Volume 41, Issue 1 pp. 47-58

ORIGINAL ARTICLE

Time-Dependent Morphological Changes in Traumatic Immature Teeth With Necrotic Pulps Following Regenerative Endodontic Treatment: A Retrospective Study

Manal Maree,

Manal Maree

Endodontics Department, School of Dentistry, Rambam Health Care Campus, Haifa, Israel

Search for more papers by this author

Omri Nabriski,

Omri Nabriski

Endodontics Department, School of Dentistry, Rambam Health Care Campus, Haifa, Israel

Search for more papers by this author

Margarita Yoshpe,

Margarita Yoshpe

orcid.org/0000-0001-6070-5369

Department of Endodontics, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

Search for more papers by this author

Shaul Lin,

Corresponding Author

Shaul Lin

orcid.org/0000-0002-4535-0157

Endodontics Department, School of Dentistry, Rambam Health Care Campus, Haifa, Israel

The Israeli National Center for Trauma & Emergency Medicine Research, the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel

Correspondence:

Shaul Lin ([email protected]; [email protected])

Search for more papers by this author

Arieh Y. Kaufman,

Arieh Y. Kaufman

Department of Endodontology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel

Search for more papers by this author

Manal Maree,

Manal Maree

Endodontics Department, School of Dentistry, Rambam Health Care Campus, Haifa, Israel

Search for more papers by this author

Omri Nabriski,

Omri Nabriski

Endodontics Department, School of Dentistry, Rambam Health Care Campus, Haifa, Israel

Search for more papers by this author

Margarita Yoshpe,

Margarita Yoshpe

orcid.org/0000-0001-6070-5369

Department of Endodontics, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

Search for more papers by this author

Shaul Lin,

Corresponding Author

Shaul Lin

orcid.org/0000-0002-4535-0157

Endodontics Department, School of Dentistry, Rambam Health Care Campus, Haifa, Israel

The Israeli National Center for Trauma & Emergency Medicine Research, the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel

Correspondence:

Shaul Lin ([email protected]; [email protected])

Search for more papers by this author

Arieh Y. Kaufman,

Arieh Y. Kaufman

Department of Endodontology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel

Search for more papers by this author

First published: 23 October 2024

https://doi.org/10.1111/edt.12986

Citations: 2

Funding: The authors received no specific funding for this work.

Manal Maree and Omri Nabriski contributed equally to this manuscript.

Share a link

Email
Wechat
Bluesky

ABSTRACT

Background/Aim

Regenerative endodontic treatment is a promising approach for healing periapical lesions and continuous root maturation. Although previous studies have reported its outcomes, the dynamics of morphological changes over time remain unclear. Therefore, this study aimed to evaluate changes in the periapical status and root dimensions over a 60-month follow-up period.

Materials and Methods

The follow-up duration, periapical status changes, calcific barrier formation, degree of apical closure and radiographic root area changes were compared with those of the last follow-up in this retrospective study. Radiographic root area changes were calculated as the difference between the total root and total canal areas.

Results

Fifty-eight patients (81 teeth) underwent regenerative endodontic treatment during the study period, of whom 32 patients (36 teeth, 62%) were included. The survival and success rates of the treated teeth were 100% and 94.4%, respectively. All teeth developed a calcific bridge in the cervical third of the root canal, indicating the presence of vital tissue. Apical narrowing (partial or total) was observed in 75% of the cases. The root maturation stage affected the percentage increase in the radiographic root area. Teeth in Cvek stages II–III showed a higher radiographic root area increase than more mature teeth. All tooth radiographic root areas increased significantly in the initial 20 months of the treatment and moderately thereafter.

Conclusions

Regenerative endodontic treatment is a safe approach for traumatised immature teeth. The presence of a radiographic calcified bridge may be an early indication of treatment success. The main complete tooth morphological changes occur after approximately 20 months posttreatment. These findings may help clinicians better understand the time-dependent changes in the root morphology after treatment, improve the follow-up schedule and predict the progress of healing during follow-up visits.

Conflicts of Interest

The authors declare no conflicts of interest.

Open Research

Data Availability Statement

The data that supports the findings of this study are available in the Supporting Information of this article.

References

1M. Trope, “Treatment of the Immature Tooth With a Non-Vital Pulp and Apical Periodontitis,” Dental Clinics of North America 54 (2010): 313–324.
10.1016/j.cden.2009.12.006
PubMed Google Scholar
2A. L. Frank, “Therapy for the Divergent Pulpless Tooth by Continued Apical Formation,” Journal of the American Dental Association 72 (1966): 87–93.
10.14219/jada.archive.1966.0017
CAS PubMed Web of Science® Google Scholar
3M. Duggal, H. J. Tong, M. Al-Ansary, W. Twaty, P. F. Day, and H. Nazzal, “Interventions for the Endodontic Management of Non-Vital Traumatised Immature Permanent Anterior Teeth in Children and Adolescents: A Systematic Review of the Evidence and Guidelines of the European Academy of Paediatric Dentistry,” European Archives of Paediatric Dentistry 18 (2017): 139–151.
10.1007/s40368-017-0289-5
CAS PubMed Web of Science® Google Scholar
4M. Torabinejad and N. Chivian, “Clinical Applications of Mineral Trioxide Aggregate,” Journal of Endodontia 25 (1999): 197–205.
10.1016/S0099-2399(99)80142-3
CAS PubMed Web of Science® Google Scholar
5M. Cvek, “Prognosis of Luxated Non-Vital Maxillary Incisors Treated With Calcium Hydroxide and Filled With Gutta-Percha. A Retrospective Clinical Study,” Endodontics & Dental Traumatology 8 (1992): 45–55.
10.1111/j.1600-9657.1992.tb00228.x
CAS PubMed Web of Science® Google Scholar
6B. Nygaard-Østby and O. Hjortdal, “Tissue Formation in the Root Canal Following Pulp Removal,” Scandinavian Journal of Dental Research 79 (1971): 333–349.
CAS PubMed Google Scholar
7S. I. Iwaya, M. Ikawa, and M. Kubota, “Revascularization of an Immature Permanent Tooth With Apical Periodontitis and Sinus Tract,” Dental Traumatology 17 (2001): 185–187.
10.1034/j.1600-9657.2001.017004185.x
CAS PubMed Web of Science® Google Scholar
8F. Banchs and M. Trope, “Revascularization of Immature Permanent Teeth With Apical Periodontitis: New Treatment Protocol?,” Journal of Endodontia 30 (2004): 196–200.
10.1097/00004770-200404000-00003
PubMed Web of Science® Google Scholar
9T. M. Geisler, “Clinical Considerations for Regenerative Endodontic Procedures,” Dental Clinics of North America 56 (2012): 603–626.
10.1016/j.cden.2012.05.010
PubMed Google Scholar
10K. M. Galler, G. Krastl, S. Simon, et al., “European Society of Endodontology Position Statement: Revitalization Procedures,” International Endodontic Journal 49 (2016): 717–723.
10.1111/iej.12629
CAS PubMed Web of Science® Google Scholar
11R. Bose, P. Nummikoski, and K. Hargreaves, “A Retrospective Evaluation of Radiographic Outcomes in Immature Teeth With Necrotic Root Canal Systems Treated With Regenerative Endodontic Procedures,” Journal of Endodontia 35 (2009): 1343–1349.
10.1016/j.joen.2009.06.021
PubMed Web of Science® Google Scholar
12T. Jeeruphan, J. Jantarat, K. Yanpiset, L. Suwannapan, P. Khewsawai, and K. M. Hargreaves, “Mahidol Study 1: Comparison of Radiographic and Survival Outcomes of Immature Teeth Treated With Either Regenerative Endodontic or Apexification Methods: A Retrospective Study,” Journal of Endodontia 38 (2012): 1330–1336.
10.1016/j.joen.2012.06.028
PubMed Web of Science® Google Scholar
13T. M. Saoud, A. Zaazou, A. Nabil, S. Moussa, L. M. Lin, and J. L. Gibbs, “Clinical and Radiographic Outcomes of Traumatized Immature Permanent Necrotic Teeth After Revascularization/Revitalization Therapy,” Journal of Endodontia 40 (2014): 1946–1952.
10.1016/j.joen.2014.08.023
PubMed Web of Science® Google Scholar
14T. M. Saoud, G. Martin, Y. H. Chen, et al., “Treatment of Mature Permanent Teeth With Necrotic Pulps and Apical Periodontitis Using Regenerative Endodontic Procedures: A Case Series,” Journal of Endodontia 42 (2016): 57–65.
10.1016/j.joen.2015.09.015
PubMed Web of Science® Google Scholar
15R. Brignardello-Petersen, “High Survival and Clinical Success Rates, But Also High Discoloration Rates, in Immature Necrotic Teeth Treated With Regenerative Endodontic Procedures,” Journal of the American Dental Association 148 (2017): e57.
10.1016/j.adaj.2017.02.041
PubMed Google Scholar
16E. K. Chan, M. Desmeules, M. Cielecki, B. Dabbagh, and B. F. Dos Santos, “Longitudinal Cohort Study of Regenerative Endodontic Treatment for Immature Necrotic Permanent Teeth,” Journal of Endodontia 43 (2017): 395–400.
10.1016/j.joen.2016.10.035
PubMed Web of Science® Google Scholar
17L. Li, Y. Pan, L. Mei, and J. Li, “Clinical and Radiographic Outcomes in Immature Permanent Necrotic Evaginated Teeth Treated With Regenerative Endodontic Procedures,” Journal of Endodontia 43 (2017): 246–251.
10.1016/j.joen.2016.10.015
PubMed Web of Science® Google Scholar
18H. J. Tong, S. Rajan, N. Bhujel, J. Kang, M. Duggal, and H. Nazzal, “Regenerative Endodontic Therapy in the Management of Nonvital Immature Permanent Teeth: A Systematic Review-Outcome Evaluation and Meta-Analysis,” Journal of Endodontia 43 (2017): 1453–1464.
10.1016/j.joen.2017.04.018
PubMed Web of Science® Google Scholar
19M. Torabinejad, A. Nosrat, P. Verma, and O. Udochukwu, “Regenerative Endodontic Treatment or Mineral Trioxide Aggregate Apical Plug in Teeth With Necrotic Pulps and Open Apices: A Systematic Review and Meta-Analysis,” Journal of Endodontia 43 (2017): 1806–1820.
10.1016/j.joen.2017.06.029
PubMed Web of Science® Google Scholar
20Z. C. Cehreli, B. Isbitiren, S. Sara, and G. Erbas, “Regenerative Endodontic Treatment (Revascularization) of Immature Necrotic Molars Medicated With Calcium Hydroxide: A Case Series,” Journal of Endodontia 37 (2011): 1327–1330.
10.1016/j.joen.2011.05.033
PubMed Web of Science® Google Scholar
21A. Nosrat, A. Seifi, and S. Asgary, “Regenerative Endodontic Treatment (Revascularization) for Necrotic Immature Permanent Molars: A Review and Report of Two Cases With a New Biomaterial,” Journal of Endodontia 37 (2011): 562–567.
10.1016/j.joen.2011.01.011
PubMed Web of Science® Google Scholar
22M. Torabinejad and M. Turman, “Revitalization of Tooth With Necrotic Pulp and Open Apex by Using Platelet-Rich Plasma: A Case Report,” Journal of Endodontia 37 (2011): 265–268.
10.1016/j.joen.2010.11.004
PubMed Web of Science® Google Scholar
23R. Lenzi and M. Trope, “Revitalization Procedures in Two Traumatized Incisors With Different Biological Outcomes,” Journal of Endodontia 38 (2012): 411–414.
10.1016/j.joen.2011.12.003
PubMed Web of Science® Google Scholar
24D. Keswani and R. K. Pandey, “Revascularization of an Immature Tooth With a Necrotic Pulp Using Platelet-Rich Fibrin: A Case Report,” International Endodontic Journal 46 (2013): 1096–1104.
10.1111/iej.12107
CAS PubMed Web of Science® Google Scholar
25G. Jadhav, N. Shah, and A. Logani, “Revascularization With and Without Platelet-Rich Plasma in Nonvital, Immature, Anterior Teeth: A Pilot Clinical Study,” Journal of Endodontia 38 (2012): 1581–1587.
10.1016/j.joen.2012.09.010
PubMed Web of Science® Google Scholar
26T. Bezgin, A. D. Yilmaz, B. N. Celik, M. E. Kolsuz, and H. Sonmez, “Efficacy of Platelet-Rich Plasma as a Scaffold in Regenerative Endodontic Treatment,” Journal of Endodontia 41 (2015): 36–44.
10.1016/j.joen.2014.10.004
PubMed Web of Science® Google Scholar
27I. Narang, N. Mittal, and N. Mishra, “A Comparative Evaluation of the Blood Clot, Platelet-Rich Plasma, and Platelet-Rich Fibrin in Regeneration of Necrotic Immature Permanent Teeth: A Clinical Study,” Contemporary Clinical Dentistry 6 (2015): 63–68.
10.4103/0976-237X.149294
PubMed Google Scholar
28H. L. Ray, Jr., J. Marcelino, R. Braga, R. Horwat, M. Lisien, and S. Khaliq, “Long-Term Follow up of Revascularization Using Platelet-Rich Fibrin,” Dental Traumatology 32 (2016): 80–84.
10.1111/edt.12189
CAS PubMed Web of Science® Google Scholar
29J. Choukroun, F. Adda, C. Schoeffler, and A. Vervelle, “The Opportunity in Perio-Implantology: The PRF,” Implantodontie 42 (2001): 55–62.
Google Scholar
30D. M. Dohan, J. Choukroun, A. Diss, et al., “Platelet-Rich Fibrin (PRF): A Second-Generation Platelet Concentrate. Part I: Technological Concepts and Evolution,” Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology Endod 101 (2006): e37–e44.
10.1016/j.tripleo.2005.07.008
PubMed Google Scholar
31L. He, Y. Lin, X. Hu, Y. Zhang, and H. Wu, “A Comparative Study of Platelet-Rich Fibrin (PRF) and Platelet-Rich Plasma (PRP) on the Effect of Proliferation and Differentiation of Rat Osteoblasts In Vitro,” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics 108 (2009): 707–713.
10.1016/j.tripleo.2009.06.044
PubMed Web of Science® Google Scholar
32M. Yoshpe, A. Y. Kaufman, S. Lin, and M. Ashkenazi, “Regenerative Endodontics: A Promising Tool to Promote Periapical Healing and Root Maturation of Necrotic Immature Permanent Molars With Apical Periodontitis Using Platelet-Rich Fibrin (PRF),” European Archives of Paediatric Dentistry 22 (2021): 527–534.
10.1007/s40368-020-00572-4
CAS PubMed Google Scholar
33M. Yoshpe, N. Ruparel, S. Einy, S. Ganatra, and A. Y. Kaufman, “Treatment of Necrotic Anterior and Posterior Teeth With Regenerative Endodontic Procedures Using PRF as a Scaffold: A Retrospective Study,” Applied Sciences 12 (2022): 6774.
10.3390/app12136774
CAS Google Scholar
34N. M. Flake, J. L. Gibbs, A. Diogenes, K. M. Hargreaves, and A. A. Khan, “A Standardized Novel Method to Measure Radiographic Root Changes After Endodontic Therapy in Immature Teeth,” Journal of Endodontia 40, no. 1 (2014): 46–50.
10.1016/j.joen.2013.09.025
PubMed Google Scholar
35L. Levin, P. F. Day, L. Hicks, et al., “International Association of Dental Traumatology Guidelines for the Management of Traumatic Injuries: General Introduction,” Dental Traumatology 36 (2020): 309–313.
10.1111/edt.12574
PubMed Web of Science® Google Scholar
36K. Feigin and B. Shope, “Regenerative Endodontics,” Journal of Veterinary Dentistry 34 (2017): 161–178.
10.1177/0898756417722022
PubMed Web of Science® Google Scholar
37R. Weisleder and C. R. Benitez, “Maturogenesis: Is It a New Concept?,” Journal of Endodontia 29 (2003): 776–778.
10.1097/00004770-200311000-00022
PubMed Web of Science® Google Scholar
38V. Amit, A. Jain, U. A. Nayak, and M. Bhat, “Maturogenesis by Revascularisation in an Infected Immature Permanent Tooth,” Journal of the Indian Society of Pedodontics and Preventive Dentistry 32 (2014): 172–175.
10.4103/0970-4388.130992
PubMed Google Scholar
39R. Patel and N. Cohenca, “Maturogenesis of a Cariously Exposed Immature Permanent Tooth Using MTA for Direct Pulp Capping: A Case Report,” Dental Traumatology 22 (2006): 328–333.
10.1111/j.1600-9657.2006.00471.x
CAS PubMed Web of Science® Google Scholar
40G. T.-J. Huang and L. M. Lin, “Letter to the Editor: Comments on the Use of the Term “Revascularization”,” Journal of Endodontia 34 (2008): 511; author reply 512.
10.1016/j.joen.2008.02.009
CAS PubMed Web of Science® Google Scholar
41P. E. Murray, F. Garcia-Godoy, and K. M. Hargreaves, “Regenerative Endodontics: A Review of Current Status and a Call for Action,” Journal of Endodontia 33 (2007): 377–390.
10.1016/j.joen.2006.09.013
PubMed Web of Science® Google Scholar
42J. Y. Nagata, A. J. Soares, F. J. Souza-Filho, et al., “Microbial Evaluation of Traumatized Teeth Treated With Triple Antibiotic Paste or Calcium Hydroxide With 2% Chlorhexidine Gel in Pulp Revascularization,” Journal of Endodontia 40 (2014): 778–783.
10.1016/j.joen.2014.01.038
PubMed Web of Science® Google Scholar
43N. B. Ruparel, F. B. Teixeira, C. C. Ferraz, and A. Diogenes, “Direct Effect of Intracanal Medicaments on Survival of Stem Cells of the Apical Papilla,” Journal of Endodontia 38 (2012): 1372–1375.
10.1016/j.joen.2012.06.018
PubMed Web of Science® Google Scholar
44J. H. Kim, Y. Kim, S. J. Shin, J. W. Park, and I. Y. Jung, “Tooth Discoloration of Immature Permanent Incisor Associated With Triple Antibiotic Therapy: A Case Report,” Journal of Endodontia 36 (2010): 1086–1091.
10.1016/j.joen.2010.03.031
PubMed Web of Science® Google Scholar
45R. E. Marx, E. R. Carlson, R. M. Eichstaedt, S. R. Schimmele, J. E. Strauss, and K. R. Georgeff, “Platelet-Rich Plasma: Growth Factor Enhancement for Bone Grafts,” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics 85 (1998): 638–646.
10.1016/S1079-2104(98)90029-4
CAS PubMed Web of Science® Google Scholar
46L. Brass, “Understanding and Evaluating Platelet Function,” Hematology. American Society of Hematology. Education Program 2010 (2010): 387–396.
10.1182/asheducation-2010.1.387
PubMed Web of Science® Google Scholar
47V. Chrepa, R. Joon, O. Austah, et al., “Clinical Outcomes of Immature Teeth Treated With Regenerative Endodontic Procedures—A San Antonio Study,” Journal of Endodontia 46 (2020): 1074–1084.
10.1016/j.joen.2020.04.008
PubMed Web of Science® Google Scholar
48A. Glynis, F. Foschi, I. Kefalou, D. Koletsi, and G. N. Tzanetakis, “Regenerative Endodontic Procedures for the Treatment of Necrotic Mature Teeth With Apical Periodontitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials,” Journal of Endodontia 47 (2021): 873–882.
10.1016/j.joen.2021.03.015
PubMed Web of Science® Google Scholar
49T. K. Ong, G. S. Lim, M. Singh, and A. V. Fial, “Assessment of Root Development After Regenerative Endodontic Therapy: A Systematic Review and Meta-Analysis,” Journal of Endodontics 46 (2020): 1856–1866.e2.
10.1016/j.joen.2020.08.016
PubMed Web of Science® Google Scholar
50 American Association of Endodontists and American Academy of Oral and Maxillofacial Radiology, “Use of Cone Beam Computed Tomography in Endodontics Joint Position Statement of the American Association of Endodontists and the American Academy of Oral and Maxillofacial Radiology,” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics 111 (2011): 234–237.
10.1016/j.tripleo.2010.11.012
PubMed Web of Science® Google Scholar
51A. S. Alobaid, L. M. Cortes, J. Lo, et al., “Radiographic and Clinical Outcomes of the Treatment of Immature Permanent Teeth by Revascularization or Apexification: A Pilot Retrospective Cohort Study,” Journal of Endodontics 40 (2014): 1063–1070.
10.1016/j.joen.2014.02.016
PubMed Web of Science® Google Scholar

Citing Literature

Volume41, Issue1

February 2025

Pages 47-58

Time-Dependent Morphological Changes in Traumatic Immature Teeth With Necrotic Pulps Following Regenerative Endodontic Treatment: A Retrospective Study

ABSTRACT

Background/Aim

Materials and Methods

Results

Conclusions

Conflicts of Interest

Open Research

Data Availability Statement

References

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Time-Dependent Morphological Changes in Traumatic Immature Teeth With Necrotic Pulps Following Regenerative Endodontic Treatment: A Retrospective Study

ABSTRACT

Background/Aim

Materials and Methods

Results

Conclusions

Conflicts of Interest

Open Research

Data Availability Statement

References

Citing Literature

References

Related

Information