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| Title |
There Is Preliminary Evidence That Single Visit Regenerative Endodontic Therapy On Immature Necrotic Permanent Teeth Promotes Similar Amount of Radiographic Root Development as Use of an Interappointment Dressing |
| Clinical Question |
In immature teeth needing regenerative endodontic therapy, does the use of an interappointment dressing lead to more radiographic root development compared to no interappointment dressing? |
| Clinical Bottom Line |
There is preliminary evidence that single visit regenerative endodontic therapy on immature necrotic permanent teeth promotes similar amount of radiographic root development as the use of an interappointment dressing. However, current studies have small sample sizes and short follow ups. More research is required before any single visit protocols can be recommended. |
| 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) 34310980 | Cerqueira-Neto/2021 | 17 Children with a total of 20 immature necrotic maxillary incisors from trauma | Randomized Controlled Trial | | Key results | At 24 month follow up there was no significant difference between the interappointment calcium hydroxide / 2% chlorhexidine gel dressing group and the single visit group based on radiographic reduction in apical diameter, increase in root width, and increase in root length. | | #2) 28844307 | Botero/2017 | 25 Young patients with 28 necrotic immature permanent teeth | Randomized Controlled Trial | | Key results | There was 12-month success of 71% for the delayed group and 33% for the immediate group with no statistically significant difference. All successful cases started at stage 9 of root development (Nolla), and the majority showed healing type 2. | |
| Evidence Search |
“single-visit” AND “regenerative endodontic” |
Comments on
The Evidence |
Cerqueira-Neto has a well-designed clinical trial with a small sample size. This paper looked at 20 traumatized immature permanent teeth. Eleven teeth were in the two-visit group where calcium hydroxide and 2% chlorhexidine gel were used as an interappointment dressing for 21 days. Nine teeth were in the one-visit group. The teeth were followed for 24 months. The preoperative type of trauma was noted. Preoperative and postoperative radiographs were used to quantify changes in apical diameter, root width, root length, and cervical barrier placement. Changes in root development compared with T test or Mann-Whitney U test. There was no significant difference in root development noted.
Botero has an incomplete study examining root length changes. Data collection is not complete. This study has 28 necrotic immature permanent teeth. Fifteen teeth were in the two-appointment group with calcium hydroxide used as the intracanal medication. Thirteen teeth were in the one appointment group. Postoperative evaluation was conducted at 1, 3, and 12 months. Radiographic results were noted. A reduction in lesion size and the absence of signs or symptoms were used to denote success. Success was compared with the Pearson chi-square test or the Fisher exact test. The two-group visit had 71% success and the single visit group had 33% success. No significant difference was found between the groups. Not all teeth have completed their 12 month follow up at the time of publication and changes in root length and width have not been determined.
More radiographic follow up is needed on a greater number of immature necrotic teeth. The limited amount of data weakens the finding of no significant changes between the two-appointment and one-appointment groups. |
| Applicability |
Providers routinely encounter young patients with immature necrotic permanent teeth. Historically, apexification has been the only single visit option while regenerative endodontics traditionally is done in a minimum of two appointments with the use of an interappointment dressing. The benefit of a single visit can be the deciding factor to choose apexification. While apexification has similar survival rates to regenerative endodontics, the lack of continued root development is a point of concern in apexification. Shorter and thinner roots increase risk of root fracture. Exploring single visit regenerative endodontic treatment may allow more patients that cannot return for a second visit the benefits of continued root development. |
| Specialty/Discipline |
(Endodontics) (Pediatric Dentistry) |
| Keywords |
single-visit, regenerative endodontic
|
| ID# |
3513 |
| Date of submission: |
11/29/2022 |
| E-mail |
slykhous@uthscsa.edu |
| Author |
Rene Slykhous, DMD |
| Co-author(s) |
Justin Tuft, DDS |
| Co-author(s) e-mail |
tuft@uthscsa.edu |
| Faculty mentor/Co-author |
Nikita Ruparel, DDS, MS, PhD |
| Faculty mentor/Co-author e-mail |
ruparel@uthscsa.edu |
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?) |
post a rationale |
| 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) |
post a comment |
| None available | |
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