ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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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 (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 CaOH apexification cases, 19 MTA apexification cases, 20 revascularization cases).Other
Key resultsThe 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/Discipline (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: 03/13/2014spacer
E-mail ibrik@livemail.uthscsa.edu
Author Taj Ibrik
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Kenneth M. Hargreaves, DDS, PhD
Faculty mentor/Co-author e-mail Hargreaves@uthscsa.edu
Basic Science Rationale
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