Treatment of Mature Permanent Teeth with Necrotic Pulps and Apical Periodontitis Using Regenerative Endodontic Procedures: A Case Series

Tarek Mohamed Saoud, Gabriela Martin, Yea Huey M. Chen, Kuang Liang Chen, Chao An Chen, Kamolthip Songtrakul, Matthew Malek, Asgeir Sigurdsson, Louis M. Lin

Research output: Contribution to journalArticle

Abstract

Introduction Regenerative endodontic procedures (REPs) are usually used to treat human immature permanent teeth with necrotic pulps and/or apical periodontitis. Successful REPs result in the elimination of clinical signs/symptoms, the resolution of apical periodontitis, and, in some cases, thickening of the canal walls and/or continued root development with or without apical closure. REPs can restore the vitality of tissue in the canals of immature permanent teeth previously destroyed by infection or trauma. Vital tissue is inherited with immune defense mechanisms to protect itself from foreign invaders. Recently, REPs have also been used to successfully treat human mature permanent teeth with necrotic pulps and apical periodontitis. The purpose of this case series was to present the potential of using REPs for mature permanent teeth with necrotic pulps and apical periodontitis. Methods This case series consisted of 6 patients, 4 females and 2 males. The patients' ages ranged from 8-21 years old. Seven permanent teeth, 4 anterior and 3 molar teeth, with necrotic pulps and apical periodontitis were treated using REP. Radiographically, the root development of all teeth was almost completed except the apices of 2 molars, which showed slightly open. Complete chemomechanical debridement of the canals of the teeth was performed, and the canals were dressed with Metapaste (Meta Biomed Co, Ltd, Chungbuk, Korea) during treatment visits. Periapical bleeding into the canals was induced at the last treatment visit by placing a hand #20 or #25 K-file with the tip slightly bent through the apical foramina into the periapical tissues. A 3-mm thickness of mineral trioxide aggregate was placed into the coronal canals over semicoagulated blood. The access cavities were restored with either composite resin or amalgam. Results Follow-ups of the 7 teeth ranged from 8 to 26 months. The periapical lesions of 2 teeth were considered healed, and 5 teeth revealed healing. Clinical signs/symptoms were absent in all teeth at follow-up visits at different time points. None of the treated teeth responded to cold and electric pulp tests. Conclusions This case series shows the potential of using REPs for mature teeth with necrotic pulp and apical periodontitis.

Original languageEnglish (US)
Pages (from-to)57-65
Number of pages9
JournalJournal of endodontics
Volume42
Issue number1
DOIs
StatePublished - Jan 1 2016

Keywords

  • Apical periodontitis
  • immune defense mechanisms
  • mature teeth
  • necrotic pulps
  • regenerative endodontic therapy
  • vital tissue

ASJC Scopus subject areas

  • Dentistry(all)

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