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Title Regenerative Endodontic Procedures and Apexification Procedures are Viable Options for Treating Immature Teeth with Pulpal Necrosis
Clinical Question In patients with immature teeth with pulpal necrosis, are apexification procedures more effective at healing apical periodontitis compared to regenerative endodontic procedures?
Clinical Bottom Line For patients with immature nonvital teeth, both apexification procedures and regenerative procedures are equally effective for improving and healing the periapical bone density. There was no significant difference between the different treatment types.
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) 24461403Nagy/201436 patients with immature, nonvital maxillary anterior teeth between the ages of 9 and 13 years.Randomized Controlled Trial
Key resultsIn both the mineral trioxide aggregate (MTA) group and the two Regenerative groups, there was significant periapical bone healing at the 18 months. There was no significant difference between the three treatment protocols used in the experiment at the 18 month follow-up (P=.6191). The apexification (MTA apical plug) group had a 100% success rate and displayed an increase in periapical bone density with a percent of change in density from the preoperative radiograph of 14.61 ± 7.1% (P=.0021). The regenerative endodontic protocol group (REG) had a 90% success rate and displayed an increased periapical bone density with a percent of change in density of 12.77 ± 5.5 % (P<.001). The regenerative endodontic protocol that used an injectable hydrogel scaffold impregnated with basic fibroblast growth factor (FGF) has an 80% success rate and also displayed an increased periapical bone density with a percent change in density of 12.21 ± 6% (P<.001).
Evidence Search Regenerative[All Fields] AND endodontic[All Fields] AND ("therapy"[Subheading] OR "therapy"[All Fields] OR "therapeutics"[MeSH Terms] OR "therapeutics"[All Fields]) AND periapical[All Fields] AND ("wound healing"[MeSH Terms] OR ("wound"[All Fields] AND "healing"[All Fields]) OR "wound healing"[All Fields] OR "healing"[All Fields])
Comments on
The Evidence
Validity: This randomized controlled trial used groups that started out with the same clinical presentation and had adequate follow-up. Of the 36 patients that were in the study, 7 were excluded due to inadequate compliance or failure to recall. Perspective: Based on this randomized controlled trial, both types of therapies, apexification and regenerative endodontic therapies could be used to heal periapical lesions. It is useful to note that there was 1 failed case in the FGF group and 2 failed cases in the REG group that were re-evaluated and placed in the MTA group, which has a 100% success rate. It may be beneficial to attempt regenerative procedures with the chance of increasing root length and closing the apex first. In cases of unsuccessful outcomes with regenerative approaches or persistent disease, apexification procedures can be employed.
Applicability In clinical practice, the findings in this study are applicable to patients with immature teeth with pulpal necrosis and apical periodontitis. Patients could undergo regenerative therapies to heal apical periodontitis and potentially enable tissue and root regeneration. If that therapy was unsuccessful, the patient can still undergo apexification and have a successful result.
Specialty/Discipline (Endodontics) (Pediatric Dentistry)
Keywords Regenerative endodontics, apexification, apical periodontitis, pulpal necrosis, immature teeth
ID# 3042
Date of submission: 03/13/2016spacer
E-mail duongr@livemail.uthscsa.edu
Author Rose Duong
Co-author(s) e-mail
Faculty mentor/Co-author Anibal Diogenes, DDS, MS, PhD
Faculty mentor/Co-author e-mail diogenes@uthscsa.edu
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