Title |
For Patients with Pulp Necrosis of Immature Permanent Teeth, Revascularization is More Effective Than Ca(OH)2 or MTA Apexification in Increasing Root Length and Width as Well as Improving Overall Survival Rates |
Clinical Question |
In patients with pulp necrosis of immature permanent teeth, does revascularization through regenerative endodontic procedures, when compared to apexification using either calcium hydroxide or mineral trioxide aggregate (MTA), lead to a greater increase in root width and root length as well as overall survival rates? |
Clinical Bottom Line |
For patients with pulp necrosis of immature permanent teeth, revascularization is more effective than apexification with either Ca(OH)2 or MTA apexification in increasing root length and width as well as improving overall survival rates of teeth. This is supported by a retrospective analysis of 61 cases showing an increase in root length and width by a clinically significant margin through revascularization when compared to a much slimmer margin by CaOH and MTA apexification treatments. |
Best Evidence |
|
PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
22980172 | Jeeruphan/2012 | 61 cases (22 CaOH apexification cases, 19 MTA apexification cases, 20 revascularization cases). | Other | Key results | The results of this study included: a 28.2% increase in root width through revascularization treatment whereas MTA apexification resulted in a 0% increase and Ca(OH)2 apexication resulted in a 1.52% increase (with a P <.0001 for both comparisons). In terms of root length, the revascularization treatment resulted in a 14.9% root increase compared to a 6.1% increase with MTA treatment and a 0.4% increase with Ca(OH)2 treatment. In terms of tooth survival, revascularization was 100%, MTA apexification was 94% and Ca(OH)2 apexification was 77% (p<0.05). | |
Evidence Search |
((regeneration) AND apexification) AND dental pulp necrosis AND calcium hydroxide and MTA and Survival |
Comments on
The Evidence |
Validity: The study protocol was approved by the Ethics Committee of Mahidol University. The immature permanent tooth was treated by either Ca(OH)2 apexification, MTA apexification, or revascularization. The study goes into meticulous detail about the procedures followed for the radiographic analysis of each case as well as the assessment of treatment outcomes. As a result of all these findings, I would not dispute the validity of this study.
Perspective: Although my clinical experience is extremely limited, especially in the field of endodontics, I think this study shows some of the potential of regenerative endodontics and is a positive step forward for the future of regenerative pulp treatment. Toward this end, it is important to note that the ADA has now published CDT treatment codes for regenerative endodontic procedures. |
Applicability |
In patients with immature permanent teeth, this study is very applicable in showcasing the potential of revascularization as a treatment option. In terms of pulp therapy in general, I think that exploring the vast utility of stem cells in the field of endodontics will reshape the way dentists approach pulpal treatment. |
Specialty |
(Endodontics) (Pediatric Dentistry) |
Keywords |
Apexification, revascularization, mineral trioxide aggregate, calcium hydroxide, immature permanent teeth, dental pulp necrosis, root length, root width
|
ID# |
2677 |
Date of submission |
03/13/2014 |
E-mail |
ibrik@livemail.uthscsa.edu |
Author |
Taj Ibrik |
Co-author(s) |
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Co-author(s) e-mail |
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Faculty mentor |
Kenneth M. Hargreaves, DDS, PhD |
Faculty mentor e-mail |
Hargreaves@uthscsa.edu |
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Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
None available | |
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
None available | |