ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title In An Immature Tooth With Pulpal Necrosis, Regenerative Endodontics and MTA Apexification Methods Are Viable Treatment Options
Clinical Question In an immature tooth with pulpal necrosis, are regenerative endodontics and MTA apexification methods viable treatment options?
Clinical Bottom Line The survival rates of teeth treated with revascularization (via regenerative endodontics) and MTA apexification was higher than in teeth treated with calcium hydroxide apexification. This conclusion was supported by a retrospective cohort study of 61 cases in which revascularization treatment noted 100% survival of teeth diagnosed with pulpal necrosis. In a randomized controlled trial of 36 cases, MTA apexification showed slightly higher success rates in healing apical periodontitis than regenerative endodontics, but the difference was not statistically significance. MTA apexification and revascularization protocols can both help successfully treat immature permanent teeth with pulpal necrosis in an endodontics office. However, regenerative endodontics provides the only opportunity for continued root development. It is also worth noting, that should revascularization prove unsuccessful, MTA apexification can easily be attempted.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22980172Jeeruphan/201261 cases (22 calcium hydroxide apexification cases, 19 MTA apexification cases and 20 revascularization cases).Retrospective chart review
Key resultsIn this study, revascularization was associated with increased percentages of root width (28.2%) and root length (14.9%) compared to calcium hydroxide and MTA apexification procedures. More importantly, the survival of teeth with pulpal necrosis with revascularization treatment is 100%, MTA apexification is 95% and calcium hydroxide apexification is only 77.2%.
#2) 24461403Nagy/201436 patients between the ages of 9 and 13 years were divided into three groups: the MTA group, the REG (regenerative endodontic protocol via blood clot) and the FGF group (regenerative endodontic protocol-blood clot + injectable scaffold). RCT
Key resultsRegenerative endodontics provides an increase in root length and width compared to MTA apexification. MTA apexification did however show the greatest decrease in apical diameter of all the treatments. The three treatments showed similar increases in bone density. The success rate in terms of healing apical periodontitis for the MTA, REG, and FGF groups were 100%, 90%, and 80%, respectively. Regenerative endodontics and MTA apexification are successful treatment options for an immature tooth with pulpal necrosis.
Evidence Search Revascularization AND apexification
Comments on
The Evidence
Validity: Jeeruphan et.al., radiographic outcomes showed that revascularization treatment increases root width by 28.2% (P<.0001). Similarly, the treatment group with revascularization showed a greater percentage increase in root length than apexification methods (14.9%) (P<.001). In regards to tooth survival, revascularization and MTA apexification showed similar survival rates (95-100%) compared to treatment with calcium hydroxide apexification (77%) (P<.05). Nagy et. al., radiographic outcomes showed that regenerative endodontics (both the REG and the FBF groups) showed an increase in root width and root length (P value < .001). MTA apexification showed the greatest decrease in apical diameter (P value <.001). Periapical bone density increased the most with MTA apexification treatment, (P value=.0021) but regenerative endodontics also showed a similar increase (P value < .001). Perspective: Nagy et. al., 7 patients were excluded from the study due to inadequate recalls. The percentages of recall for the MTA, REG, and FGF groups were 75%, 83%, and 83% respectively.
Applicability Patients must have an immature permanent tooth requiring endodontic therapy. They are likely to receive treatment from a pediatric dentist or an endodontist rather than a general dentist.
Specialty/Discipline (Endodontics) (Pediatric Dentistry)
Keywords Immature teeth, regerative endodontics, revascularization
ID# 2662
Date of submission: 03/22/2014spacer
E-mail sukumar@livemail.uthscsa.edu
Author Pooja Sukumar
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author James Ball, DDS
Faculty mentor/Co-author e-mail ballj@livemail.uthscsa.edu
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