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ABSTRACT Objective Methods Results Conclusion Clinical Significance Tooth bleaching procedures on nonvital teeth have been performed for crown discoloration caused by regenerative endodontic therapy (RET). However, leakage of bleaching agents across the root canal can be detrimental. This study aimed to assess and compare the penetration levels of hydrogen peroxide (HP) from different bleaching agents across calcium silicate‐based coronal barriers in immature permanent teeth.Fifty extracted single‐rooted human teeth were randomly divided into four groups (n = 10): Group I (HH)–35% hydrogen peroxide (HP); Group II (SS)−a mixture of sodium perborate (SP) powder and saline; Group III (SH)−a mixture of SP powder and 30% HP liquid; Group IV (CP)–10% carbamide peroxide gel. The control group (Group V, CC) was treated with distilled water. The bleaching agent was replaced on the 4th day, and penetration analysis was performed on the 7th day using ferro thiocyanate (FTC) method and a UV‐spectrophotometer at a wavelength of 480 nm.Compared with the control group, the SH group (SP mixed with HP) showed a significant difference, indicating substantial HP penetration across the root canal space (p value < 0.0001). Intergroup comparisons also revealed a significant difference between the SS and SH groups (p value < 0.0001), suggesting that the SS group had less penetration.Compared with other bleaching agents, SP mixed with saline/water resulted in the lowest HP penetration in the pulp canals of the RET‐simulated tooth models.This study is the first to investigate HP penetration from different bleaching agents in teeth that have undergone RET, identifying the safest bleaching agent for use in these cases. This study also provides a foundation for further research to develop precise guidelines for nonvital tooth bleaching protocols in RET‐treated teeth. [ABSTRACT FROM AUTHOR]

Pulp necrosis is the most common complication following dental trauma and is often associated with apical periodontitis. The management of these teeth is challenging in terms of large root canals, open apices, thin dentinal walls, and short roots. Over decades the conventional treatment for these teeth was calcium hydroxide apexification, a time‐consuming procedure despite high success rates. Subsequently after the introduction of mineral trioxide aggregate and hydraulic calcium silicate materials single visit apical plug procedures became increasingly practiced with comparable success rates to the conventional apexification. The search continued afterward for a clinical procedure that may stimulate further root development and apical closure to avoid the long‐term complication of root fracture after apexification. Regenerative procedures using stem cells derived from the apical papilla and blood clots as scaffolds were then introduced for the management of immature teeth, with variable protocols and success rates. This review will cover the evidence available and current position of regenerative endodontic procedures in traumatized immature teeth with apical periodontitis, in terms of clinical protocols, outcome, and potential prognostic factors. [ABSTRACT FROM AUTHOR]

Abstract Objective To evaluate histologically and radiographically the potential of dog’s immature roots with apical periodontitis to regenerate after regenerative endodontic treatment using mesoporous silica nanoparticles (MSNs) with/without bone morphogenic protein (BMP-2) as scaffolds. Methods In 4 mongrel dogs, 56 immature teeth with 96 roots were infected, resulting in necrotic pulps and periapical pathosis. According to the evaluation time (Group I = 30 days and Group II = 90 days), 90 roots were divided into two equal groups (45 roots each) and 6 roots used to replace any lost root during the procedure. The two main groups were further divided according to treatment protocol into 5 subgroups (9 roots each): blood clot (BC subgroup), mesoporous silica nanoparticles scaffold only (MSNs subgroup), mesoporous silica nanoparticles impregnated with BMP2 (MSNs + BMP2 subgroup), infected teeth without treatment (+ ve control subgroup) and normal untouched teeth (-ve control subgroup). All teeth surfaces were coated with Tincture iodine and calcium hydroxide was applied prior to treatment protocols. Then, teeth were restored with glass ionomer filling to seal the remaining part of the access cavity. Radiography evaluation of the increase in root length, root thickness and occurrence of apical closure were performed. Following the sacrifice of the two dogs at each time of evaluation, histopathological analysis was performed and included the inflammatory cells count, bone resorption, tissue ingrowth, deposition of hard tissue, and closure of the apical part. All data were statistically analyzed. Results Compared to BC subgroup, MSNs and MSNs + BMP-2 subgroups exhibited significant higher increase in root length and thickness as well as higher vital tissue in-growth and new hard tissue formation in group II (P 0.05). Conclusion MSNs with/without BMP-2 scaffolds enabled the continuing growth of roots in immature teeth with necrotic pulps and periapical pathosis. Addition of BMP-2 to MSNs scaffold improved its outcome in regenerative endodontics. Clinical relevance MSNs with/without BMP-2 scaffolds may alternate blood clot for regenerative endodontic treatment of immature teeth with necrotic pulps.

This review article describes the methods and clinical recommendations for reinforcing traumatized anterior immature teeth with pulp necrosis treated with mineral trioxide aggregate (MTA) apexification. Traumatic injury can cause pulp necrosis and incomplete root formation in immature teeth. MTA apexification is the treatment of choice for necrotic immature teeth, particularly during the middle or late stages of root development. MTA apexification has a high success rate; however, failures due to cervical or root fractures occasionally occur. The risk of fracture is higher in immature teeth with thin root dentin, particularly those with external root resorption. Furthermore, the loading force from any parafunctional habit also increases fracture risk. Therefore, intra‐radicular reinforcement may be necessary after MTA apexification. In vitro, intraradicular restoration with a resin composite/core build‐up material or a prefabricated fiber post demonstrated better root reinforcement than root canal obturation materials (i.e., gutta‐percha and sealer). However, the root‐reinforcement effect of MTA orthograde filling in the entire root canal remains unclear. In vivo, the survival of fractured teeth with intraradicular restorations (resin composite/core build‐up material or prefabricated fiber posts) is extremely high. Moreover, the survival of teeth with gutta‐percha/sealer obturation or MTA orthograde filling and restoration with resin composite extending into the cervical third of the root canal approximately 1–2 mm below the cemento‐enamel junction is acceptably high. Based on this evidence, the remaining tooth/root structure and loading force should be carefully examined when considering intra‐radicular reinforcement of immature anterior teeth treated with MTA apexification. [ABSTRACT FROM AUTHOR]

Objective: It is aimed to evaluate the color changes of upper central incisor teeth with different root maturation levels after 15 min of dehydration and rehydration. Materials and Methods: Using the Cvek classification, 60 participants were divided into five groups. A spectrophotometer, equipped with a specially designed jig, was utilized for color measurements. Following isolation, color measurements were conducted at the dehydration process intervals of baseline, 1st, 2nd, 3rd, 5th, 7th, 10th, and 15th minutes. After mouth rinsing, measurements were repeated at the same time intervals during the rehydration process. CIEDE2000 (ΔE00) values and the Whiteness Index (WID) were obtained to compare the color changes between the initial readings and each interval. Friedman and Repeated Measures ANOVA were applied to compare classes by time during the dehydration and rehydration periods, as well as ANOVA and Kruskal‐Wallis tests to compare by classes for each time (p < 0.05). Results: Significant differences emerged in the mean ΔE00 values during dehydration and rehydration periods across all Cvek Classes (p < 0.05). While no statistically significant differences were observed among Classes at different minutes during the rehydration period (p > 0.05), it was particularly noted that the mean ΔE00 values of Classes 2, 3, and 5 at the 2nd minute of dehydration were statistically significantly higher than the mean of Class 1 (p < 0.05). However, when evaluating the starting and ending measurements of both dehydration and rehydration processes, and the overall change in ΔE00 and ΔWID, no significant variations were detected across the Classes (p > 0.05). Conclusions: In teeth that have just erupted and are still undergoing root development, dehydration in the initial minutes results in noticeable color changes. However, the change in ΔE00 and ΔWID of the teeth was found to be similar after the dehydration and rehydration processes. Clinical Significance: According to the Cvek classification, the lower color change in Class 1 teeth within the first 2 min of dehydration and the need for more than 15 min of rehydration for immature teeth with an open apex to return to their initial state after a 15‐min dehydration are crucial for clinicians in terms of color assessment timing. [ABSTRACT FROM AUTHOR]

The primary aim of this study was to compare the radiographic changes of immature incisors with periapical radiolucency after treatment with platelet-rich fibrin (PRF) and concentrated growth factor (CGF) platelet concentrate scaffolds as well as assessment of the clinical success rate over 12 months. The secondary aim was to monitor the radiographic changes in terms of reduction of periapical lesion diameter (PALD), root dentine thickness (RDT), root length (RL), and apical foramen width (AFW). The tertiary aim was to assess and pulp responses, after 12 months. Fifty six children with seventy necrotic, single-rooted maxillary incisors with periapical radiolucency were treated with either CGF or PRF scaffolds (35 teeth per group). Two patients with 4 teeth (2 teeth in each group) failed to attain the follow-up recalls. Radiographic changes in terms of reduction of PALD, RDT, RL, and AFW were monitored using a 2-dimensional (2D) radiograph and cone-beam computed tomography (CBCT) scan. The clinical performance of teeth receiving both scaffolds was assessed after 6 and 12 months. Categorical and continuous data were analyzed using the chi-square test and the t test, respectively. The time and group effects on the means of different radiographic dimensions were tested using the general linear model. Bland-Altman plots were used to assess the level of agreement between the 2D radiographs and CBCT. The level of significance was defined at 0.05 and a 95% confidence interval. The means of PALD and RL showed significant enhancement in the CGF group compared to the PRF group (P <.05). While the difference between the 2 scaffolds in terms of RDT and AFW was not significant (P >.05). The findings of the 2D radiograph and CBCT were consistent. Clinically, both scaffold success rates were similar (93.9%) over the follow-up intervals. The influence of study independent variables had no significant effect on the success of the regenerative endodontic procedures outcome (P >.05). There was no significant difference in the positive pulp responses to the thermal and electric pulp tests after one year of treatment (P >.05). According to the short-term follow-up, PRF and CGF were successful in treating immature teeth with periapical radiolucency by regenerative endodontics. Both scaffold systems induced periapical healing and root lengthening with significant superiority of CGF. [ABSTRACT FROM AUTHOR]

Objective: To investigate the influence of citric acid on the osteogenic and angiogenic potential of stem cells from apical papillae (SCAPs). Materials and methods: Stem cells from apical papillae were isolated from freshly extracted third permanent molars. These cells were treated with 20 and 100 μM citric acid. Alizarin red staining was used to evaluate mineral deposition. The secreted levels of vascular endothelial growth factor (VEGF) were assessed by ELISA on days 18, 24 and 28. Immunofluorescence analysis was performed to assess the expression of surface markers after exposure to 20 and 100 μM citric acid. Results: Different mineralisation patterns were observed. Supplemented with citric acid, media showed more diffuse and less dense crystals. On day 18, most VEGF was secreted from the cells with no added citric acid. On day 24, there was a significant increase (p < 0.05) in the levels of VEGF secreted from cells treated with 20 μM citric acid. On day 28, cells from the control group did not secrete VEGF. There was a reduction in the levels of VEGF secreted by cells treated with 20 μM citric acid and a significant increase in the cells exposed to 100 μM citric acid (p < 0.05). Conclusion: Citric acid can promote the differentiation of SCAPs and angiogenesis.

Dental pulp regeneration is challenging in endodontics. Cellular therapy is an alternative approach to induce dental pulp regeneration. Mesenchymal stromal cells (MSCs) have the capacity to induce dental pulp-like tissue formation. In this study, we evaluated the capacity of allogeneic bone marrow MSCs (BM-MSCs) to regenerate pulp following necrosis and apical periodontitis in children's permanent immature apex teeth. Patients aged 8 to 12 years with pulp necrosis and apical periodontitis were evaluated. The study included 15 teeth (13 incisors and 2 molars) from 14 patients (8 boys and 6 girls). Radiographic evaluation showed periapical radiolucency and immature apex teeth. There was no response to cold or electric pulp testing. The root canal of each tooth was cleaned, shaped, and Ca(OH) 2 used as an interappointment medication. Cryopreserved allogeneic BM-MSCs were thawed, expanded, incorporated into preclotted platelet-rich plasma, and implanted into the tooth's pulp cavity. They were sealed with bioceramic cement and composite. Sensibility, apical foramen, calcium deposits within the root canal, and resolution of periapical lesions were evaluated in each tooth over the following 12 months. Based on 9 variables established for dental pulp-like tissue regeneration, all MSC-treated teeth showed evidence of successful regeneration. Clinical and radiographic evaluation of the treated teeth showed periapical lesion healing, sensitivity to cold and electricity, decreased width of the apical foramen, and mineralization within the canal space. Transplantation of allogeneic MSCs induces the formation of dental pulp-like tissue in permanent immature apex teeth with pulp necrosis and apical periodontitis. Implant of MSCs constitutes a potential therapy in regenerative endodontics in pediatric dentistry. Future studies incorporating a larger sample size may confirm these results. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to assess the outcome of biodentine apexification for the management of traumatized immature teeth with necrotic pulp over a period of 12 months. Methods: Eighty-five human maxillary incisors with traumatized immature necrotic pulp in patients aged 10–50 years were selected for this study. Root canal treatment was initiated and the biodentine apexification procedure was performed in a single appointment for all teeth. Intraoral preoperative and postoperative periapical radiographs were used to assess periapical (PA) changes, changes in root length (RL), and radiographic root area (RRA). Preoperative and postoperative cone-beam computed tomography (CBCT) images were used to assess the three-dimensional (3D) volumetric changes. Patients were recalled at 12 months posttreatment for the evaluation of clinical symptom, percussion, and palpation examination. Descriptive statistics was computed for preoperative demographic, patient-centric data, and treatment success. Paired t-test was used to compare the preoperative and 12-month postoperative changes in RRA, RL, and 3D volumetric changes of the parameters. Results: Forty-eight out of the 49 teeth that completed the study were asymptomatic and functional. Comparing the preoperative and the 12-month review radiographs using the periapical index scores based on the size of the lesion, completely healed lesions were 79.16% while lesions in the process of healing were 20.83%. There was a significant (P < 0.05) increase in RL (14.17%), RRA (40.87%), and dentin volume (26.63%). Conclusion: 3D volumetric analysis suggests that biodentine apexification has the ability to deposit hard tissue 3-dimensionally, and it is an effective alternative to the conventional apexification materials.

Objective In light of the potential drawbacks associated with certain intracanal medicaments, such as triple antibiotic paste (TAP) and calcium hydroxide (Ca(OH 2)), the introduction of herbal agents has ushered in a new era in the field of dentistry. Consequently, this study aimed to explore the impact of oleanolic acid (OA) on the viability and proliferation of dental pulp stem cells (DPSCs), comparing its effects to those of conventional intracanal medicaments, TAP and Ca(OH 2). Materials and Methods DPSCs were derived from the third molars of an adult donor. Flow cytometry was utilized to do a phenotypic study on DPSCs. The methyl-thiazol tetrazolium (MTT) test was used to evaluate cellular viability. The cells were subjected to various concentrations of TAP and Ca(OH) 2 (5, 2.5, 1, 0.5, and 0.25 mg/mL), in addition to OA (40, 20, 10, 5, and 2.5 µM). A cell proliferation experiment assessed the cell growth precisely at 3, 5, and 7 days. Results DPSCs were characterized by flow cytometry. The mesenchymal markers (CD73, CD90, and CD105) had a positive expression. However, the hematological markers (CD14, CD34, and CD45) showed negligible expression. A notable reduction in cellular viability was seen in cells subjected to concentrations exceeding 0.5 mg/mL of TAP and Ca(OH) 2 compared to the cells that were not treated (p < 0.05). The cells treated with different concentrations of OA 2.5, 5, 10, and 20 µM did not exhibit any significant variance in cell viability compared to untreated cells (p > 0.05). Moreover, the concentrations of OA (20, 10, and 5 µM) showed high proliferation level compared to TAP and Ca(OH 2) especially 5µM of OA after 7 days (p < 0.05). Conclusion Our results revealed that OA exerted significant effect on the viability and proliferation of DPSCs compared to TAP and Ca(OH 2). [ABSTRACT FROM AUTHOR]

Background: The literature is scanty regarding the effect of radiation therapy (RT) on the mechanical properties of immature permanent teeth. Aim: To evaluate the effect of RT on the fracture resistance of simulated immature teeth submitted to different types of root reinforcement. Design: Sixty‐four human teeth simulating the Cvek stage 3 of root development were distributed into eight groups (n = 8), according to exposure or not to RT (70 Gy) and the root reinforcement method: Group NR (control)—no reinforcement/no RT; Group NR + RT (control)—no reinforcement/RT; Group PO—tricalcium silicate‐based cement (TS) apical plug/canal obturation/no RT; Group PO + RT—TS apical plug/canal obturation/RT; Group TS—canal filling with TS/no RT; Group TS + RT—canal filling with TS/RT; Group FP—TS apical plug/fibreglass post/no RT; and Group FP + RT—TS apical plug/fibreglass post/RT. Fracture resistance was determined using a universal testing machine (0.5 mm/min). Results: In the intergroup comparison, nonirradiated teeth had higher fracture resistance (p <.05). Groups FP and FP + RT had higher fracture resistance (p <.001). Conclusion: Radiotherapy affected the fracture resistance of simulated immature teeth. Reinforcement with fibreglass posts increased the fracture resistance, regardless of the radiation. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to assess the outcome of biodentine apexification for the management of traumatized immature teeth with necrotic pulp over a period of 12 months. Methods: Eighty-five human maxillary incisors with traumatized immature necrotic pulp in patients aged 10-50 years were selected for this study. Root canal treatment was initiated and the biodentine apexification procedure was performed in a single appointment for all teeth. Intraoral preoperative and postoperative periapical radiographs were used to assess periapical (PA) changes, changes in root length (RL), and radiographic root area (RRA). Preoperative and postoperative cone-beam computed tomography (CBCT) images were used to assess the three-dimensional (3D) volumetric changes. Patients were recalled at 12 months posttreatment for the evaluation of clinical symptom, percussion, and palpation examination. Descriptive statistics was computed for preoperative demographic, patient-centric data, and treatment success. Paired t-test was used to compare the preoperative and 12-month postoperative changes in RRA, RL, and 3D volumetric changes of the parameters. Results: Forty-eight out of the 49 teeth that completed the study were asymptomatic and functional. Comparing the preoperative and the 12-month review radiographs using the periapical index scores based on the size of the lesion, completely healed lesions were 79.16% while lesions in the process of healing were 20.83%. There was a significant (P < 0.05) increase in RL (14.17%), RRA (40.87%), and dentin volume (26.63%). Conclusion: 3D volumetric analysis suggests that biodentine apexification has the ability to deposit hard tissue 3-dimensionally, and it is an effective alternative to the conventional apexification materials. [ABSTRACT FROM AUTHOR]

Abstract Background The present study aimed to investigate whether incorporating metformin in double antibiotic paste (DAP) can promote the regeneration process of non-vital immature teeth. Methods Out of 32 pediatric patients undergoing regenerative endodontic procedures (REPs), 6 cases with a follow-up period of less than 12 months or lack of documentation were excluded then the remaining 26 were analyzed. 15 cases received DAP, and 11 cases received a DAP + metformin as the intra-canal medicament, kept for an average of 23 days. During 18 months of follow-up, clinical and radiographic examinations were performed to evaluate the treatment outcomes based on the resolution of apical periodontitis, root development, and the occurrence of intracanal calcification. The chi-square test was used for the statistical analysis (P

Abstract Aim To determine the efficacy of endodontic microsurgery for teeth with an undeveloped root apex and periapical periodontitis caused by an abnormal central cusp fracture after failed nonsurgical treatment. Methodology Eighty teeth in 78 patients were subjected to endodontic microsurgery. All patients were clinically and radiologically examined 1 year postoperatively. The data were statistically analyzed using SPSS 27.0 software. Results Of the 80 teeth in 78 patients, periapical lesions had disappeared in 77 teeth at 1-year postoperative follow-up, with a success rate of approximately 96.3% (77/80). The efficacy of endodontic microsurgery was not affected by sex, age, extent of periapical lesions, and presence of the sinus tract. Between-group differences were not statistically significant (P > 0.05). Conclusions Endodontic microsurgery can be an effective alternative treatment option for teeth with an undeveloped root apex and periapical periodontitis caused by an abnormal central cusp fracture after nonsurgical treatment failure.

Background: The present study aimed to investigate whether incorporating metformin in double antibiotic paste (DAP) can promote the regeneration process of non-vital immature teeth. Methods: Out of 32 pediatric patients undergoing regenerative endodontic procedures (REPs), 6 cases with a follow-up period of less than 12 months or lack of documentation were excluded then the remaining 26 were analyzed. 15 cases received DAP, and 11 cases received a DAP + metformin as the intra-canal medicament, kept for an average of 23 days. During 18 months of follow-up, clinical and radiographic examinations were performed to evaluate the treatment outcomes based on the resolution of apical periodontitis, root development, and the occurrence of intracanal calcification. The chi-square test was used for the statistical analysis (P < 0.05). Results: All patients demonstrated resolution of apical periodontitis; however, complete apical closure was only seen in 50% of the patients. The rate of apical closure and root length was significantly higher in the DAP + metformin group (P = 0.047), although the two groups were not significantly different in terms of root width (P = 0.184). Canal obliteration was seen in 15% of cases, all of which were in the DAP group. Conclusions: According to the present findings, metformin could promote root development in the regeneration process when incorporated in DAP. Trial registration: This clinical trial was registered on the Iranian Registry of Clinical Trials (IRCT20200120046197N1) on 26.2.2021. [ABSTRACT FROM AUTHOR]

In a growing child, preservation of traumatized immature permanent upper incisors is challenging. This study aimed to evaluate the long-term outcome of endodontically treated traumatized immature upper incisors and associated variables. A total of 183 traumatized immature upper incisors treated with pulpotomy, apexification, or regenerative endodontic procedure (REP), with follow-up between 4 and 15 years, were assessed for presence of pulpal responses or periodontal/bone responses using standardized clinical and radiologic criteria. Logistic regression, including stage of root development, type and complexity of traumatic event, type of endodontic intervention, and history of orthodontic management, were used to estimate impact on tooth survival and occurrence of tissue responses. Study approved by Ethics Committee Research UZ/KU Leuven (S60597). After a median follow-up of 7.3 years (interquartile range, 6.1–9.2), 159 teeth (86.9%) were still functional. From these teeth, 58 (36.5%) developed tissue responses. This was significantly associated with stage of root development at moment of trauma (root length <¾) and type of endodontic intervention (REP presenting worst outcome). Tooth loss (24 teeth, 13.1%) occurred after a mean time span of 3.2 years (±1.5) and was significantly associated with type and complexity of the traumatic event and type of endodontic intervention, with apexification showing better results than REP (odds ratio, 0.30; 95% confidence interval, 0.11–0.79). A large number of endodontically treated traumatized immature teeth could be kept functional. Very immature teeth, teeth with periodontal tissue damage, and teeth treated with REP were at highest risk for an unfavorable outcome. [ABSTRACT FROM AUTHOR]

Regenerative endodontic treatment is a biologically based approach for the treatment of immature teeth with pulp necrosis. In this approach, a sequence of procedural steps, such as disinfection of the root canal space, introduction of a scaffold into the root canal, sealing of the scaffold with an intracanal coronal barrier and restoration of crowns, is followed. Most commonly, hydraulic calcium silicate cements such as mineral trioxide aggregate have been used as the coronal barrier in regenerative endodontic treatment. Although there is still much to be known regarding the details of each step, the procedures performed before and after establishment of the coronal barrier may interact with hydraulic calcium silicate cements and play a role in some of the outcomes of regenerative endodontic treatment. Tooth discolouration has been reported as a common unwanted patient-orientated outcome. This review provides an overview of the probable impact of each procedural step on hydraulic calcium silicate cements in regenerative endodontic treatment, with special attention paid to tooth discolouration. [ABSTRACT FROM AUTHOR]

Regenerative endodontic treatment (RET) has been described as a 'paradigm shift' in the treatment of immature teeth with pulp necrosis. It has been suggested that RET should be the first option for treating immature teeth when the roots are not yet fully developed. The European Society of Endodontology and the American Association of Endodontists have released position statements and clinical considerations for RET. Treatment modalities rely on the tissue engineering concept components stem cells, scaffolds and signalling molecules. Clinically, the treatment involves disinfection of, and often the introduction of a blood clot into, the root canal space. RET has three goals: 1) resolution of clinical signs and symptoms; 2) further root maturation; and 3) restoration of neurogenesis. To date, RET has been unable to establish a real regeneration of the pulp tissue and dentine space. Histologically, healing is achieved with repair from tissues derived primarily for the periodontal and osseous tissues such as bone-like tissue and cementum, rather than pulp tissue and odontoblasts. This review aims to present a clinical focus on RET and to provide a current view on this emerging clinical technique. [ABSTRACT FROM AUTHOR]

Background/Aim: Pulp mineralisation is a survival process that may occur in the pulp of immature teeth following trauma. However, the mechanism of this process remains unclear. The aim of this study was to evaluate the histological manifestations of pulp mineralisation after intrusion in immature molars of rats. Materials and Methods: Three‐week‐old male Sprague–Dawley rats were subjected to intrusive luxation of the right maxillary second molar by an impact force from a striking instrument through a metal force transfer rod. The left maxillary second molar of each rat was used as a control. The control and injured maxillae were collected at 3, 7, 10, 14, and 30 days after trauma (n = 15 per time group) and evaluated using haematoxylin and eosin staining and immunohistochemistry. Independent two‐tailed Student's t‐test was used for statistical comparison of the immunoreactive area. Results: Pulp atrophy and mineralisation were observed in 30%–40% of the animals, and no pulp necrosis occurred. Ten days after trauma, pulp mineralisation, with osteoid tissue rather than reparative dentin, formed around the newly vascularised areas in the coronal pulp. CD90‐immunoreactive cells were observed in the sub‐odontoblastic multicellular layer in control molars, whereas the number of these cells was decreased in the traumatised teeth. CD105 localised in cells around the pulp osteoid tissue of the traumatised teeth, whereas in control teeth, it was only expressed in the vascular endothelial cells of capillaries in the odontoblastic or sub‐odontoblastic layers. In specimens with pulp atrophy at 3–10 days after trauma, hypoxia inducible factor expression and CD11b‐immunoreactive inflammatory cells increased. Conclusions: Following intrusive luxation of immature teeth without crown fractures in rats, no pulp necrosis occurred. Instead, pulp atrophy and osteogenesis around neovascularisation with activated CD105‐immunoreactive cells were observed in the coronal pulp microenvironment characterised by hypoxia and inflammation. [ABSTRACT FROM AUTHOR]

Introduction: External inflammatory root resorption (EIRR) in immature permanent teeth is a common complication after severe dental trauma. The management of this condition requires thorough disinfection of the root canal in order to arrest the resorptive process. However, current guidelines regarding the recommended treatment of EIRR following traumatic dental injuries vary, mainly in regard to the type of intracanal medication and its retention time in the root canal system. The objective of this case series was to present both the apical barrier technique (MTA plug) and revitalization procedures as valid treatment options in immature teeth with EIRR. Methods: Four cases of post-traumatic immature teeth diagnosed with pulp necrosis and EIRR, with or without apical periodontitis, were treated either by an MTA plug (two teeth) or revitalization (two teeth). Cases were followed between 12 and 24 months. Results: Both treatment methods were efficient in arresting EIRR and enabled bone healing. After revitalization, partial root maturation was observed. Conclusion: Whereas the key to achieve periodontal healing in cases of EIRR is thorough disinfection of the root canal, both a subsequent MTA plug as well as revitalization may represent adequate treatment methods. An additional benefit lies in the potential of revitalization to promote further root maturation through hard tissue apposition. [ABSTRACT FROM AUTHOR]

Aim: To determine the efficacy of endodontic microsurgery for teeth with an undeveloped root apex and periapical periodontitis caused by an abnormal central cusp fracture after failed nonsurgical treatment. Methodology: Eighty teeth in 78 patients were subjected to endodontic microsurgery. All patients were clinically and radiologically examined 1 year postoperatively. The data were statistically analyzed using SPSS 27.0 software. Results: Of the 80 teeth in 78 patients, periapical lesions had disappeared in 77 teeth at 1-year postoperative follow-up, with a success rate of approximately 96.3% (77/80). The efficacy of endodontic microsurgery was not affected by sex, age, extent of periapical lesions, and presence of the sinus tract. Between-group differences were not statistically significant (P > 0.05). Conclusions: Endodontic microsurgery can be an effective alternative treatment option for teeth with an undeveloped root apex and periapical periodontitis caused by an abnormal central cusp fracture after nonsurgical treatment failure. [ABSTRACT FROM AUTHOR]

Introduction: Endodontics faces several clinical difficulties while treating young necrotic permanent teeth. The use of regenerative endodontic procedures (REPs) enables apical closure, improved canal wall thickness, and root growth. The objective of this study was to assess the effects of these regenerative procedures on immature necrotic permanent teeth. Methods: This prospective clinical study was conducted at the tertiary care hospital for the study period of 2 years. This study includes 30 necrotic permanent immature teeth that were studied in 30 subjects of both genders. A standard REP protocol was used to treat every tooth. A follow-up visit was scheduled for each patient at timely intervals. Various study parameters as well as the demographics were assessed at each visit. To examine various parameters, a calibrated endodontist also performed a radiographic evaluation. Results: Our findings point to excellent rates of survival, clinical success, and apical pathological resolution for 29 teeth. After 2 years, there were significant variations in the root thickness area and the average root length. The apical diameter significantly decreased during the research period, with 30.8% of the instances exhibiting full apical closure. Apical diameter, root length, and thickness changed more frequently in teeth with the level of the immaturity of the root, although the variations were not significant. Conclusions: REP treatment for teeth preceded symptom relief. Increased root thickness, root length, and apical closure were seen at 30 months, even if the clinically meaningful change was not attained in all patients.

Aim: This in vitro study aimed to compare the fracture resistance of simulated immature permanent teeth restored with apical plugs of mineral trioxide aggregate (MTA), Biodentine, and bone cement. Methods: Forty-eight single-rooted human maxillary central incisors were selected and decoronated 6 mm above and 9 mm below the cementoenamel junction to simulate the immature teeth. Based on weight and homogeneity, the samples were distributed into three experimental groups (n = 12) and one control group (n = 12). In all the experimental group samples, a peeso reamer size 5 was stepped out 1 mm beyond the apex to enlarge the apices to a diameter of 1.5 mm. Apical plugs of MTA Plus (Prevest DenPro Limited, India), Biodentine (Septodont, France), and Bone cement (Surgical Simplex P, Stryker, Australia) were placed to 4 mm, and obturation was done using gutta-percha and AH Plus® sealer (Dentsply DeTrey, Konstanz, Germany). The force was applied at 45° angulation until fracture, using the universal testing machine. The results were analyzed using a one-way analysis of variance followed by Tukey's post hoc test at a 95% confidence level. Results: The Biodentine group showed a statistically higher fracture resistance value than the MTA Plus and bone cement group (P = 0.014 and P = 0.016, respectively). No statistically significant difference was reported between MTA Plus and the bone cement group. Conclusion: Within the limitations of this study, using Biodentine as an apical plug increases the fracture resistance of immature teeth. Bone cement can be used as a viable alternative to MTA.

The influence of intracoronal sealing biomaterials on the newly formed regenerative tissue after endodontic revitalisation therapy remains unexplored. The objective of this study was to compare the gene expression profiles of two different tricalcium silicate-based biomaterials alongside the histological outcomes of endodontic revitalisation therapy in immature sheep teeth. The messenger RNA expression of TGF-β, BMP2, BGLAP, VEGFA, WNT5A, MMP1, TNF-α and SMAD6 was evaluated after 1 day with qRT-PCR. For evaluation of histological outcomes, revitalisation therapy was performed using Biodentine (n = 4) or ProRoot white mineral trioxide aggregate (WMTA) (n = 4) in immature sheep according to the European Society of Endodontology position statement. After 6 months' follow-up, one tooth in the Biodentine group was lost to avulsion. Histologically, extent of inflammation, presence or absence of tissue with cellularity and vascularity inside the pulp space, area of tissue with cellularity and vascularity, length of odontoblast lining attached to the dentinal wall, number and area of blood vessels and area of empty root canal space were measured by two independent investigators. All continuous data were subjected to statistical analysis using Wilcoxon matched-pairs signed rank test at a significance level of p < 0.05. Biodentine and ProRoot WMTA upregulated the genes responsible for odontoblast differentiation, mineralisation and angiogenesis. Biodentine induced the formation of a significantly larger area of neoformed tissue with cellularity, vascularity and increased length of odontoblast lining attached to the dentinal walls compared to ProRoot WMTA (p < 0.05), but future studies with larger sample size and adequate power as estimated by the results of this pilot study would confirm the effect of intracoronal sealing biomaterials on the histological outcome of endodontic revitalisation. [ABSTRACT FROM AUTHOR]

This study aimed to assess the apical extrusion of sodium hypochlorite in immature teeth caused by needle irrigation, ultrasonic irrigation, EDDY, Er:YAG, and diode lasers. Seventy-five human maxillary anterior teeth were selected. After the apical 3 mm of the roots was resected, the canal lumen was enlarged with #2 to #5 Gates-Glidden burs. The teeth were fixed to the lid of a flat-sided clear plastic container, and the plastic containers were filled with 0.2% agarose gel containing 1 mL of 0.1% m-cresol purple. Then, the specimens were allocated into five groups according to the irrigation activation techniques: needle irrigation, ultrasonic irrigation, EDDY, Er:YAG laser, and diode laser. The apical extrusion of sodium hypochlorite caused the color change in the gel. The containers were digitally photographed, and the percentage of pixels of irrigant extrusion (the color change) in each photograph was calculated. The diode laser group showed a significantly lower percentage of pixels than needle irrigation, EDDY, and Er:YAG laser (p < 0.05). The irrigant extrusion value of the ultrasonic irrigation group was significantly lower than that of the EDDY and Er:YAG laser groups (p < 0.05). There was no significant difference between the other groups (p > 0.05). All the groups caused irrigant extrusion in the immature teeth. The diode laser and ultrasonic irrigation caused less sodium hypochlorite extrusion than EDDY and Er:YAG laser. The needle irrigation showed more irrigant extrusion than the only diode laser group. [ABSTRACT FROM AUTHOR]

Aim: This in vitro study aimed to compare the fracture resistance of simulated immature permanent teeth restored with apical plugs of mineral trioxide aggregate (MTA), Biodentine, and bone cement. Methods: Forty-eight single-rooted human maxillary central incisors were selected and decoronated 6 mm above and 9 mm below the cementoenamel junction to simulate the immature teeth. Based on weight and homogeneity, the samples were distributed into three experimental groups (n = 12) and one control group (n = 12). In all the experimental group samples, a peeso reamer size 5 was stepped out 1 mm beyond the apex to enlarge the apices to a diameter of 1.5 mm. Apical plugs of MTA Plus (Prevest DenPro Limited, India), Biodentine (Septodont, France), and Bone cement (Surgical Simplex P, Stryker, Australia) were placed to 4 mm, and obturation was done using gutta-percha and AH Plus® sealer (Dentsply DeTrey, Konstanz, Germany). The force was applied at 45° angulation until fracture, using the universal testing machine. The results were analyzed using a one-way analysis of variance followed by Tukey's post hoc test at a 95% confidence level. Results: The Biodentine group showed a statistically higher fracture resistance value than the MTA Plus and bone cement group (P = 0.014 and P = 0.016, respectively). No statistically significant difference was reported between MTA Plus and the bone cement group. Conclusion: Within the limitations of this study, using Biodentine as an apical plug increases the fracture resistance of immature teeth. Bone cement can be used as a viable alternative to MTA. [ABSTRACT FROM AUTHOR]

Background: Revitalization is a type of regenerative endodontic treatment (RET) that offers the exciting prospect of revitalizing damaged tissue, therefore improving outcomes for non‐vital immature teeth. To evaluate its potential, there needs to be consistency in outcome reporting of clinical studies investigating revitalization to allow for evidence synthesis and inform clinical decision making. Objectives: The aim of this scoping review was to identify outcomes that are reported in systematic reviews on revitalization including how and when these outcomes are measured. Additionally, evidence of selective reporting bias in the reviews was assessed. Methods: A comprehensive electronic search of healthcare databases and grey literature was conducted to identify systematic reviews published in the English language reporting outcomes of revitalization in permanent immature teeth. There was no restriction on the date of publication. Outcome data was extracted by four reviewers independently and mapped with a healthcare taxonomy into five core areas: survival, clinical/physiological changes, life impact, resource use and adverse events. Selective reporting bias and how it was measured was assessed independently by two reviewers. Results: Twenty‐six systematic reviews were included in this scoping review. There was lack of standardization in reporting and significant heterogeneity across reviews in outcome endpoints. The outcomes reported could be aligned within the five core areas of the taxonomy including tooth survival which was reported in nine reviews. Patient‐reported outcomes were generally limited and no review reported on Oral Health Related Quality of Life. Many of the reviews reporting on randomized control trials were at low risk of selective reporting bias whilst other study designs were at higher risk. Discussion: Consistency in outcome reporting is necessary to realize the benefits of old but particularly novel therapies. Data from this review confirmed heterogeneity in reporting outcomes of revitalization and the need for development of a core outcome set (COS). Conclusions: Several important outcomes including survival, root development, tooth discolouration and periapical healing have been identified in this review which could inform the development of a COS in this area. Registration: Core Outcome Measures in Effectiveness Trials (COMET) database (registration no. 1879). [ABSTRACT FROM AUTHOR]

This study compared standard needle irrigation, passive ultrasonic irrigation, XP‐Endo Finisher and Easy Clean in the apical extrusion of sodium hypochlorite (NaOCl) in a model simulating immature teeth. Ten bovine teeth were maintained in suspension in a container with the apical portion in contact with 0.2% agarose gel containing 0.1% metacresol purple. The canals were irrigated with 2.5% NaOCl, according to each irrigation protocol. After 3 min, apical extrusion of NaOCl was observed by the colour gel change when in contact with NaOCl. The containers were photographed, and the NaOCl extrusion area was measured. All protocols showed NaOCl extrusion, providing similar area (P > 0.05). Considering the similarity among the studied protocols, all of them can be considered during the endodontic treatment of immature teeth. Further studies on the particularities of immature teeth should be performed to evaluate cell viability, cleaning efficiency, disinfection capacity and dentin removal promoted by the irrigation protocols. [ABSTRACT FROM AUTHOR]

A 15-year-old patient reported persistent pain in the left mandibular second premolar (#35) following a traumatic bite 3 months ago. Clinical examination revealed a fractured central cusp suggestive of dens evaginatus. Intraoral periapical radiograph revealed an immature permanent tooth with a periapical radiolucency. A diagnosis of pulp necrosis with symptomatic apical periodontitis was made. The tooth was treated according to the revised guidelines of regenerative endodontic procedure by the American Association of Endodontics. The follow-up evaluation revealed a complete resolution of periapical pathology. A detached radiopaque tissue was appreciated at the 12-month follow-up. It resembled a broken root tip at the 24-month follow-up. Both the main root body and disjointed root tip developed independently. A cone-beam computed tomography evaluation at the 36-month follow-up confirmed the segmented development of the apical root tip.

This systematic review aimed to assess if the use of fiber posts reinforces weakened immature teeth. A systematic review was conducted of laboratory studies that evaluated the fracture resistance of simulated immature teeth restored with fiber posts compared to teeth restored exclusively with resin. An electronic search was performed using the following databases: PubMed/MEDLINE, Web of Science, Scopus and LILACS, BBO, and grey literature. Two independent researchers screened the titles and abstracts of the retrieved studies for relevance to the research question. Subsequently, the full texts of potentially relevant studies were screened based on the exclusion criteria. Ten out of 1792 unique records were included in this systematic review. Risk of bias was assessed using an adapted tool based on the Cochrane risk of bias tool. The laboratory studies included in this systematic review were performed on both human and bovine teeth. Eight studies concluded that fiber posts reinforce the structure of weakened roots, and two studies reported that fiber posts did not strengthen the radicular structure compared to teeth exclusively restored with resin composite. The highly heterogeneous data made it challenging to synthesize the results into a summary estimate, and thus no meta-analysis was undertaken. A summary effect could not be estimated without a meta-analysis. Although the laboratory literature suggests that fiber posts reinforce the structure of immature teeth, the results should be interpreted with caution, as most of the studies had an unclear or high risk of bias. [ABSTRACT FROM AUTHOR]

Aim: This study investigates the accuracy of an apex locator in mature and immature teeth with divergent root canals ex vivo., Materials and Methods: Fifty extracted premolar teeth were utilized for the study, with 25 mature teeth (Nolla stage 9 or 10) and 25 immature teeth (Nolla stages ≤ 8). The discrepancies between the actual length (AL) and the electronic length (EL), measured using a Bingo 1020 apex locator, were compared and analyzed. Statistical analysis included Pearson's correlation analysis, a T-test for independent samples, and multiple linear regression. Statistical significance was set at p < 0.05., Results: The difference between AL and EL in immature teeth was significantly higher than in mature premolar teeth. Nonetheless, patient gender or jaw type (upper/lower) did not affect the accuracy of electronic apex locator (EAL) measurements., Conclusion: EAL readings are less accurate in immature teeth than in mature teeth. Supplementary measures, such as radiographic length determination and wet-dry paper point tests, are required to confirm the working length for improved treatment outcomes and patient compliance., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Hadassah Medical Center Ethics Committee issued approval HMO-21-0583. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kaufman et al.)

Introduction: External inflammatory root resorption (EIRR) in immature permanent teeth is a common complication after severe dental trauma. The management of this condition requires thorough disinfection of the root canal in order to arrest the resorptive process. However, current guidelines regarding the recommended treatment of EIRR following traumatic dental injuries vary, mainly in regard to the type of intracanal medication and its retention time in the root canal system. The objective of this case series was to present both the apical barrier technique (MTA plug) and revitalization procedures as valid treatment options in immature teeth with EIRR. Methods: Four cases of post-traumatic immature teeth diagnosed with pulp necrosis and EIRR, with or without apical periodontitis, were treated either by an MTA plug (two teeth) or revitalization (two teeth). Cases were followed between 12 and 24 months. Results: Both treatment methods were efficient in arresting EIRR and enabled bone healing. After revitalization, partial root maturation was observed. Conclusion: Whereas the key to achieve periodontal healing in cases of EIRR is thorough disinfection of the root canal, both a subsequent MTA plug as well as revitalization may represent adequate treatment methods. An additional benefit lies in the potential of revitalization to promote further root maturation through hard tissue apposition.

The current case report documents the clinical approach adopted for a traumatized immature necrotic permanent upper left central incisor after a bike accident. The treatment involved regenerative endodontic procedures (REPs) using "High Plasticity Mineral Trioxide Aggregate" (MTA Repair HP) as a cervical barrier over blood clot. The preservation included three years of follow-up appointments of clinical evaluations and periapical digital radiographs. Cone beam computer tomography (CBCT) was taken at six and thirty-six months for the evaluation of root development. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effectiveness of apexification versus revascularization in the treatment of necrotic immature teeth and determine which strategy affords the greatest radiological success rate. Methods: An analysis was made of 18 teeth subjected to mineral trioxide aggregate (MTA) apical plugging and regenerative endodontic treatment, assessing healing of the apical lesions and the changes in root dimensions. Results: Significantly greater root growth was observed with revascularization in terms of the percentage change in length (12.75% at 6 months) and dentin thickness (34.57% at 6 months) (p < 0.05). There were no significant differences between the two treatments in terms of the apical healing scores after 6 months of follow-up (p > 0.05). Conclusion: Apexification with an MTA apical plug and pulp regeneration are reliable treatments for non-vital immature teeth. The radiographic outcomes are comparable between the immature teeth subjected to MTA apexification versus those subjected to revascularization. The results of the present study indicate a greater increase in root length and width with regenerative endodontic treatment. [ABSTRACT FROM AUTHOR]

Background. Regenerative endodontic treatment (RET) is a clinically advanced procedure for necrotic immature teeth. However, root canal walls of these teeth are brittle especially in the cervical region and need reinforcement. This in vitro study is conducted to evaluate the effect of intra-orifice barrier materials on the fracture resistance of immature teeth treated with regenerative procedure. Methods. Forty-eight maxillary central incisors were used. Twelve intact teeth were selected for the control group. Remained teeth were prepared using peeso drills to simulate immature teeth and assigned into three groups according to the intra-orifice barrier material placed over MTA (n=12); Composite resin (CR), ProRoot MTA and Resin-modified glass ionomer cement (RMGIC). Fracture strength test was applied using a universal testing machine. One-way ANOVA and Tukey post hoc tests were used at P=0.05. Results. A significant difference was obtained among groups (P0.05). Conclusion. Intra-orifice restorative materials have reinforcement affect in immature teeth treated with regenerative endodontic procedure. RMGIC or CR can be regarded as a viable choice to reduce the occurrence of cervical root fracture of immature teeth treated with a regenerative therapy.

The influence of intracoronal sealing biomaterials on the newly formed regenerative tissue after endodontic revitalisation therapy remains unexplored. The objective of this study was to compare the gene expression profiles of two different tricalcium silicate-based biomaterials alongside the histological outcomes of endodontic revitalisation therapy in immature sheep teeth. The messenger RNA expression of TGF-β, BMP2, BGLAP, VEGFA, WNT5A, MMP1, TNF-α and SMAD6 was evaluated after 1 day with qRT-PCR. For evaluation of histological outcomes, revitalisation therapy was performed using Biodentine (n = 4) or ProRoot white mineral trioxide aggregate (WMTA) (n = 4) in immature sheep according to the European Society of Endodontology position statement. After 6 months’ follow-up, one tooth in the Biodentine group was lost to avulsion. Histologically, extent of inflammation, presence or absence of tissue with cellularity and vascularity inside the pulp space, area of tissue with cellularity and vascularity, length of odontoblast lining attached to the dentinal wall, number and area of blood vessels and area of empty root canal space were measured by two independent investigators. All continuous data were subjected to statistical analysis using Wilcoxon matched-pairs signed rank test at a significance level of p < 0.05. Biodentine and ProRoot WMTA upregulated the genes responsible for odontoblast differentiation, mineralisation and angiogenesis. Biodentine induced the formation of a significantly larger area of neoformed tissue with cellularity, vascularity and increased length of odontoblast lining attached to the dentinal walls compared to ProRoot WMTA (p < 0.05), but future studies with larger sample size and adequate power as estimated by the results of this pilot study would confirm the effect of intracoronal sealing biomaterials on the histological outcome of endodontic revitalisation.

Regenerative endodontic treatment such as revitalization provides a treatment option for immature teeth with pulp necrosis. The main difference to the alternative procedure, the apical plug, is the induction of a blood clot inside the canal as a scaffold for healing and new tissue formation. Due to the biology‐based and minimally‐invasive nature of the treatment, revitalization has raised considerable interest in recent years. Whereas the procedure is fairly new and recommendations from endodontic societies have been in place only for a few years, the treatment protocol has evolved over the past two decades. Evidence has been created, not only from laboratory and animal work, but also from clinical studies including case reports, cohort studies and eventually prospective randomized controlled clinical trials, systematic reviews and meta‐analyses. However, the research methods and clinical studies with subsequent reports oftentimes present with methodical limitations, which makes it difficult to objectively assess the value of this treatment modality. Several open questions remain, including the need for a more differentiated indication of revitalization after different traumatic injuries, the long‐term prognosis of treated teeth and the true benefits for the patient. Therefore, this review aims to identify and reflect on such limitations, scrutinizing study design, diagnostic tools, procedural details and outcome parameters. A core outcome set is also proposed in this context, which can be considered in future clinical investigations. These considerations may lead to a more detailed and stringent planning and execution of future studies in order to create high‐quality evidence for the treatment modality of revitalization and thus provide more robust data, create a larger body of knowledge for clinicians and further specify current recommendations. [ABSTRACT FROM AUTHOR]

Regenerative endodontic treatment (RET) may not be suitable in some necrotic young permanent molars due to coexistent roots with closed and open apices, and/or inadequate apical bleeding in one or more roots. Here, we present a combined treatment approach utilising conventional root canal treatment in the closed‐apex roots and RET on the open‐apex roots of necrotic young molars. The closed‐apex roots of 8 molars received root fillings, and their open‐apex roots were treated with a regenerative endodontic procedure. In another molar, the failed RET on one root was retreated by conventional root canal filling, preserving other revitalised roots. After 4–6 years, all teeth showed periapical healing in the absence of clinical symptoms. The combined conventional and regenerative treatment approach can yield favourable healing outcomes in necrotic, young molar roots with different levels of apical closure. Likewise, failed revitalised roots can be retreated separately with conventional root filling. [ABSTRACT FROM AUTHOR]

Regenerative endodontic treatment (RET) is a biologically based treatment approach to provide root development and increase the prognosis of teeth. The purpose of this case series was to evaluate the clinical and radiological results of RET using platelet-rich fibrin (PRF), in 4 immature teeth with necrotic pulps. At the end of 18-24-month follow-up, no clinical symptoms were recorded. Apical closure was observed in 3 of the 4 teeth. All of the preoperative periapical lesions were healed. However, a calcified tissue formed in the middle third of the root in one case diagnosed with chronic apical periodontitis at 3-month follow-up. PRF was successful as a scaffold and can be recommended for revascularization protocol of necrotic immature teeth. However, prognosis of tooth can be attributed to many factors such as duration of pulp necrosis, pretreatment status of the periapical region and viability of living tissues.

Introduction: This systematic review was planned to summarize and quantitatively assess the effect of various tissue regenerative scaffolds on the success of regenerative endodontic techniques in nonvital immature permanent teeth. Materials and Methods: An organized electronic search was conducted through multiple databases. Only randomized controlled trials in patients with nonvital immature teeth were included. The main outcomes were the healing of periapical radiolucency, apical closure, and an increase in root length. The Cochrane risk of bias assessment tool was used for evaluating the risk of bias in the included studies. The quality of each outcome was assessed through the use of the Grading of Recommendations, Assessment, Development, and Evaluation approach. A random-effects model was used for meta-analysis. Results: Sixteen studies involving 153 patients were included, and the overall risk of bias in these studies was moderate. A comparison between blood clot (BC) and platelet-rich plasma (PRP) showed that BC had the greater healing of periapical radiolucency, with an odds ratio (OR) of 3.99; 95% confidence interval (CI): 1.073–14.79; P = 0.04; I2 = 0% (certainty of evidence = moderate), as well as greater root length development, with an OR of 2.94; 95% CI: 1.34–6.48; P = 0.007; I2 = 83% (certainty of evidence = moderate). However, no significant difference in apical closure had been found between the BC and PRP groups, with an OR of 1.73; 95% CI: 0.53–5.70; P = 0.36; I2 = 46% (certainty of evidence = moderate). Conclusions: Moderate quality evidence showed that BC and platelet-rich fibrin are equally effective in the healing of apical radiolucency, apical closure, and an increase in root length of nonvital immature permanent teeth during tissue regeneration. BC scaffold performs better than PRP. Additional well-designed randomized controlled trials on other scaffolds are recommended.

Nonvital immature teeth are newly erupted teeth with open apices and necrotic pulp that usually treated by apexification, a treatment that puts certain materials such as Ca (OH)2 and MTA on the open apices. BiodentineTM then introduced as an alternative material for immature teeth. This study aimed to give an overview of BiodentineTM effectiveness as apical plug material in nonvital immature teeth apexification treatment. A rapid systematic review was conducted on PubMed, ScienceDirect, EBSCOhost, ClinicalKey databases using predefined search keywords, inclusion and exclusion criteria. Found the total of 138 articles which then filtered gradually according to PRISMA so the final results were 11 articles. Follow-up of 11 selected articles (7 case reports and 4 case series) showed satisfactory treatment outcomes. Clinical aspect of 8 articles reported variously, such as absence of swelling, pain, pus and sinus tract; revert of aesthetics and function; there is no teeth discoloration. Radiographic aspects of 11 articles reported varying results including: periapical lesions healing, periradicular tissues regeneration, continued root growth (increase in thickness and length of the apical, also formation of calcified apical barrier). Based on its outcomes, BiodentineTM is effective to use as an alternative apical plug material for nonvital immature teeth apexification treatment. [ABSTRACT FROM AUTHOR]

A 15-year-old patient reported persistent pain in the left mandibular second premolar (#35) following a traumatic bite 3 months ago. Clinical examination revealed a fractured central cusp suggestive of dens evaginatus. Intraoral periapical radiograph revealed an immature permanent tooth with a periapical radiolucency. A diagnosis of pulp necrosis with symptomatic apical periodontitis was made. The tooth was treated according to the revised guidelines of regenerative endodontic procedure by the American Association of Endodontics. The follow-up evaluation revealed a complete resolution of periapical pathology. A detached radiopaque tissue was appreciated at the 12-month follow-up. It resembled a broken root tip at the 24-month follow-up. Both the main root body and disjointed root tip developed independently. A cone-beam computed tomography evaluation at the 36-month follow-up confirmed the segmented development of the apical root tip. [ABSTRACT FROM AUTHOR]

Introduction. Root resorption may occur as a consequence of avulsion injury and may lead to the progressive loss of tooth structure. The aim was to report the outcome of root resorption treated with mineral trioxide aggregate in a replanted immature permanent incisor after 10 years of follow-up. Case outline. This case presents external root resorption that was detected 18 months after the avulsion injury in a nine-year-old child. Apical portion of the canal was filled with mineral trioxide aggregate and the rest of the canal was filled with a canal sealer and gutta-percha. Control examinations were performed six months after the completion of the endodontic treatment and afterwards yearly. The tooth was asymptomatic clinically and radiographs did not show progression of root resorption up to four years of follow-up. Infraposition of the injured tooth was detected five years after the replantation, but without significant radiographic changes, until the eight-year follow-up, when root resorption was detected again. However, the tooth was still hard and symptomless at the 10-year follow-up. Conclusion. Mineral trioxide aggregate may have an important role in the preservation of replanted immature teeth for a prolonged period.

Intrusive luxation injuries often result in severe damage to the tooth itself and surrounding tissues. Furthermore, treatment outcome is often unpredictable because of the large number of injury-related variables (such as time passed, patient age, comorbidities and related treatment, and patient cooperation) which influence the choice of treatment and prognosis. This report presents the case of an 8-year-old boy with a severely intruded immature permanent upper incisor combined with missing alveolar socket wall. The treatment option chosen by the parents was to replace the tooth and fix it by glass fibers as splinting material. Four months after the trauma, the tooth was vital and asymptomatic, and radiographic examination showed satisfactory periapical and periodontal healing. The outcome of the presented case highlights the importance of the timely and properly performed management together with the regular long-term follow-ups for the survival rate of severely intruded immature teeth, even with a missing supporting alveolar wall due to the facilitated revascularization through their wide open root foramina.