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Regenerative endodontics--biologically-based treatment for immature permanent teeth: a case report and review of the literature.

AbstractBACKGROUND:
A paradigm shift in the treatment of immature, necrotic teeth has occurred with biologically-based principles and regenerative endodontic protocols replacing traditional 'apexification' procedures. Preliminary research suggests that stem and progenitor cells from the pulp and/or periodontium contribute to continued root development when regenerative procedures are followed.
METHODS:
A mandibular premolar tooth with a chronic periapical abscess was irrigated with sodium hypochlorite with minimal instrumentation and then dressed with tri-antibiotic paste consisting of ciprofloxacin, metronidazole and amoxicillin. At a subsequent visit a blood clot was evoked in the canal by irritating periapical tissues and the canal sealed with mineral trioxide aggregate, glass ionomer cement and composite resin.
RESULTS:
Resolution of apical periodontitis and the draining sinus, continued root maturation and apical closure occurred over an 18-month period. The tooth became responsive to pulp sensibility testing.
CONCLUSIONS:
It is important that dentists recognize the potential of regenerative endodontics in the treatment of necrotic, immature teeth. Initial management should involve irrigation with sodium hypochlorite only. Intra-canal medicaments, such as calcium hydroxide, are contraindicated as they inhibit further root growth. This report uses a variation of the tri-antibiotic paste currently recommended for regenerative procedures that avoided the discolouration of the crown associated with current protocols. Regenerative endodontics with continued root growth may reduce the risk of fracture and premature tooth loss associated with traditional 'apexification' procedures where the root remains thin and weak.
AuthorsA Thomson, B Kahler
JournalAustralian dental journal (Aust Dent J) Vol. 55 Issue 4 Pg. 446-52 (Dec 2010) ISSN: 1834-7819 [Electronic] Australia
PMID21133946 (Publication Type: Case Reports, Journal Article, Review)
Copyright© 2010 Australian Dental Association.
Chemical References
  • Anti-Bacterial Agents
  • Drug Combinations
  • Root Canal Irrigants
  • Metronidazole
  • Ciprofloxacin
  • Amoxicillin
  • Sodium Hypochlorite
Topics
  • Amoxicillin (therapeutic use)
  • Anti-Bacterial Agents (therapeutic use)
  • Bicuspid
  • Blood Coagulation
  • Child
  • Ciprofloxacin (therapeutic use)
  • Dental Pulp (blood supply)
  • Dental Pulp Necrosis (drug therapy)
  • Drug Combinations
  • Female
  • Humans
  • Metronidazole (therapeutic use)
  • Neovascularization, Physiologic
  • Periapical Abscess (drug therapy)
  • Regeneration
  • Root Canal Irrigants (therapeutic use)
  • Root Canal Obturation
  • Sodium Hypochlorite (therapeutic use)
  • Tooth Apex (growth & development)

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