Case Report/Clinical Techniques| Volume 38, ISSUE 6, P864-868, June 2012

A Clinical and Histological Report of a Tooth with an Open Apex Treated with Regenerative Endodontics Using Platelet-rich Plasma



      In patients, the outcomes of teeth with necrotic pulps and open apexes that have been treated with regenerative endodontics have always been evaluated clinically and radiographically. The purpose of this case report is to present the clinical, radiographic, and histological findings of a regenerative procedure using platelet-rich plasma (PRP) 14 months after the procedure.


      A 12-year-old boy whose maxillary second premolar tooth had been treated with regenerative endodontics was seen with a chief complaint of pain and sensitivity to cold. After clinical and radiographic examinations, a pulpal diagnosis of reversible pulpitis and normal periapical tissues was made for this tooth. Because of the patient’s complaint and his guardian’s insistence on either a root canal treatment or an extraction, a root canal treatment was performed in this tooth. After entry into the root canal, the soft tissue present in the canal was removed with the aid of a large barbed broach and examined histologically.


      Examination of the tissue removed from the root canal of this tooth revealed the presence of a vital pulp-like vital connective tissue. There was no evidence of bone in the specimen. Very few inflammatory cells were noted in the periphery of the specimen.


      Based on these findings, it appears that pulp-like tissue can be generated in a human tooth with the use of PRP as a scaffold in regenerative endodontic procedures.

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        • Kling M.
        • Cvek M.
        • Mejare I.
        Rate and predictability of pulp revascularization in therapeutically reimplanted permanent incisors.
        Endod Dent Traumatol. 1986; 2: 83-89
        • Cvek M.
        • Cleaton-Jones P.
        • Austin J.
        • Lownie J.
        • Kling M.
        • Fatti P.
        Pulp revascularization in reimplanted immature monkey incisors–predictability and the effect of antibiotic systemic prophylaxis.
        Endod Dent Traumatol. 1990; 6: 157-169
        • Ham J.W.
        • Patterson S.S.
        • Mitchell D.F.
        Induced apical closure of immature pulpless teeth in monkeys.
        Oral Surg Oral Med Oral Pathol. 1972; 33: 438-449
        • Rule D.C.
        • Winter G.B.
        Root growth and apical repair subsequent to pulpal necrosis in children.
        Br Dent J. 1966; 120: 586-590
        • Nevins A.
        • Wrobel W.
        • Valachovic R.
        • Finkelstein F.
        Hard tissue induction into pulpless open-apex teeth using collagen-calcium phosphate gel.
        J Endod. 1977; 3: 431-433
        • Iwaya S.I.
        • Ikawa M.
        • Kubota M.
        Revascularization of an immature permanent tooth with apical periodontitis and sinus tract.
        Dent Traumatol. 2001; 17: 185-187
        • Banchs F.
        • Trope M.
        Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol?.
        J Endod. 2004; 30: 196-200
        • Chueh L.H.
        • Huang G.T.
        Immature teeth with periradicular periodontitis or abscess undergoing apexogenesis: a paradigm shift.
        J Endod. 2006; 32: 1205-1213
        • Cotti E.
        • Mereu M.
        • Lusso D.
        Regenerative treatment of an immature, traumatized tooth with apical periodontitis: report of a case.
        J Endod. 2008; 34: 611-616
        • Jung I.Y.
        • Lee S.J.
        • Hargreaves K.M.
        Biologically based treatment of immature permanent teeth with pulpal necrosis: a case series.
        J Endod. 2008; 34: 876-887
        • Shah N.
        • Logani A.
        • Bhaskar U.
        • Aggarwal V.
        Efficacy of revascularization to induce apexification/apexogensis in infected, nonvital, immature teeth: a pilot clinical study.
        J Endod. 2008; 34: 919-925
        • Chueh L.H.
        • Ho Y.C.
        • Kuo T.C.
        • Lai W.H.
        • Chen Y.H.
        • Chiang C.P.
        Regenerative endodontic treatment for necrotic immature permanent teeth.
        J Endod. 2009; 35: 160-164
        • Ding R.Y.
        • Cheung G.S.
        • Chen J.
        • Yin X.Z.
        • Wang Q.Q.
        • Zhang C.F.
        Pulp revascularization of immature teeth with apical periodontitis: a clinical study.
        J Endod. 2009; 35: 745-749
        • Bose R.
        • Nummikoski P.
        • Hargreaves K.
        A retrospective evaluation of radiographic outcomes in immature teeth with necrotic root canal systems treated with regenerative endodontic procedures.
        J Endod. 2009; 35: 1343-1349
        • Reynolds K.
        • Johnson J.D.
        • Cohenca N.
        Pulp revascularization of necrotic bilateral bicuspids using a modified novel technique to eliminate potential coronal discolouration: a case report.
        Int Endod J. 2009; 42: 84-92
        • Shin S.Y.
        • Albert J.S.
        • Mortman R.E.
        One step pulp revascularization treatment of an immature permanent tooth with chronic apical abscess: a case report.
        Int Endod J. 2009; 42: 1118-1126
        • Mendoza A.M.
        • Reina E.S.
        • Garcia-Godoy F.
        Evolution of apical formation on immature necrotic permanent teeth.
        Am J Dent. 2010; 23: 269-274
        • Petrino J.A.
        • Boda K.K.
        • Shambarger S.
        • Bowles W.R.
        • McClanahan S.B.
        Challenges in regenerative endodontics: a case series.
        J Endod. 2010; 36: 536-541
        • Thomson A.
        • Kahler B.
        Regenerative endodontics–biologically-based treatment for immature permanent teeth: a case report and review of the literature.
        Aust Dent J. 2010; 55: 446-452
        • Nosrat A.
        • Seifi A.
        • Asgary S.
        Regenerative endodontic treatment (revascularization) for necrotic immature permanent molars: a review and report of two cases with a new biomaterial.
        J Endod. 2011; 37: 562-567
        • Cehreli Z.C.
        • Isbitiren B.
        • Sara S.
        • Erbas G.
        Regenerative endodontic treatment (revascularization) of immature necrotic molars medicated with calcium hydroxide: a case series.
        J Endod. 2011; 37: 1327-1330
        • Chen M.Y.
        • Chen K.L.
        • Chen C.A.
        • Tayebaty F.
        • Rosenberg P.A.
        • Lin L.M.
        Responses of immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscess to revascularization procedures.
        Int Endod J. 2011; 45: 294-305
        • Torneck C.D.
        • Smith J.S.
        • Grindall P.
        Biologic effects of endodontic procedures on developing incisor teeth. 3. Effect of debridement and disinfection procedures in the treatment of experimentally induced pulp and periapical disease.
        Oral Surg Oral Med Oral Pathol. 1973; 35: 532-540
        • Myers W.C.
        • Fountain S.B.
        Dental pulp regeneration aided by blood and blood substitutes after experimentally induced periapical infection.
        Oral Surg Oral Med Oral Pathol. 1974; 37: 441-450
        • Nevins A.J.
        • Finkelstein F.
        • Borden B.G.
        • Laporta R.
        Revitalization of pulpless open apex teeth in rhesus monkeys, using collagen-calcium phosphate gel.
        J Endod. 1976; 2: 159-165
        • Nevins A.
        • Finkelstein F.
        • Laporta R.
        • Borden B.G.
        Induction of hard tissue into pulpless open-apex teeth using collagen-calcium phosphate gel.
        J Endod. 1978; 4: 76-81
        • Das S.
        • Das A.K.
        • Murphy R.A.
        Experimental apexigenesis in baboons.
        Endod Dent Traumatol. 1997; 13: 31-35
        • Thibodeau B.
        • Teixeira F.
        • Yamauchi M.
        • Caplan D.J.
        • Trope M.
        Pulp revascularization of immature dog teeth with apical periodontitis.
        J Endod. 2007; 33: 680-689
        • Zuong X.Y.
        • Yang Y.P.
        • Chen W.X.
        • Zhang Y.J.
        • Wen C.M.
        [Pulp revascularization of immature anterior teeth with apical periodontitis].
        Hua Xi Kou Qiang Yi Xue Za Zhi. 2010; 28: 672-674
        • Wang X.
        • Thibodeau B.
        • Trope M.
        • Lin L.M.
        • Huang G.T.
        Histologic characterization of regenerated tissues in canal space after the revitalization/revascularization procedure of immature dog teeth with apical periodontitis.
        J Endod. 2010; 36: 56-63
        • da Silva L.A.
        • Nelson-Filho P.
        • da Silva R.A.
        • et al.
        Revascularization and periapical repair after endodontic treatment using apical negative pressure irrigation versus conventional irrigation plus triantibiotic intracanal dressing in dogs' teeth with apical periodontitis.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 109: 779-787
        • Scarparo R.K.
        • Dondoni L.
        • Bottcher D.E.
        • Grecca F.S.
        • Rockenbach M.I.
        • Batista Jr., E.L.
        Response to intracanal medication in immature teeth with pulp necrosis: an experimental model in rat molars.
        J Endod. 2011; 37: 1069-1073
        • Torabinejad M.
        • Turman M.
        Revitalization of tooth with necrotic pulp and open apex by using platelet-rich plasma: a case report.
        J Endod. 2011; 37: 265-268
        • Johnson R.H.
        • Dachi S.F.
        • Haley J.V.
        Pulpal hyperemia—a correlation of clinical and histologic data from 706 teeth.
        J Am Dent Assoc. 1970; 81: 108-117
        • Lovelace T.W.
        • Henry M.A.
        • Hargreaves K.M.
        • Diogenes A.
        Evaluation of the delivery of mesenchymal stem cells into the root canal space of necrotic immature teeth after clinical regenerative endodontic procedure.
        J Endod. 2011; 37: 133-138
        • Buhrley M.R.
        • Corr R.
        • Shabahang S.
        • Torabinejad M.
        Identification of tissues formed after pulp revascularization in a Ferret model.
        J Endod. 2011; 37: 29