Title

Regenerative Endodontic Procedures Increase Both Root Length and Width of Necrotic Immature Permanent Teeth Compared to MTA Apexification

Clinical Question

For patients who have necrotic immature permanent teeth, are regenerative endodontic procedures more effective than MTA apexification in promoting further root development?

Clinical Bottom Line

For patients who have necrotic immature permanent teeth, regenerative endodontic procedures are more effective in furthering root development of necrotic immature permanent teeth compared to traditional MTA apexification. This has been best shown by a retrospective study in which regenerative endodontic procedures yielded a more significant increase in root length and width of immature necrotic teeth and higher survival rates compared with traditional apexification procedures using MTA. Immature teeth normally exhibit thinner root dentin and incomplete root length, increasing the likelihood of fracture if these teeth are obturated in the existing condition. Regenerative endodontic procedures offer patients a superior treatment outcome than MTA apexification.

Best Evidence

PubMed ID	Author / Year	Patient Group	Study type (level of evidence)
22980172	Jeeruphan/2012	61 patients with necrotic immature incisors and premolars	Retrospective study
Key results	Regenerative endodontic procedures (REP) showed a significant increase of 28.2% for root width compared with 0% for MTA apexification (P<.0001). Root length increased by 14.9% for REP whereas MTA apexification increased by 6.1% (P<.01).
19801227	Bose/2009	90 immature permanent necrotic teeth	Retrospective study
Key results	Regenerative endodontic procedures with triple antibiotic paste (TAP) and calcium hydroxide as intracanal medicament produced a more significant increase in root length than control groups of MTA apexification and nonsurgical root canal therapy (P<.001). The TAP increased dentin wall thickness more significantly than formocresol or calcium hydroxide (P<.05).
24461403	Nagy/2014	36 immature necrotic permanent maxillary incisors of patients aged 9-13	Randomized Controlled Trial
Key results	Treatment groups using regenerative endodontic protocol with blood clot (REG) and with blood clot and injectable scaffold (FGF) both showed progressive increase in root length (P<.001) and width (P<.001) in the follow up period of 18 months compared with groups using MTA apical plug.

Evidence Search

“regenerative endodontic procedures”, “immature necrotic teeth”, “MTA apexification”

Comments on
The Evidence

Validity: This study evaluated the effectiveness of three treatment protocols (regenerative endodontic procedure, MTA apexification, calcium hydroxide apexification) for necrotic immature teeth in 61 cases. Due to the retrospective nature of the study, sample randomization was not done. However, all teeth presented with similar conditions preoperatively, which was necrotic pulp with immature root development. The only difference in the three samples was the treatment received. An adequte follow-up period was documented in the range of 14 months to 27 months. Results showed a statistically significant increase in root length and width development in patients who received regenerative endodontic procedures. Perspective: Regenerative endodontic procedures are stem cell-based therapies that aim at regenerating the pulp-dentin complex post pulp necrosis in immature teeth. With traditional MTA or calcium hydroxide apexification, infection of teeth can be resolved, but future prognosis of weakened root dentin is guarded. The increased root width and length are extremely valuable in improving these teeth’s longevity.

Applicability

In clinical practice, many young patients can present with necrotic immature teeth most likely due to injuries from trauma, caries, or dental anomalies. Many of the teeth have short and incomplete root formation. Regenerative endodontic procedures are the only treatment option currently available to increase root length and width of these teeth. The procedure is also reversible, as MTA apexification can be performed in case of sub-optimal clinical outcome.

Specialty

(Endodontics) (General Dentistry)

Keywords

Regenerative endodontic procedure, MTA apexification, immature necrotic teeth

ID#

3103

Date of submission

11/14/2016

E-mail

wangy9@livemail.uthscsa.edu

Author

Jenny Sun, DDS

Co-author(s)

Co-author(s) e-mail

Faculty mentor

Nikita Ruparel, DDS, MS, PhD

Faculty mentor 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?)

None available

Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs)

None available