Review Article| Volume 43, ISSUE 7, P1052-1057, July 2017

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An Evidence-based Review of the Efficacy of Treatment Approaches for Immature Permanent Teeth with Pulp Necrosis


      • 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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