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Three-dimensional qualitative and quantitative analyses of the effect of periradicular lesions on the outcome of regenerative endodontic procedures: A prospective clinical study

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Abstract

Objectives

Qualitative and quantitative evaluation of the outcomes of regenerative endodontic procedure (REP) on human immature necrotic teeth with apical periodontitis using cone-beam computed tomography (CBCT)

Materials and methods

Immature permanent teeth (n = 50) with necrotic pulp and periradicular pathosis were treated with a cell-homing concept-based REP. Following the procedure, a limited field-of-view CBCT scan was obtained. At each recall session (6, 12, 18 months), clinical tests were performed, and a digital periapical radiograph was taken. When significant radiographic changes were evident in the follow-up, a final CBCT scan was taken for qualitative and quantitative assessment. These initial and follow-up CBCT scans were assessed for quantification of changes in root length, pulp space diameter and periradicular lesion size. The data were statistically analysed using t test, one-way ANOVA, post hoc test and paired t test (P = 0.05).

Results

Of the teeth, 94.6% were clinically successful based on the lack or regression of signs and symptoms after 48 months follow-up. REP resulted in a statistically significant increase in root length, decrease in pulp space diameter and periradicular radiolucency (P < 0.05). CBCT images illustrated various patterns of root maturation including an increased thickening of the canal walls and continued root maturation (37.1%), continued root development with the apical foramen remaining open (57.1%), severe calcification (obliteration) of the canal space (2.9%) and hard tissue barrier formation in the canal space between the coronal plug and the root apex (2.9%).

Conclusion

This study highlighted that the expected outcome of radiographic root development was less predictable when immature permanent teeth with periradicular pathosis were treated with REP.

Clinical relevance

The size and extent (expansion/destruction of the cortical plate) of periradicular lesions and abscesses influence the outcome of REP. These factors must be taken into consideration during treatment planning.

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Authors and Affiliations

  1. Department of Conservative Dentistry and Endodontics, Nair Hospital Dental College, Mumbai, India

    Heeresh Shetty

  2. Department of Conservative Dentistry and Endodontics, A.B. Shetty Memorial Institute of Dental Sciences, Mangalore, India

    Heeresh Shetty, Shishir Shetty & Aditya Shetty

  3. Department of Pediatric Dentistry, Nair Hospital Dental College, Mumbai, India

    Adesh Kakade & Sayali Mali

  4. Discipline of Endodontology, Division of Restorative Dental Sciences, Faculty of Demtistry, The University of Hong Kong, 34, Hospital Road, Sai Ying Pun, Hong Kong SAR

    Prasanna Neelakantan

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  1. Heeresh Shetty
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  2. Shishir Shetty
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  3. Adesh Kakade
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Contributions

All authors contributed to the study conceptualization and design. Material preparation, data collection and analysis were performed by Heeresh Shetty, Shishir Shetty, Adesh Kakade, Sayali Mali and Aditya Shetty. The manuscript was written and revised by Heeresh Shetty, Shishir Shetty and Prasanna Neelakantan. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Prasanna Neelakantan.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Table 1 Patient evaluation chart (DOCX 32 kb)

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Table 2 Quantitative analysis data (DOCX 19 kb)

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Shetty, H., Shetty, S., Kakade, A. et al. Three-dimensional qualitative and quantitative analyses of the effect of periradicular lesions on the outcome of regenerative endodontic procedures: A prospective clinical study. Clin Oral Invest 25, 691–700 (2021). https://doi.org/10.1007/s00784-020-03583-z

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