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)
22980172Jeeruphan/201261 patients with necrotic immature incisors and premolars Retrospective study
Key resultsRegenerative 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).
19801227Bose/200990 immature permanent necrotic teethRetrospective study
Key resultsRegenerative 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).
24461403Nagy/201436 immature necrotic permanent maxillary incisors of patients aged 9-13Randomized Controlled Trial
Key resultsTreatment 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) 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
None available