- •The present systematic review summarizes studies that undertook a quantitative assessment of further root maturation of necrotic/immature teeth after treatment with regenerative endodontic procedures (REPs).
- •Outcome measures for the management of necrotic/immature teeth with REPs were considered in terms of clinician- and patient- based criteria.
- •REPs were associated with variable degrees of further root maturation unlike the alternative treatment procedures.
- •Tooth survival and clinical and radiographic healing success rates were similar for REPs and alternative treatments.
- •REPs may be associated with more adverse effects.
Two fundamental assumptions for teeth treated with regenerative endodontic procedures (REPs) are (1) that the clinical outcome is comparable with the traditional techniques of calcium hydroxide apexification and mineral trioxide aggregate apical barrier techniques and (2) that REPs will result in further root maturation.
A systematic review of the electronic databases (Scopus, PubMed, and Web of Science) involved a search for studies that used quantitative assessments of root maturation. The search terms were “dental pulp,” “regenerative endodontic therapy,” “revascularization,” and “revitalization.” The identified studies were further screened for cohort studies that compared clinical outcomes between teeth treated with REPs and apexification/apical barrier approaches. The primary question under review was framed according to the population, exposure, and outcome format.
Of the 368 studies identified by the search, 6 cohort studies used quantitative assessments of any further root maturation after REPs, and a subset of 4 of these cohort studies assessed and compared clinical outcomes between the different treatment approaches.
Immature teeth with pulp necrosis treated with REPs generally show further root maturation although the results are variable. Clinical outcomes were similar for both groups. Patient-based criteria such as tooth discoloration, indications for changing the treatment option, and number of treatment appointments are all important for discussion before electing the appropriate treatment plan for the management of immature teeth with pulp necrosis.
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- Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with gutta-percha. A retrospective study.Endod Dent Traumatol. 1992; 8: 45-55
- Treatment of non-vital permanent incisors with calcium hydroxide. 1. Follow-up of periapical repair and apical closure of immature roots.Odontol Revy. 1972; 23: 27-44
- Calcium hydroxide in the treatment of pulpless teeth with associated pathology.J Br Endod Soc. 1975; 8: 74-93
- Long-term calcium hydroxide as a root canal dressing may increase risk of root fracture.Dent Traumatol. 2002; 18: 134-137
- One-visit apexification: technique for inducing root end barrier formation in apical closures.Pract Proced Aesthet Dent. 2001; 13: 455-460
- Retrospective analysis of open apex teeth obturated with mineral trioxide aggregate.J Endod. 2008; 34: 1171-1176
- Revascularization of an immature permanent tooth with apical periodontitis and sinus tract.Dent Traumatol. 2001; 17: 185-187
- Regenerative endodontics. A way forward.J Am Dent Assoc. 2016; 147: 372-380
- The effectiveness of pulp revascularization in root formation of necrotic immature permanent teeth: a systematic review.Acta Odontol Scand. 2016; 74: 161-169
- Is revascularization of immature permanent teeth an effective and reproducible technique?.Dent Traumatol. 2015; 31: 429-436
American Association of Endodontists. AAE clinical considerations for a regenerative procedure. Available at: https://www.aae.org/uploadedfiles/publications_and_research/research/currentregenerativeendodonticconsiderations.pdf. Accessed May 5, 2017.
- Levels of evidence for the outcome of regenerative endodontic therapy.J Endod. 2014; 40: 1045-1053
- Regenerative endodontic therapy: a data analysis of clinical protocols.J Endod. 2015; 41: 146-154
- 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
- Mahidol study 1: comparison of radiographic and survival outcomes of immature teeth treated with either regenerative endodontic or apexification methods—a retrospective study.J Endod. 2012; 38: 1330-1336
- Regenerative potential of immature permanent teeth with necrotic pulps after different regenerative protocols.J Endod. 2014; 40: 192-198
- Revascularization outcomes: a prospective analysis of sixteen consecutive cases.J Endod. 2014; 40: 333-338
- Radiographic and clinical outcomes of the treatment of immature permanent teeth by revascularization or apexification: a pilot retrospective cohort study.J Endod. 2014; 40: 1063-1070
- Clinical and radiographic outcomes of traumatized immature permanent necrotic teeth after revascularization/revitalization therapy.J Endod. 2014; 40: 1946-1952
- Prognosis of luxated permanent teeth – the development of pulp necrosis.Endod Dent Traumatol. 1985; 1: 207-220
- Bacterial penetration of the root canal of intact incisor teeth after a simulated traumatic injury.Endod Dent Traumatol. 1996; 12: 289-293
- Bacteriological studies of necrotic dental pulps [odontological dissertation no. 7].University of Umeå, Umeå, Sweden1976
- Bacteria in the apical 5 mm of infected root canals.J Endod. 1991; 17: 380-383
- An update on clinical regenerative endodontics.Endod Topics. 2013; 28: 2-23
- Drawbacks and unfavorable outcomes of regenerative endodontic treatments of necrotic immature teeth: a literature review and report of a case.J Endod. 2012; 38: 1428-1434
- Revitalization procedures in two traumatized incisors with different biological outcomes.J Endod. 2012; 38: 411-414
- A review of tooth discoloration after regenerative endodontic therapy.J Endod. 2016; 42: 563-569
- Mineral trioxide aggregate: a comprehensive literature review–part III: clinical applications, drawbacks, and mechanism of action.J Endod. 2010; 36: 400-413
Published online: May 13, 2017
© 2017 American Association of Endodontists.