Use of Endodontic Procedures in Young Permanent Teeth

Background

Regenerative endodontic procedures (REPs) have emerged as a promising treatment option for young permanent teeth with pulp necrosis, offering the potential for tissue repair and preservation.

Materials and Methods

A retrospective analysis was conducted on a cohort of 30 patients aged 8 to 16 years with pulp necrosis in young permanent teeth. The patients underwent REPs, including disinfection, triple antibiotic paste application, and a coronal barrier. Clinical and radiographic data were collected at baseline and follow-up appointments at 6, 12, and 24 months. Radiographs were analyzed for root lengthening, apical closure, and resolution of periapical lesions.

Results

The mean increase in root length after 24 months was 3.42 mm (SD ± 1.12 mm), and 90% of cases demonstrated complete apical closure. The overall success rate, defined as the absence of clinical symptoms and radiographic evidence of pathology, was 80.

Conclusion

REPs show promising outcomes in young permanent teeth with pulp necrosis, promoting root development, and apical closure.

Regenerative Therapy for the Permanent Immature Teeth: A Long Term Study. An Original Research

Introduction

Endodontics faces several clinical difficulties while treating young necrotic permanent teeth. The use of regenerative endodontic procedures (REPs) enables apical closure, improved canal wall thickness, and root growth. The objective of this study was to assess the effects of these regenerative procedures on immature necrotic permanent teeth.

Methods

This prospective clinical study was conducted at the tertiary care hospital for the study period of 2 years. This study includes 30 necrotic permanent immature teeth that were studied in 30 subjects of both genders. A standard REP protocol was used to treat every tooth. A follow-up visit was scheduled for each patient at timely intervals. Various study parameters as well as the demographics were assessed at each visit. To examine various parameters, a calibrated endodontist also performed a radiographic evaluation.

Results

Our findings point to excellent rates of survival, clinical success, and apical pathological resolution for 29 teeth. After 2 years, there were significant variations in the root thickness area and the average root length. The apical diameter significantly decreased during the research period, with 30.8% of the instances exhibiting full apical closure. Apical diameter, root length, and thickness changed more frequently in teeth with the level of the immaturity of the root, although the variations were not significant.

Conclusions

REP treatment for teeth preceded symptom relief. Increased root thickness, root length, and apical closure were seen at 30 months, even if the clinically meaningful change was not attained in all patients.

Efficacy of propolis and triple antibiotic paste as intra-canal medicaments for revascularisation of immature teeth in dogs: a comparative study

AIM

Revascularisation is a therapeutic approach for treatment of immature teeth with necrotic pulp. The conventional protocol includes application of triple antibiotic paste (TAP). The present study aimed to compare the efficacy of propolis and TAP as intra-canal medicaments for revascularisation of immature teeth in dogs.

METHODOLOGY

This study was conducted on 20 immature (open-apex) canine teeth in mixed breaded dogs. First, the teeth were exposed to oral environment, followed by intra-canal cleaning and shaping 2 weeks later.. The teeth were divided into two groups. The TAP group received paste comprising of ciprofloxacin, metronidazole, and minocycline (at a concentration of 100 µg/mL), while propolis (15% w/v) was used in the other group. The revascularisation procedure was done by means of sodium hypochlorite, EDTA and distilled water as final irrigant. After dehumidifying and induction of bleeding, mineral trioxide aggregate (MTA) was applied At 6-month follow-up, radiographs were evaluated by two observers regarding root length and thickness, intra-canal calcification, periapical lesions, and apex formation. Data were analysed by the Chi-square and Fisher's exact tests.

RESULTS

There was no significant difference between the TAP and propolis groups in root length or root thickness increase, calcification, related lesions, or apex formation (P > 0.05).

CONCLUSION

Findings of the present study in experimental animals revealed that the efficacy of propolis as an intra-canal medicament is comparable to that of triple antibiotic paste for revascularisation therapy.

Combination Therapy of Antibiotics and Platelet-rich Fibrin for Apical Closure: Case Series

The aim of endodontic treatment in immature teeth is to disinfect and regenerate tissues in the apical region for the closure of the root. Stem cells from apical papilla (SCAP) by differentiating into odontogenic and osteogenic tissues create apical closure. Triple antibiotic pastes (TAP) disinfect the root canal without adversely affecting the SCAP. Differentiation of SCAP is promoted by platelet-rich fibrin (PRF). Hence, combining TAP and PRF could have a synergistic effect.

Case description

An 11-year-old girl, a 9-year-old boy, and a 13-year-old boy, symptomatic patients with open apex, are treated with TAP, PRF, and mineral trioxide aggregate (MTA) as an apical barrier sequentially. There was the formation of a calcific barrier at the end of 12, 6, and 3 months, respectively.

Conclusion

Correct diagnosis and protocol of sequential disinfection, regeneration, and finally filling the canal with an apical barrier could yield better results.

How to cite this article

Biradar N, Ragulakollu R, Tej G, et al. Combination Therapy of Antibiotics and Platelet-rich Fibrin for Apical Closure: Case Series. Int J Clin Pediatr Dent 2023;16(3):541-546.

Biodentine as BioRoot Inlay: A Case Report

Aims and background

The success of endodontic treatment in open apex teeth depends on the establishment of an ideal apical barrier so that apical canal space between the periodontium and the root canal system is filled. Biodentine is a calcium silicate-based cement having several advantages over mineral trioxide aggregate (MTA), glass ionomer cement (GIC), and calcium hydroxide in the treatment of teeth with open apices. Orthograde delivery of biodentine is technique-sensitive and requires multiple radiographs for verification, as well as retrograde placement of biodentine requires surgical intervention. To use the advantages of biodentine and to overcome the disadvantages of placement techniques, an innovative technique was done to obturate the tooth with an open apex using a custom-fit prefabricated BioRoot inlay in this case report.

Case description

In the present case, biodentine has been used as a BioRoot inlay to overcome the disadvantages of various management options of open apex with parallel dentinal walls. BioRoot inlay is an intraradicular custom-made prefabricated restoration which provides the three-dimensional seal of the root canal space and promotes an apical barrier formation in a wide-open apex. This BioRoot inlay, placed passively in the canal, had a good seal laterally and apically along with the Biodentine as sealer forming a monoblock. This sealer helps in sealing milder discrepancies between the plug and the root, providing a three-dimensional seal which had resulted in good healing of periradicular bone.

Conclusion

Biodentine, when used as BioRoot inlay, has been shown to induce faster periapical healing. It provides promising results when used in open apices with parallel walls. It establishes three-dimensional obturation and proper apical seal, which promotes effective root-end induction.

Clinical significance

It can be considered as the effective and definitive alternative for nonsurgical and surgical approaches to treating open apex.

How to cite this article

Thiyagarajan G, Manoharan M, Veerabadhran MM, et al. Biodentine as BioRoot Inlay: A Case Report. Int J Clin Pediatr Dent 2023;16(2):400-404.

Biodentine™ Pulpotomy in Stage I primary Molars: A 12-month Follow-up

Aim

This study aims to evaluate, over 12 months of clinical and radiographic follow-ups, the performance and outcomes of Biodentine™ pulpotomy in stage I primary molars.

Materials and methods

A total number of 20 stage I primary molars requiring pulpotomy were selected from eight healthy patients aged between 34 and 45 months. Patients presenting a negative attitude toward dental treatment on the dental chair were scheduled for dental treatments under general anesthesia.Pulpotomy with Biodentine™ as a pulp-dressing material was performed on all selected molars. The patients were called back at 1 and 3 months for clinical follow-ups, then at 6 and 12 months for clinical and radiographic follow-ups. Data were tabulated according to follow-up intervals and occurrence of any changes in root maturation, pulp canal obliteration (PCO), periodontal ligament space (PLS), and bone or root lesion.

Results

No statistically significant differences were recorded at 1, 3, 6, and 12 months. There was a statistically significant increase in number of roots with closed apices from six roots at 6 months to 50 roots at 12 months (p < 0.0005) and the PCO was present in all 50 roots at 12 months, after it was present in 36 roots only at 6 months (p = 0.0001).

Conclusion

This is the first randomized clinical trial that evaluates the performance of Biodentine™ as a pulp-dressing agent in stage I primary molar pulpotomy over 12 months of follow-up. Contrary to previous studies, the present work highlights the continued root formation and apical closure (AC) in pulpotomized immature primary molars.

How to cite this article

Nasrallah H, Noueiri BE. Biodentine™ Pulpotomy in Stage I primary Molars: A 12-month Follow-up. Int J Clin Pediatr Dent 2022;15(6):660-666.

Histologic, Radiographic, and Micro-Computed Tomography Evaluation of Experimentally Enlarged Root Apices in Dog Teeth with Apical Periodontitis after Regenerative Treatment

Background

Blood clot (BC) and platelet-rich fibrin (PRF) has been successfully used to biologically treat immature roots. It is nowadays considered the treatment of choice.

Objective

This study aimed to determine the ability of PRF and BC scaffolds to enhance regeneration of disinfected root canals and healing of apical periodontitis within experimentally enlarged canal apices of dog teeth.

Methods

Forty-eight root canals in 28 mandibular premolars from 4 healthy adult dogs were experimentally infected and developed apical periodontitis. The teeth were randomly divided into a control (untreated) group, a disinfection only group, a group that received disinfection and a BC scaffold, and a group that received disinfection and a BC + PRF scaffold. Healing of the apical radiolucency was evaluated by conventional radiography, micro-computed tomography, and histology after 3 months. The data were analyzed by χ² test.

Results

Healing was achieved in 49% of roots as seen on radiograph and 43% as seen on micro-computed tomography. There was no significant between-group difference in the presence or absence of periapical radiolucency in the mesial roots when seen on conventional images (P = 0.255), but there was a significant difference in the distal roots (P = 0.001); similarly, on micro-computed tomography, there was no significant between-group difference in the mesial roots (P = 0.174) but there was a significant difference in the distal roots (P = 0.001). Histologically, apical closure was significantly not greater in the BC + PRF scaffold group than in the BC scaffold group (P = 0.001).

Conclusions

A mix of BC + PRF scaffold did not improve tissue regeneration in experimentally enlarged dog teeth. (Curr Ther Res Clin Exp. 2021; 82:XXX–XXX) © 2021 Elsevier HS Journals, Inc.

Evaluation of antibacterial activity of propolis on regenerative potential of necrotic immature permanent teeth in dogs

Background

This study evaluated the antibacterial efficiency and ability of propolis to promote regeneration of immature permanent non-vital dogs’ teeth.

Methods

Ninety six immature permanent premolars teeth in 6 mongrel dogs were divided randomly into: experimental teeth (N = 72) and control teeth (N = 24). Periapical pathosis was induced in all experimental and positive control teeth. Experimental teeth were classified according to the used intra-canal medication into: group I (N = 36), propolis paste was used and group II (N = 36), triple antibiotic paste (TAP) was used. Bacteriologic samplings were collected before and after exposure to intra-canal medicaments. After the disinfection period (3 weeks), revascularization was induced in all experimental teeth. Each group was subdivided according to the root canal orifice plug into: subgroup A (N = 18), propolis paste was used and subgroup B (N = 18), mineral trioxide aggregates (MTA) was used. Each subgroup was further subdivided according to the evaluation period into 3 subdivisions (6 teeth each): subdivision 1; after 2 weeks, subdivision 2; after one month and subdivision 3; after 2 months. Positive control group had 12 teeth with induced untreated periapical pathosis. Negative control group had 12 untouched sound teeth. All teeth were evaluated with radiography and histology. The bacteriologic and radiographic data were analyzed using repeated measures ANOVA and post-hoc Tukey tests. The histologic data were analyzed using Kruskal-Wallis test, Mann-Whitney U test with Bonferroni’s adjustment and Chi-square test. The significance level was set at P ≤ .05.

Results

There was no significant difference in the antibacterial effectiveness between TAP and propolis groups (P > .05). In all subdivisions, there was no significant difference between the experimental groups in terms of increase in root length and dentin thickness, decrease in apical closure, new hard tissue formation, vital tissue formation inside the pulp canal and apical closure scores (P > .05).

Conclusion

Propolis can be comparable with TAP as a disinfection treatment option in regenerative endodontic. As a root canal orifice plug after revascularization of necrotic immature permanent teeth in dogs, propolis induces a progressive increase in root length and dentin thickness and a decrease in apical diameter similar to those of MTA.

Minireview of the clinical efficacy of platelet-rich plasma, platelet-rich fibrin and blood-clot revascularization for the regeneration of immature permanent teeth

The aim of this mini-review was to investigate and compare the clinical efficacy of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), vs blood clot revascularization (BCR) for the regeneration of immature permanent teeth. The clinical efficacy of PRP, PRF, and BCR to regenerate 90 immature permanent teeth after one year, were compared for their ability to accomplish apical closure, a periapical lesion healing response, root lengthening, and dentinal wall thickening. The 90 cases were published in three different articles. The mean success rate for apical closure after one year was: PRP (89.2%) PRF (80%), and BCR (75.6%). The mean success rate for root lengthening after one year was: BCR (88.9%), PRP (68.2%), and PRF (65%). The periapical lesion healing response was 100% for BCR and 100% for PRP. Dentinal wall thickening was 100% for BCR, and 100% for PRP. All the PRP, PRF, and BCR treatments appeared to be effective. The published clinical results for PRP, PRF, and BCR indicate that these treatments are effective for the regeneration of immature permanent teeth.

A clinicoradiographic comparison of the effects of platelet-rich fibrin gel and platelet-rich fibrin membrane as scaffolds in the apexification treatment of young permanent teeth

AIMS

This triple blinded clinical trial was undertaken to check whether Platelet rich firin in its membrane form is as reliable as when it is in the gel form.

SETTINGS AND DESIGN

Triple blinded randomized clinical trial.

METHODS AND MATERIAL

20 patients in PRF gel group and 20 patients in PRF membrane group selected after randomization and considering inclusion and exclusion criteria were taken up for this study. The samples were clinically and radiographically evaluated for success.

RESULTS AND CONCLUSIONS

Regenerative endodontics with PRF membrane is easier and less time consuming. They have similar clinical success.PRF gel gave a better radiographic success in 12 months period.