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The purpose of this report is to present conservative treatment for two immature premolars with apical periodontitis. A triple antibiotic paste was used to disinfect the root canal systems for revascularization. In both cases, residual vital pulp tissue was noted in the root canal system after the opening of each premolar. The canals in both cases were irrigated with copious sodium hypochlorite solution and medicated with a paste consisting of ciprofloxacin, metronidazole, and minocycline. The teeth were sealed with mineral trioxide aggregate and restored with composite resin. There were satisfactory outcomes after 18 months. The patients were asymptomatic, with radiographic evidence of complete resolution of radiolucency, continual thickening of dentinal walls, apical closure, and increased root length.

Background: The purpose of this study was to evaluate the long-term fracture resistance of simulated immature teeth filled with Biodentine (BD) and white mineral trioxide aggregate (WMTA) as pulp space barriers for regenerative endodontic procedures (REPs)., Materials and Methods: Sixty extracted human maxillary anterior teeth were divided into four groups of 15 teeth each. Positive control teeth received no treatment. The remaining teeth were prepared until a size 6 Peeso (1.7 mm) could be passed 1 mm beyond the apex. Then, an engineering twist drill of 3 mm diameter was used to extend the preparation of the canal 3 mm below CEJ. The root canals were irrigated and disinfected according to AAE considerations for REPs. The canals were filled with either BD or WMTA. The negative control canals were left unfilled. The coronal access cavities were restored with glass ionomer followed by composite resin. The teeth were placed in phosphate-buffered saline solution and stored for 12 months. Each specimen was then subjected to fracture testing using a universal testing machine. The peak load to fracture and the fracture resistance were recorded, and the data were analysed statistically., Results: The positive control group had the highest fracture resistance and differed significantly (P < 0.05) from the other experimental groups. No significant difference was found between BD and WMTA (P > 0.05)., Conclusions: Considering the risk of cervical root fracture for pulpless infected immature teeth treated with REPs, after 12 months, there was no difference between WMTA and BD regarding the resistance to root fracture., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To compare the fracture resistance of simulated immature teeth filled with an apical barrier of mineral trioxide aggregate (MTA), Biodentine, and calcium-enriched mixture (CEM)., Materials and Methods: Fifty-two single-rooted human maxillary central incisors were used. For standardization, the teeth were sectioned 6 mm above and 9 mm below the cementoenamel junction to simulate immature apex. Simulations of roots into immature apices were carried out using 1.5 mm diameter drills. The specimens were then randomly divided into three experimental groups (n = 13) and one control group (n = 13). In experimental groups, MTA, Biodentine, and CEM were placed to apical 4 mm of the simulated immature roots. The samples were stored at 37° C and 100% humidity for 1 week. A load was applied on the crown of all teeth at 135° to their long axis until fracture. The data were analyzed using one-way analysis of variance and Tukey post-hoc tests., Results: No statistically significant differences were found among MTA, CEM, and Biodentine (P > 0.05), and these groups demonstrated higher fracture resistance than control group (P < 0.05)., Conclusions: Using any of the MTA, Biodentine, and CEM as an apical plug and restoring with fiber post and composite resin increases the fracture resistance of immature teeth.

Objective: The purpose of this study was to evaluate fracture resistance of teeth with immature apices treated with coronal placement of mineral trioxide aggregate (MTA), bioaggregate (BA), and Biodentine., Materials and Methods: Forty-one freshly extracted, single-rooted human premolar teeth were used for the study. At first, the root length was standardized to 9 mm. The crown-down technique was used for the preparation of the root canals using the rotary ProTaper system (Dentsply Maillefer, Ballaigues, Switzerland) of F3 (30). Peeso reamer no. 6 was stepped out from the apex to simulate an incompletely formed root. The prepared roots were randomly assigned to one control (n = 5) and three experimental (n = 12) groups, as described below. Group 1: White MTA (Angelus, Londrina, Brazil) was prepared as per the manufacturer's instructions and compacted into the root canal using MAP system (Dentsply Maillefer, Ballaigues, Switzerland) and condensed by pluggers (Angelus, Londrina, Brazil). Group 2: The canals were filled with DiaRoot-BA (DiaDent Group International, Canada). Group 3: Biodentine (Septodont, Saint Maur des Fosses, France) solution was mixed with the capsule powder and condensed using pluggers. Instron was used to determine the maximum horizontal load to fracture the tooth, placing the tip 3 mm incisal to the cementoenamel junction. Mean values of the fracture strength were compared by ANOVA followed by a post hoc test. P < 0.05 was considered statistically significant., Results: No significant difference was observed among the MTA, BA, and biodentine experimental groups., Conclusion: All the three materials tested, may be used as effective strengthening agents for immature teeth.

Endodontic management of the permanent immature tooth continues to be a challenge for both clinicians and researchers. Clinical concerns are primarily related to achieving adequate levels of disinfection as 'aggressive' instrumentation is contraindicated and hence there exists a much greater reliance on endodontic irrigants and medicaments. The open apex has also presented obturation difficulties, notably in controlling length. Long-term apexification procedures with calcium hydroxide have proven to be successful in retaining many of these immature infected teeth but due to their thin dentinal walls and perceived problems associated with long-term placement of calcium hydroxide, they have been found to be prone to cervical fracture and subsequent tooth loss. In recent years there has developed an increasing interest in the possibility of 'regenerating' pulp tissue in an infected immature tooth. It is apparent that although the philosophy and hope of 'regeneration' is commendable, recent histologic studies appear to suggest that the calcified material deposited on the canal wall is bone/cementum rather than dentine, hence the absence of pulp tissue with or without an odontoblast layer., (© 2016 Australian Dental Association.)

Caries is the most common cause of pulp-periapical disease. When the pulp tissue involved in caries becomes irreversibly inflamed and progresses to necrosis, the treatment option is root canal therapy because the infected or non-infected necrotic pulp tissue in the root canal system is not accessible to the host's innate and adaptive immune defense mechanisms and antimicrobial agents. Therefore, the infected or non-infected necrotic pulp tissue must be removed from the canal space by pulpectomy. As our knowledge in pulp biology advances, the concept of treatment of pulpal and periapical disease also changes. Endodontists have been looking for biologically based treatment procedures, which could promote regeneration or repair of the dentin-pulp complex destroyed by infection or trauma for several decades. After a long, extensive search in in vitro laboratory and in vivo preclinical animal experiments, the dental stem cells capable of regenerating the dentin-pulp complex were discovered. Consequently, the biological concept of 'regenerative endodontics' emerged and has highlighted the paradigm shift in the treatment of immature permanent teeth with necrotic pulps in clinical endodontics. Regenerative endodontics is defined as biologically based procedures designed to physiologically replace damaged tooth structures, including dentin and root structures, as well as the pulp-dentin complex. According to the American Association of Endodontists' Clinical Considerations for a Regenerative Procedure, the primary goal of the regenerative procedure is the elimination of clinical symptoms and the resolution of apical periodontitis. Thickening of canal walls and continued root maturation is the secondary goal. Therefore, the primary goal of regenerative endodontics and traditional non-surgical root canal therapy is the same. The difference between non-surgical root canal therapy and regenerative endodontic therapy is that the disinfected root canals in the former therapy are filled with biocompatible foreign materials and the root canals in the latter therapy are filled with the host's own vital tissue. The purpose of this article is to review the potential of using regenerative endodontic therapy for human immature and mature permanent teeth with necrotic pulps and/or apical periodontitis, teeth with persistent apical periodontitis after root canal therapy, traumatized teeth with external inflammatory root resorption, and avulsed teeth in terms of elimination of clinical symptoms and resolution of apical periodontitis.

Endodontic treatment of immature necrotic teeth is a real challenge. Recently, a biologically based treatment strategy, referred to as regeneration, has been introduced. Tissue regeneration requires the presence of stems cells, a scaffold, and growth factors. Endodontic regeneration may improve the prognosis of immature necrotic teeth by re-establishing the functional pulpal tissue and further development of the root. However, the tissue formed in the pulpal space may not be original pulp tissue, and in some cases, it may result in uncontrolled calcification of the pulp. This study reports a case of successful endodontic regeneration and compares this process with the normal development of the contralateral tooth. Finally, it discusses the nature of the tissue formed during endodontic regeneration., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

This study evaluates the regenerative potential of immature permanent non-vital teeth following different dentin surface treatments in dogs. Periapical lesions and necrotic pulps were induced in 288 roots of 144 teeth in twelve dogs. Teeth were randomly divided into 3 equal groups according to the evaluation period. Each group was subdivided into 8 subgroups according to the treatment modalities including; blood clot, blood clot and collagen, blood clot and Ethylenediaminetetraacetic acid (EDTA), blood clot, collagen and EDTA, blood clot and Mixture Tetracycline Citric Acid and Detergent (MTAD), blood clot, collagen and MTAD, positive control and negative control. Apart from control subgroups, all infected root canals were cleaned with sodium hypochlorite solution and triple antibiotics paste before different treatment protocols. After different treatments, the root length, thickness and apical diameter were evaluated by radiographic examination. Histopathological examination was carried out to evaluate the inflammation, bone/root resorption, tissue in-growth in pulp space, new hard tissue formation and apical closure. Using EDTA solution as a surface modifier showed significantly higher levels of tissue in-growth in the pulp space after 6 weeks and 3 months. Addition of collagen as a scaffold caused significantly more bone/root resorption than the other subgroups while EDTA caused significantly lower inflammatory cell counts only after 2 weeks. Final rinse with 17% EDTA solution before blood clot induction has positive impact on tissue interaction along dentinal walls without modification of the cell type. Moreover, the use of collagen as a scaffold material and MTAD as a surface modifier did not improve the quality of the regenerative process., (Copyright © 2015 Elsevier GmbH. All rights reserved.)

Introduction: The purpose of this study was to evaluate the effectiveness of autologous platelet concentrates (APCs) in promoting pulp and dentin regeneration in animal models., Methods: An electronic search was performed on MEDLINE, Embase, Scopus, SciELO, LILACS, and CENTRAL. Animal studies using APC as a root filling material after pulpectomy in mature or immature teeth were included. Articles underwent risk of bias assessment. Histologic evaluation of intracanal neoformed tissue was the primary outcome; root development, root wall thickening, apical closure, and periapical healing in apical periodontitis were the secondary outcomes., Results: Seven articles were included. Platelet-rich plasma (PRP) was used as root filling material during regenerative procedures in the experimental group in either mature or immature teeth. After revascularization with PRP alone or in conjunction with stem cells of a different source, the histologic analyses revealed that, in addition to an odontoblastic cell layer or dentinlike structure, the neoformed intracanal tissues were mainly cementumlike, bonelike, and connective tissues., Conclusions: True regeneration of necrotic pulp may not be achieved with current techniques using PRP, all of which stimulated tissue repair. Benefits of PRP adjunct for pulp tissue regeneration in preclinical studies remain unclear. Further studies with standardized protocols are necessary to assess the actual contribution of PRP in endodontic regenerative therapies., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

The endodontic management of permanent immature teeth is fraught with challenges. Although treatment modalities for vital pulp therapy in these teeth provide long-term favorable outcome, the outcomes from the treatment of pulp necrosis and apical periodontitis are significantly less predictable. Immature teeth diagnosed with pulp necrosis have been traditionally treated with apexification or apexogenesis approaches. Unfortunately, these treatments provide little to no benefit in promoting continued root development. Regenerative endodontic procedures have emerged as an important alternative in treating teeth with otherwise questionable long-term prognosis because of thin, fragile dentinal walls and a lack of immunocompetency. These procedures rely heavily on root canal chemical disinfection of the root canal system. Traditionally, irrigants and medicaments have been chosen for their maximum antimicrobial effect without consideration for their effects on stem cells and the dentinal microenvironment. Translational research has been crucial to provide evidence for treatment modifications that aim to increase favorable outcome while steering away from common pitfalls in the currently used protocols. In this review, recent advances learned from translational research related to disinfection in regenerative endodontics are presented and discussed. [ABSTRACT FROM AUTHOR]

Background: Revascularization has been proposed as an improved alternative treatment for irreversibly damaged pulp of immature teeth as it has been shown to preserve the potential for continued root growth in treated teeth., Aim: To review clinical cases of revascularization in humans to evaluate their utility and reproducibility., Material and Methods: A structured electronic search of scientific articles published between 2001 and 2014 was carried out using the following keywords: 'pulp revascularization', 'pulp revitalization' and/or 'immature tooth'. Clinical revascularization cases conducted on human subjects were selected, reviewed and organized into two charts including patient information, diagnostic information, treatment and results in follow-up visits., Results: Ninety-seven of 101 teeth (96.0%) were successfully treated with the revascularization technique. The range of technique variations available for irrigation, disinfection and blood clot induction have a negligible impact on the clinical outcome variables tested in our analysis. During the follow-up visits, apical closure was detected in fewer cases (55.4%) as compared to the other apexogenesis phenomena (increased root length, 76.2%; increased root width, 79.2%)., Conclusions: The review shows that the revascularization technique showed marked increase in the root length, width and apical closure in the cases that were reported independently of clinical variables such as operator and material selection and individual differences in protocols., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Apexogenesis after traumatic exposure in vital young permanent teeth can be accomplished by implementing the appropriate vital pulp therapy such as pulp capping (direct or indirect) or pulpotomy (partial or complete) depending on the time between the trauma and treatment of the patient, degree of root development, and size of the pulp exposure., Case Report: Two children with respectively 2 and 1 complicated enamel dentine fractures in immature permanent incisors were treated with new tricalcium silicate cement (Biodentine™). The treatment plan in these cases was to maintain pulp vitality aiming for apexogenesis which allows continued root development along the entire root length. Endodontic management included partial pulpotomy or pulpotomy using Biodentine™. Clinical and radiographical evaluation (up to 48 months) showed continual apexogenesis with no periodontal or periapical pathology. The appropriate restorations were functionally acceptable and aesthetically satisfying. The three traumatised teeth showed complete success both clinically (vitality and aesthetic outcome) as well as radiographically (apexogenesis and absence of pathological findings) after up to 48 months follow-up., Conclusion: Biodentine™ is a suitable alternative to MTA for vital pulpotomy in traumatised permanent incisors. It is also beneficial as a temporary filling without any risk of discolouration.

The aim of this study was to evaluate the effectiveness of endodontic instrument systems in the removal of calcium hydroxide [Ca(OH)(2)] from simulated immature teeth. The root canals of 106 human single-rooted teeth were shaped with ProTaper rotary files up to an F5 file size. Simulation of roots with immature apices was carried out using size 4 green 1.5-mm diameter Unicore drills. A non-setting Ca(OH)(2) was injected into each root canal and inserted into the working length using lentulo spiral, after which cotton pellets were placed over canal orifices. The apical and coronal side of the roots were then sealed with glass ionomer cement and light cured. Specimens were stored in distilled water for 3 months at 37 °C. After 3 months, the temporary coronal seal was removed and the samples were randomly divided into five experimental groups according to the method used for Ca(OH)(2) removal (ProTaper, Reciproc, OneShape, WaveOne, and Manual) (n = 20), one positive control group (n = 3) and one negative control group (n = 3). The amount of remaining Ca(OH)(2) in the canal walls was measured under a stereomicroscope at 30× magnification. The data were analyzed using Kruskal-Wallis test and Mann-Whitney U test at a significance level of 0.05. Positive and negative control groups were found to be statistically different from all other groups (p < 0.05). There were no significant differences among the ProTaper, Reciproc, OneShape, WaveOne, and Manual groups (p > 0.05). As a conclusion, none of the techniques completely removed Ca(OH)(2) from simulated immature teeth., (© Wiley Periodicals, Inc.)

Aim: The present study was to evaluate pH values of apexification materials., Materials and Methods: The materials were placed in 1 cm long and 4 mm diameter tubes. After sample immersion, glass flasks were hermetically sealed with rubber caps to attenuate any effects of external environmental factors and maintained at 37°C. The power hydrogen of the pastes was measured 1 hour, 3 hours, 8 hours, 24 hours, 72 hours and 7 days after preparation. pH was calibrated with solutions of known pH (7.0). Mann-Whitney test were used to determine significant differences., Results: The mean pH of all medications was < 12.0 throughout the experiment. At 24 hours, EndoCal 10 had the highest pH of all the materials (p < 0.05)., Conclusion: According to the results obtained, it may be concluded that calcium oxide (EndoCal 10) presented the highest pH compared with mineral trioxide aggregate (MTA) and Calasept Plus [Ca(OH)2]., Clinical Significance: Apexification is an important treatment in immature teeth. For this reason, used materials in apexification should have some properties, such as high pH and stimulating to be hard tissue. Therefore, the material should be chosen carefully in apexification of immature teeth.

Abstract – Fifty-six extracted maxillary central incisors were used for this study. The crown of each tooth was removed in order to obtain a standard length of 13 mm. Root canals were enlarged to simulate immature teeth after apexification. The apical 2 mm of the root canal was obturated with gutta-percha and AH26 sealer. The specimens were divided into two groups. Group A was unrestored and served as positive control. In group B, the canal walls were reinforced with a resin modified glass ionomer using a translucent curing post. All teeth were subjected to compressive force using an Instron testing machine until fracture occurred. Group B showed an increased resistance to fracture (456.02 ± 172.47 N) compared with group A (263.46 ± 98.00 N). The difference between groups was statistically significant (P < 0.005). [ABSTRACT FROM AUTHOR]