Disorder, Dental Science Research Institute, School of Dentistry, Chonnam National University, Gwangju, South Korea
| | - Nam-Ki Choi
- Department of Pediatric Dentistry, Dental Science Research Institute, School of Dentistry, Chonnam National University, Gwangju, South Korea
| | - Won-Jae Kim
- Department of Oral Physiology, Dental Science Research Institute, School of Dentistry, Chonnam National University, Gwangju, South Korea; Research Center for Biomineralization Disorder, Dental Science Research Institute, School of Dentistry, Chonnam National University, Gwangju, South Korea
| | - Seon-Mi Kim
- Department of Pediatric Dentistry, Dental Science Research Institute, School of Dentistry, Chonnam National University, Gwangju, South Korea.
| | - Ji-Yeon Jung
- Department of Oral Physiology, Dental Science Research Institute, School of Dentistry, Chonnam National University, Gwangju, South Korea; Research Center for Biomineralization Disorder, Dental Science Research Institute, School of Dentistry, Chonnam National University, Gwangju, South Korea.
| |
Collapse
|
5
|
Alagl A, Bedi S, Hassan K, AlHumaid J. Use of platelet-rich plasma for regeneration in non-vital immature permanent teeth: Clinical and cone-beam computed tomography evaluation. J Int Med Res 2017; 45:583-593. [PMID: 28415948 PMCID: PMC5536665 DOI: 10.1177/0300060517692935] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective This study was performed to assess the clinical and radiological outcomes of a revascularization procedure in immature teeth with apical periodontitis using platelet-rich plasma (PRP). The PRP protocol and conventional revascularization protocol, which used a blood clot as the scaffold, were compared. Methods Thirty non-vital immature permanent teeth were randomly categorized into two groups. After disinfecting the root canal space with triple antibiotic paste (1:1:1 ciprofloxacin, metronidazole, and cefaclor), a tissue scaffold was created using either PRP or a blood clot (control) and covered with white mineral trioxide aggregate. All cases were followed up clinically and radiographically for 12 months. Differences in bone density, root length, and lesion size were calculated using preoperative and postoperative computed tomography images. The means of the differences in individual parameters in the blood clot and PRP groups were compared using the Mann–Whitney U test. Results After 5 months, sensitivity tests (cold and electric pulp tests) elicited a delayed positive response in 23 sites. At 12 months, cone-beam computed tomography revealed resolution or a decrease in lesion size and an increase in bone density in all 30 (100%) teeth. Additionally, continued root development was observed in 22 (73%) teeth and early root growth was observed in the test group (mineral trioxide aggregate with PRP). Conclusions The results of this study suggest that PRP can serve as a successful scaffold for regenerative endodontic treatment. With the exception of a significant increase in root length, the results of treatment with PRP were not significantly different from those of the conventional protocol using a blood clot as the scaffold.
Collapse
Affiliation(s)
- Adel Alagl
- 1 Division of Periodontics, Department of Preventive Dental Sciences, College of Dentistry, University of Dammam, Dammam, Saudi Arabia
| | - Sumit Bedi
- 2 Division of Paediatric Dentistry, Department of Preventive Dental Sciences, College of Dentistry, University of Dammam, Dammam, Saudi Arabia
| | - Khalid Hassan
- 1 Division of Periodontics, Department of Preventive Dental Sciences, College of Dentistry, University of Dammam, Dammam, Saudi Arabia
| | - Jehan AlHumaid
- 2 Division of Paediatric Dentistry, Department of Preventive Dental Sciences, College of Dentistry, University of Dammam, Dammam, Saudi Arabia
| |
Collapse
|
6
|
Meschi N, Castro AB, Vandamme K, Quirynen M, Lambrechts P. The impact of autologous platelet concentrates on endodontic healing: a systematic review. Platelets 2016; 27:613-633. [PMID: 27658056 DOI: 10.1080/09537104.2016.1226497] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The current literature was reviewed to determine the impact of autologous platelet concentrates (APCs) on endodontic healing. All types of clinical study designs concerning any kind of endodontic treatment involving the application of APCs were included. Two independent reviewers searched three databases (PubMed, Embase, and Cochrane Library) for studies, complemented by hand search, until 16/1/2016. From the 423 identified records, 48 articles met the inclusion criteria. Selected randomized controlled clinical trials (RCTs) underwent Cochrane Collaboration's risk-of-bias assessment and data extraction. Only two RCTs showed low risk of bias. There was considerable heterogeneity between the RCTs with regard to the type of therapy, type of APCs, assessment method, and study quality, and therefore the data could not be analyzed quantitatively. The included case reports/series and non-randomized comparative studies underwent qualitative analysis with the revised Methodological Index for Non-Randomized Studies (MINORS) and data extraction. The two comparative non-randomized studies scored qualitatively high, though the MINORS-scores of the case series and reports were dispersed. APCs were involved in five endodontic treatment modalities, namely apexification, regenerative endodontic procedures, pulpotomy, apical surgery, and treatment of endo-perio/perio-endo lesions. APCs seem to accelerate postoperative bone healing, augment the patients' postoperative quality of life, aid further root development, and support maintenance/regaining of pulp vitality. No adverse events were reported. APCs in endodontic treatments seem to contribute to the healing of soft and hard tissues, though there is a lack of long-term high quality clinical trials and standardized treatment protocols.
Collapse
Affiliation(s)
- Nastaran Meschi
- a Department of Oral Health Sciences, Endodontology , KU Leuven & Dentistry, University Hospitals Leuven , Leuven , Belgium
| | - Ana B Castro
- b Department of Oral Health Sciences , Periodontology, KU Leuven & Dentistry, University Hospitals Leuven , Leuven , Belgium
| | - Katleen Vandamme
- c Department of Oral Health Sciences , Restorative Dentistry, KU Leuven & Dentistry, University Hospitals Leuven , Leuven , Belgium
| | - Marc Quirynen
- b Department of Oral Health Sciences , Periodontology, KU Leuven & Dentistry, University Hospitals Leuven , Leuven , Belgium
| | - Paul Lambrechts
- a Department of Oral Health Sciences, Endodontology , KU Leuven & Dentistry, University Hospitals Leuven , Leuven , Belgium
| |
Collapse
|
7
|
Lolato A, Bucchi C, Taschieri S, Kabbaney AE, Fabbro MD. Platelet concentrates for revitalization of immature necrotic teeth: a systematic review of the clinical studies. Platelets 2016; 27:383-92. [DOI: 10.3109/09537104.2015.1131255] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Alessandra Lolato
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milano, Italia
- IRCCS Istituto Ortopedico Galeazzi, Università degli Studi di Milano, Milano, Italia
| | - Cristina Bucchi
- Facultad de Odontología, CICO Research Center, Universidad de La Frontera, Temuco, Chile
| | - Silvio Taschieri
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milano, Italia
- IRCCS Istituto Ortopedico Galeazzi, Università degli Studi di Milano, Milano, Italia
| | - Ahmed El Kabbaney
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milano, Italia
- Conservative Dentistry and Endodontic Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Massimo Del Fabbro
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milano, Italia
- IRCCS Istituto Ortopedico Galeazzi, Università degli Studi di Milano, Milano, Italia
| |
Collapse
|
8
|
Farhad AR, Shokraneh A, Shekarchizade N. Regeneration or replacement? A case report and review of literature. Dent Traumatol 2015; 32:71-9. [DOI: 10.1111/edt.12200] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Ali Reza Farhad
- Torabinejad Dental Research Center and Department of Endodontics; School of Dentistry; Isfahan University of Medical Sciences; Isfahan Iran
| | | | - Neda Shekarchizade
- Department of Endodontics; School of Dentistry; Isfahan University of Medical Sciences; Isfahan Iran
| |
Collapse
|
9
|
Rodella LF, Bonazza V. Platelet preparations in dentistry: How? Why? Where? When? World J Stomatol 2015; 4:39-55. [DOI: 10.5321/wjs.v4.i2.39] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/08/2015] [Accepted: 04/30/2015] [Indexed: 02/06/2023] Open
Abstract
The aim of this article is to review the outcomes of platelet preparations in dentistry. A structured electronic search discovered 348 articles, which described the use of autologous platelet concentrates with a relevance to clinical dentistry. Among these articles, 220 articles investigated platelet rich plasma, 99 investigated platelet rich fibrin, 22 investigated plasma rich in growth factors and 7 investigated the use of concentrated growth factors. Several studies reported beneficial treament outcomes in terms of enhanced bone and soft tissue regeneration.
Collapse
|
10
|
Sachdeva GS, Sachdeva LT, Goel M, Bala S. Regenerative endodontic treatment of an immature tooth with a necrotic pulp and apical periodontitis using platelet-rich plasma (PRP) and mineral trioxide aggregate (MTA): a case report. Int Endod J 2014; 48:902-10. [PMID: 25369448 DOI: 10.1111/iej.12407] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 11/02/2014] [Indexed: 12/30/2022]
Abstract
AIM To report the successful clinical and radiographic outcome of a regenerative endodontic treatment. SUMMARY A 16-year-old male patient presented with a discoloured, maxillary left lateral incisor with a necrotic pulp. Radiographic examination revealed an incompletely developed root with an open apex. Under local anaesthesia and rubber dam isolation, an access cavity was prepared and the necrotic pulpal remnants were removed. The canal was disinfected without mechanical instrumentation with 5.25% NaOCl solution and dried with sterile paper points. A triple antibiotic (metronidazole, ciprofloxacin and minocycline) mixed with distilled water was packed in the canal and left for 28 days. Ten millimetres of whole blood was drawn by venipuncture from the patients antecubital vein for preparation of platelet-rich plasma (PRP). After removal of the antibiotic mixture, the PRP was injected into the canal space up to the cementoenamel junction level. Three millimetres of white MTA was placed directly over the PRP clot. Two days later, the tooth was restored with permanent filling materials. The patient was recalled for 3, 6, 12, 24 and 36 months clinical/radiographic follow-up. A 3-year follow-up radiograph revealed resolution of the periapical lesion, increased thickening of the root walls, further root development and continued apical closure of the root apex. The tooth was not responsive to cold tests; however, sensitivity tests with an electric pulp tester (EPT) elicited a delayed positive response. KEY LEARNING POINTS Regeneration is a viable treatment modality that allows continued root development of immature teeth with open apices and necrotic pulps. Platelet-rich plasma appears to be a suitable scaffold for regeneration of vital tissues in teeth with a necrotic pulps and an associated periapical lesion. Regenerative endodontic procedures may offer an effective treatment option to save teeth with compromised structural integrity.
Collapse
Affiliation(s)
- G S Sachdeva
- Department of Conservative Dentistry and Endodontics, Himachal Dental College and Hospital, Sundernagar, India
| | - L T Sachdeva
- Department of Conservative Dentistry and Endodontics, Himachal Dental College and Hospital, Sundernagar, India
| | - M Goel
- Department of Conservative Dentistry and Endodontics, Himachal Dental College and Hospital, Sundernagar, India
| | - S Bala
- Department of Conservative Dentistry and Endodontics, Himachal Dental College and Hospital, Sundernagar, India
| |
Collapse
|
11
|
Utneja S, Nawal RR, Talwar S, Verma M. Current perspectives of bio-ceramic technology in endodontics: calcium enriched mixture cement - review of its composition, properties and applications. Restor Dent Endod 2014; 40:1-13. [PMID: 25671207 PMCID: PMC4320271 DOI: 10.5395/rde.2015.40.1.1] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 08/31/2014] [Indexed: 01/02/2023] Open
Abstract
Advancements in bio-ceramic technology has revolutionised endodontic material science by enhancing the treatment outcome for patients. This class of dental materials conciliates excellent biocompatibility with high osseoconductivity that render them ideal for endodontic care. Few recently introduced bio-ceramic materials have shown considerable clinical success over their early generations in terms of good handling characteristics. Calcium enriched mixture (CEM) cement, Endosequence sealer, and root repair materials, Biodentine and BioAggregate are the new classes of bio-ceramic materials. The aim of this literature review is to present investigations regarding properties and applications of CEM cement in endodontics. A review of the existing literature was performed by using electronic and hand searching methods for CEM cement from January 2006 to December 2013. CEM cement has a different chemical composition from that of mineral trioxide aggregate (MTA) but has similar clinical applications. It combines the biocompatibility of MTA with more efficient characteristics, such as significantly shorter setting time, good handling characteristics, no staining of tooth and effective seal against bacterial leakage.
Collapse
Affiliation(s)
- Shivani Utneja
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Ruchika Roongta Nawal
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Sangeeta Talwar
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Mahesh Verma
- Department of Prosthodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| |
Collapse
|
12
|
Law AS. Considerations for regeneration procedures. J Endod 2014; 39:S44-56. [PMID: 23439044 DOI: 10.1016/j.joen.2012.11.019] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 10/20/2012] [Accepted: 11/06/2012] [Indexed: 01/09/2023]
Abstract
When pulp tissue becomes necrotic in immature teeth, the prognosis of the teeth is compromised. Disinfection of the root(s) presents several challenges including difficulties in cleaning and shaping large canals with open apices, obturation of canals with open apices, and potential root fractures caused by thin and/or weakened root walls. Regenerative endodontic procedures may increase the prognosis of the compromised immature tooth by re-establishment of a functional pulp tissue that fosters continued root development and immune competency. This article reviews the literature related to and discuss considerations for regenerative endodontic procedures and how these procedures may increase the prognosis for immature teeth with necrotic pulp tissue.
Collapse
Affiliation(s)
- Alan S Law
- The Dental Specialists, 8650 Hudson Boulevard, Lake Elmo, MN 55042, USA.
| |
Collapse
|
13
|
Cotti E, Esposito S, Jacobs R, Slagmolen P, Bakland LK. Comprehensive management of a complex traumatic dental injury. Dent Traumatol 2013; 30:400-405. [PMID: 23998296 DOI: 10.1111/edt.12064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2013] [Indexed: 12/21/2022]
Abstract
A 24-year-old female patient presented with complaint of palatal swelling and a sinus tract facial to tooth #22. She reported an injury to the tooth 15 years earlier and no recollection of treatment, although there was evidence of an endodontic access into the crown. Radiographically the root appeared to have stopped developing, and it was associated with a large periapical lesion. After 3 unsuccessful attempts at apexification using calcium hydroxide (CH), further examination including use of cone-beam computed tomography (CBCT) was carried out. The latter allowed for better evaluating the situation and for better planning a more comprehensive treatment plan to include surgical removal of the apical lesion. The large radiolucent area extended from tooth #21 to #23. Using a dedicated software tool developed to be used in conjunction with CBCT, volumetric assessment of the lesion was carried out for healing follow up. The root end was filled from the apical direction with newly developed accelerated silicate cement 4-5 mm into the apical part of the canal. Subsequently, the rest of the canal was filled with the same type of cement. At the 1-year postsurgical follow up, the tooth remained asymptomatic, and using the CBCT volumetric program, bony healing could be demonstrated.
Collapse
Affiliation(s)
- Elisabetta Cotti
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
| | - Stefano Esposito
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
| | - Reinhilde Jacobs
- Department Oral health Scienced, Head Oral Imaging center, Catholic University of Leuven, Leuven, Belgium
| | - Pieter Slagmolen
- Medical Image Computing, ESAT/PSI, Department of Electrical Engineering, University of Leuven, Leuven, Belgium
| | - Leif K Bakland
- Department of Endodontics, Loma Linda University, Loma Linda, CA, USA
| |
Collapse
|
14
|
Bou Assi T, Rahme M, Saghieh S, Bou Raad Azoury N, Abdallah Hajj Hussein I, Leone A, Jurjus A. Effect of autologous platelet-rich plasma on distraction osteogenesis in the mandible of rabbits: a morphologic and morphometric approach. J BIOL REG HOMEOS AG 2013; 46:962-70. [PMID: 23489697 DOI: 10.1111/iej.12087] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 02/09/2013] [Indexed: 01/09/2023]
Abstract
Distraction osteogenesis of the jaw is a common surgical practice in the treatment of pediatric craniofacial deformities. Autologous platelet rich plasma (PRP) has been used to increase the healing potential of bones in humans during distraction osteogenesis. This article aims to study the morphometric and morphologic parameters resulting from the effect of PRP on bone healing after mandibular distraction in rabbits. Right mandibular distraction was performed in 12 rabbits divided equally into 2 groups. PRP and physiological saline were injected, according to a defined protocol, in the callus following distraction of the experimental and control groups respectively. The rabbits were sacrificed after a consolidation period of 45 days and the mandibles were surgically removed. Bone mineral density, radiographic analysis, mechanical properties and histological features of the lengthened bones were assessed using radiographic examination, dual X-ray absorptiometry, biomechanical testing and histology. Results showed that the regenerate bone density, the amount of trabeculation in addition to the bone mineral density and mineral content, as measured by absorptiometry, were better with PRP but not significantly different between groups. Two radiographs revealed a more consistent healing in the experimental mandibles compared with erratic outcomes in corresponding controls. Two of the latter could not be subjected to any mechanical testing because the mandibular parts, connected with fibrous tissue, were separated. Consequently, the biomechanical test depicted greater maximal loads in the experimental group. The histological studies exhibited more ossification and less connective tissue fibers in the experimental group. PRP accelerated healing of mandibles in rabbits following distraction and improved their biomechanical properties. These findings have significant clinical implications on reducing the period of consolidation of the mandibles which may not be immobilized like other bones for long periods of time.
Collapse
Affiliation(s)
- T Bou Assi
- Department of Pathology and Laboratory Medicine, American University of Beirut, Lebanon
| | | | | | | | | | | | | |
Collapse
|
15
|
Keswani D, Pandey RK. Revascularization of an immature tooth with a necrotic pulp using platelet‐rich fibrin: a case report. Int Endod J 2013; 46:1096-104. [DOI: 10.1111/iej.12107] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 03/06/2013] [Indexed: 11/30/2022]
Affiliation(s)
- D. Keswani
- Department of Pedodontics and Preventive Dentistry King George's Medical University (Erstwhile C. S. M. Medical University) Lucknow India
| | - R. K. Pandey
- Department of Pedodontics and Preventive Dentistry King George's Medical University (Erstwhile C. S. M. Medical University) Lucknow India
| |
Collapse
|
16
|
|
17
|
Chaturvedy V, Chaturvedy S. Regenerative therapy as an adjunct to periapical surgery: a case report. Int J Clin Pediatr Dent 2012; 5:75-7. [PMID: 25206140 PMCID: PMC4093646 DOI: 10.5005/jp-journals-10005-1139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 01/30/2012] [Indexed: 11/23/2022] Open
Abstract
Large periapical defects may adversely affect the success rate of endodontic surgery. Use of regenerative therapy may enhance the prognosis of such teeth. A case of traumatized upper anterior teeth with infected radicular cyst and associated sinus tract reported to the dental hospital. A periradicular surgical procedure was performed to remove the nonhealing pathological tissue. To augment the repair a bioactive bone graft material was placed. Six months interim results showed positive outcome of application of graft. How to cite this article: Chaturvedy V, Chaturvedy S. Regenerative Therapy as an Adjunct to Periapical Surgery: A Case Report. Int J Clin Pediatr Dent 2012;5(1):75-77.
Collapse
Affiliation(s)
- Vivek Chaturvedy
- Professor and Head, Department of Periodontics, Rajasthan Dental College and Hospital, Jaipur, Rajasthan, India, e-mail:
| | - Shefali Chaturvedy
- Senior Lecturer, Department of Pedodontics and Preventive Dentistry Rajasthan Dental College and Hospital, Jaipur, Rajasthan, India
| |
Collapse
|
18
|
Martins MAT, Martins MD, Lascala CA, Curi MM, Migliorati CA, Tenis CA, Marques MM. Association of laser phototherapy with PRP improves healing of bisphosphonate-related osteonecrosis of the jaws in cancer patients: A preliminary study. Oral Oncol 2012; 48:79-84. [DOI: 10.1016/j.oraloncology.2011.08.010] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 08/16/2011] [Accepted: 08/16/2011] [Indexed: 01/09/2023]
|
19
|
Comparative evaluation of platelet-rich plasma and guided tissue regeneration membrane in the healing of apicomarginal defects: a clinical study. J Endod 2011; 37:773-80. [PMID: 21787487 DOI: 10.1016/j.joen.2011.03.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 03/10/2011] [Accepted: 03/14/2011] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The aim of the study was to compare the healing responses of platelet-rich plasma (PRP), PRP + a collagen sponge, and a collagen membrane used as guided tissue regeneration (GTR) materials for the treatment of apicomarginal defects. METHODS Thirty patients with suppurative chronic apical periodontitis and apicomarginal communication were selected and allocated randomly into three groups according to the barrier technique to be used during periradicular surgery: the collagen membrane group, the PRP group, and the PRP + collagen sponge group. Clinical and radiographic measurements were determined at baseline and every 3 months after surgery up to 1 year. Cases were defined as healed when no clinical signs or symptoms were present, and radiographs showed complete or incomplete (scar tissue) healing of previous radiolucencies. RESULTS The PRP and PRP + collagen sponge groups depicted 83.33% and 88.89% healing, respectively, in terms of combined clinical-radiographic healing as compared with 80% in the collagen membrane group. All the three treatments showed highly significant (P < .05) reductions in the periodontal pocket depth (PD), the clinical attachment level (CAL), the gingival margin position (GMP), the size of the periapical lesion, the percentage reduction of the periapical rarefactions, and periapical healing. No significant differences between the three groups were evident for these parameters (P > .05). CONCLUSIONS GTR applied to apicomarginal defects using PRP or PRP + collagen sponge lead to similar enhancements of the clinical outcome of periradicular surgery in terms of periapical healing, gain of periodontal support, PD reduction, and PRP may be an alternative treatment for GTR membrane in the treatment of apicomarginal defects.
Collapse
|
20
|
Chhabra N, Singbal KP, Kamat S. Successful apexification with resolution of the periapical lesion using mineral trioxide aggregate and demineralized freeze-dried bone allograft. J Conserv Dent 2011; 13:106-9. [PMID: 20859486 PMCID: PMC2936089 DOI: 10.4103/0972-0707.66723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Revised: 01/10/2010] [Accepted: 11/10/2009] [Indexed: 12/27/2022] Open
Abstract
Immature teeth with necrotic pulp and large periapical lesion are difficult to treat via conventional endodontic therapy. The role of materials such as calcium hydroxide and mineral trioxide aggregate in apexification is indispensable. This case report presents the successful healing and apexification with combined use of white mineral trioxide aggregate and demineralized freeze-dried bone allograft.
Collapse
Affiliation(s)
- Naveen Chhabra
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Bareilly, India
| | | | | |
Collapse
|
21
|
Revitalization of tooth with necrotic pulp and open apex by using platelet-rich plasma: a case report. J Endod 2011; 37:265-8. [PMID: 21238815 DOI: 10.1016/j.joen.2010.11.004] [Citation(s) in RCA: 173] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Revised: 11/03/2010] [Accepted: 11/06/2010] [Indexed: 12/15/2022]
Abstract
INTRODUCTION A growing body of evidence is demonstrating the possibility for regeneration of tissues within the pulp space and continued root development in teeth with necrotic pulps and open apexes. The purpose of this case report is to add a regenerative endodontic case to the existing literature about using platelet-rich plasma (PRP). METHODS An 11-year-old boy whose maxillary second premolar tooth had been accidently extracted and immediately replanted developed pulpal necrosis and symptomatic apical periodontitis. After preparing an access cavity, its necrotic pulp was removed. The canal was irrigated with 5.25% NaOCl solution and dried with paper points. A triple antibiotic mixed with distilled water was packed in the canal and left for 22 days. Twenty milliliters of whole blood was drawn from the patient's forearm for preparation of PRP. After removal of the antibiotic mixture, the PRP was injected into the canal space up to the cementoenamel junction level. Three millimeters of grey mineral trioxide aggregate was placed directly over the PRP clot. Three days later, the tooth was double-sealed with permanent filling materials. RESULTS Clinical examination 5 1/2 half months later revealed no sensitivity to percussion or palpation tests. Radiographic examination of this tooth showed resolution of the periapical lesion, further root development, and continued apical closure. Sensitivity tests with cold and an electric pulp test elicited a positive response similar to those found in the first premolar tooth. CONCLUSIONS On the basis of short-term results of the present case, it appears that regeneration of vital tissues in a tooth with necrotic pulp and a periapical lesion is possible; PRP is potentially an ideal scaffold for this procedure.
Collapse
|
22
|
Huang FM, Yang SF, Zhao JH, Chang YC. Platelet-rich fibrin increases proliferation and differentiation of human dental pulp cells. J Endod 2010; 36:1628-32. [PMID: 20850666 DOI: 10.1016/j.joen.2010.07.004] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 07/05/2010] [Accepted: 07/05/2010] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Platelet-rich fibrin (PRF) by Choukroun's technique is derived from an autogenous preparation of concentrated platelets without any manipulation. When delicately pressed between 2 gauzes, the PRF clot becomes a strong membrane with high potential in clinical application. However, the effect of PRF on dental pulp cells (DPCs) remains to be elucidated. This study was to determine the biological effects of PRF on DPCs. METHODS PRF samples were obtained from 6 healthy volunteers. Human DPCs were derived from healthy individuals undergoing extraction for third molars. Cell proliferation resulting from PRF was evaluated by colorimetric assay. Western blot was used to evaluate the expression of osteoprotegerin (OPG). Alkaline phosphatase (ALP) activity was examined by substrate assay. RESULTS PRF did not interfere with cell viability of DPCs (P > .05). DPCs were observed to attach at the edges of PRF by phase-contrast microscopy. PRF was found to increase DPC proliferation during 5-day incubation period (P < .05). PRF was found to increase OPG expression in a time-dependent manner (P < .05). ALP activity was also significantly up-regulated by PRF (P < .05). CONCLUSIONS PRF was demonstrated to stimulate cell proliferation and differentiation of DPCs by up-regulating OPG and ALP expression. These findings might serve as a basis for preclinical studies that address the role of PRF in reparative dentin formation.
Collapse
Affiliation(s)
- Fu-Mei Huang
- Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan
| | | | | | | |
Collapse
|