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Title Regenerative Endodontic Procedure in Mature Teeth with Closed Apices Is a Promising Treatment Option
Clinical Question Is the success rate for regenerative endodontic procedures (REPs) in necrotic teeth with closed apices higher than conventional endodontic procedures (CEP)?
Clinical Bottom Line For permanent necrotic teeth with closed apices and a large apical lesion, REPs have a comparable success rate to CEPs and have the potential of becoming an alternative treatment option in the future.
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) 31155298Arslan / 201956 mature necrotic teeth with large periapical radiolucenciesRandomized Controlled Trial
Key resultsThis study included patients aged 18-30 years without systematic disease and with a single rooted (anterior or premolar) necrotic tooth with a closed apex with periapical lesion ≥3 according to the classification of Ørstavik et al. The following were excluded from the study: pregnant females, previous root canal treatment, root curvature > 25, chronic periodontal disease, apical lesion < 5 mm, probing depth > 3 mm and teeth with developmental anomalies. Out of 49 patients, 36 patients attended the follow up (follow up rate 73.4%). Criteria for success were absence or reduction in the apical radiolucency to score 1 or 2 and clinically asymptomatic teeth. The 1-year success rates were: REPs 92% (n=26), CEPs 80% (n=20). This difference was not statistically significant (P>0.05). An additional benefit of REPs was that half of the group treated with REPs tested positive with electrical pulp test.
Evidence Search MeSH Terms: regenerative endodontics; tooth; necrosis
Comments on
The Evidence
Validity: Internal validity of the study is high as this is a randomized controlled trial. However, external validity is low due to this being a single study with no replication by other groups. Strengths of this study were random assignment of participants into groups; patients were blinded to treatment; blinded investigator; data were analyzed statistically. Limitations were the limited number of participants in each group, and several were not followed up; rate of radiographic healing assessed using conventional radiographs, but volumetric analysis with CBCT may be more accurate and may have shown difference in lesion resolution between groups; 12-month period for recall, but healing may take longer than 12 months. Perspective: This study demonstrates similar success rates for REPs compared to CEPs in necrotic teeth with closed apices and large periapical radiolucencies. Positive vitality responses were seen as a unique advantage of REPs. Additional long-term research (>12 months) is needed to compare long-term survival of these teeth.
Applicability REPs showed similar success rates as CEPs. This might change the way we manage the pulpal and apical pathology. This study showed that we can use REPs in necrotic teeth with closed apices and large apical lesions. Longer follow up data with larger sample are required to compare long-term success and survival between both groups before using this technique as an alternative procedure.
Specialty/Discipline (Endodontics) (General Dentistry)
Keywords Apical periodontitis; mature tooth; necrotic tooth; pulp regeneration; pulp revascularization; pulp revitalization; regenerative endodontic procedure; regenerative endodontics
ID# 3405
Date of submission: 11/26/2019spacer
E-mail rayyan@livemail.uthscsa.edu
Author Ahmad Rayyan, BDS, DDS
Co-author(s) Panchali Patel, DDS
Co-author(s) e-mail patelp12@livemail.uthscsa.edu
Faculty mentor/Co-author Nikita Ruparel, DDS, MS, PhD
Faculty mentor/Co-author e-mail Ruparel@uthscsa.edu
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