Skip to main content

Advertisement

Log in

Regenerative endodontic therapy of immature permanent molars with pulp necrosis: a cases series and a literature review

  • Case Series Study
  • Published:
European Archives of Paediatric Dentistry Aims and scope Submit manuscript

Abstract

Aim

To present the application and the outcome of the regenerative endodontic therapy (RET) in a series of symptomatic immature mandibular molars with pulp necrosis and apical periodontitis and to review the relevant literature for the documentation of the procedure as a potential treatment option.

Methods

Three young male patients were referred with pain in the left mandibular region resulting from pulp necrosis and apical periodontitis of the first permanent molar. Regenerative endodontic approach was performed for the complete resolution of the lesions and the thickening of the apical root canal walls. The databases of Medline, Pubmed and Google Scholar were also searched for articles in which a regenerative approach has been undertaken for the endodontic management of immature permanent molars with pulp necrosis and apical periodontitis.

Results

Follow-up examinations showed that the teeth remained functional without any signs or symptoms. Final radiographic examination at 12, 18 and 36 months, respectively, revealed complete resolution of the lesions and complete apical closure in the two out of three cases. The search of the literature revealed the existence of only 25 clinical articles in which necrotic immature molars were treated by the regenerative approach. The total number of the treated teeth were 46.

Conclusions

Regenerative endodontic approach may be applied in posterior non-vital molar teeth with a possible favorable outcome. However, the literature support for the documentation of the procedure as a predictable and reproducible treatment option in posterior immature molar teeth is at present limited.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  • Ajram J, Khalil I, Gergi R, Zogheib C. Management of an immature necrotic permanent molar with apical periodontitis treated by regenerative endodontic protocol using calcium hydroxide and MM-MTA: a case report with 2 years follow up. Dent J (Basel). 2019;7:1.

    Google Scholar 

  • Alobaid AS, Cortes LM, Lo J, et al. Radiographic and clinical outcomes of the treatment of immature permanent teeth by revascularization or apexification: a pilot retrospective cohort study. J Endod. 2014;40:1063–70.

    PubMed  PubMed Central  Google Scholar 

  • Bezgin T, Yilmaz AD, Celik BN, Kolsuz ME, Sonmez H. Efficacy of platelet-rich plasma as a scaffold in regenerative endodontic treatment. J Endod. 2015;41:36–44.

    PubMed  Google Scholar 

  • Bose R, Nummikoski P, Hargreaves K. A retrospective evaluation of radiographic outcomes in immature teeth with necrotic root canal systems treated with regenerative endodontic procedures. J Endod. 2009;35:1343–9.

    PubMed  Google Scholar 

  • Bukhari S, Kohli MR, Setzer F, Karabucak B. Outcome of revascularization procedure: a retrospective case series. J Endod. 2016;42:1752–9.

    PubMed  Google Scholar 

  • Carmen L, Asunción M, Beatriz S, Rosa YV. Revascularization in immature permanent teeth with necrotic pulp and apical pathology: case series. Case Rep Dent. 2017;2017:3540159. https://doi.org/10.1155/2017/3540159.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cehreli ZC, Isbitiren B, Sara S, Erbas G. Regenerative endodontic treatment (revascularization) of immature necrotic molars medicated with calcium hydroxide: a case series. J Endod. 2011;37:1327–30.

    PubMed  Google Scholar 

  • Chen MY, Chen KL, Chen CA, Tayebaty F, Rosenberg PA, Lin LM. Responses of immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscess to revascularization procedures. Int Endod J. 2012;45:294–305.

    PubMed  Google Scholar 

  • Chueh LH, Ho YC, Kuo TC, Lai WH, Chen YH, Chiang CP. Regenerative endodontic treatment for necrotic immature permanent teeth. J Endod. 2009;35:160–4.

    PubMed  Google Scholar 

  • Cymerman JJ, Nosrat A. Regenerative endodontic treatment as a biologically based approach for non-surgical retreatment of immature teeth. J Endod. 2020;46:44–50.

    PubMed  Google Scholar 

  • Dabbagh B, Alvaro E, Vu DD, Rizkallah J, Schwartz S. Clinical complications in the revascularization of immature necrotic permanent teeth. Pediatr Dent. 2012;34:414–7.

    PubMed  Google Scholar 

  • Dhaimy S, Dhoum S, Amarir H, El Merini H, Nadifi S, Ouazzani AE. Pulpo-periodontal regeneration: management of partial failure revascularization. Case Rep Dent. 2017;2017:8302039. https://doi.org/10.1155/2017/8302039.

    Article  PubMed  PubMed Central  Google Scholar 

  • Galler KM, Krastl G, Simon S, et al. European Society of Endodontology position statement: revitalization procedures. Int Endod J. 2016;49:717–23.

    PubMed  Google Scholar 

  • Hajizadeh S, Youzbashi Zadeh R, Vatanparast N. Pulp revascularization in three immature permanent mandibular molars with necrotic pulps: a case series. Iran Endod J. 2019;14:301–5.

    Google Scholar 

  • Hargreaves KM, Diogenes A, Teixeira FB. Treatment options: biological basis of regenerative endodontic procedures. J Endod. 2013;39(3 Suppl):S30–43.

    PubMed  PubMed Central  Google Scholar 

  • Jeeruphan T, Jantarat J, Yanpiset K, Suwannapan L, Khewsawai P, Hargreaves KM. Mahidol study 1: comparison of radiographic and survival outcomes of immature teeth treated with either regenerative endodontic or apexification methods: a retrospective study. J Endod. 2012;38:1330–6.

    PubMed  Google Scholar 

  • Kim SG, Malek M, Sigurdsson A, Lin LM, Kahler B. Regenerative endodontics: a comprehensive review. Int Endod J. 2018;5:1367–88. https://doi.org/10.1111/iej.12954.

    Article  Google Scholar 

  • Kontakiotis EG, Filippatos CG, Tzanetakis GN, Agrafioti A. Regenerative endodontic therapy: a data analysis of clinical protocols. J Endod. 2015;41:146–54.

    PubMed  Google Scholar 

  • Lee JY, Kersten DD, Mines P, Beltran TA. Regenerative endodontic procedures among endodontists: a web-based survey. J Endod. 2018;44:250–5.

    PubMed  Google Scholar 

  • Lin J, Zeng Q, Wei X, et al. Regenerative endodontics versus apexification in immature permanent teeth with apical periodontitis: a prospective randomized controlled study. J Endod. 2017;43:1821–7.

    PubMed  Google Scholar 

  • Martin G, Ricucci D, Gibbs JL, Lin LM. Histological findings of revascularized/revitalized immature permanent molar with apical periodontitis using platelet-rich plasma. J Endod. 2013;39:138–44.

    PubMed  Google Scholar 

  • Masmoudi F, Bourmeche I, Sebai A, Baccouche Z, Maatouk F. Root lengthening with apical closure in two maxillary immature permanent central incisors after placement of mineral trioxide aggregate (MTA) as an apical plug. Eur Arch Paediatr Dent. 2018;19:65–71.

    PubMed  Google Scholar 

  • Mehrvarzfar P, Abbott PV, Akhavan H, Savadkouhi ST. Modified revascularization in human teeth using an intracanal formation of treated dentin matrix: a report of two cases. J Int Soc Prev Community Dent. 2017;7:218–21.

    PubMed  PubMed Central  Google Scholar 

  • Meng EKC, Desmeules M, Cielecki M, Dabbagh B, Dos Santos FB. Longitudinal cohort study of regenerative endodontic treatment for immature necrotic permanent teeth. J Endod. 2017;43:395–400.

    Google Scholar 

  • Nagata JY, Gomes BP, Rocha Lima TF, et al. Traumatized immature teeth treated with 2 protocols of pulp revascularization. J Endod. 2014;40:606–12.

    PubMed  Google Scholar 

  • Nagy MM, Tawfik HE, Hashem AA, Abu-Seida AM. Regenerative potential of immature permanent teeth with necrotic pulps after different regenerative protocols. J Endod. 2014;40:192–8.

    PubMed  Google Scholar 

  • Nosrat A, Seifi A, Asgary S. Regenerative endodontic treatment (revascularization) for necrotic immature permanent molars: a review and report of two cases with a new biomaterial. J Endod. 2011;37:562–7.

    PubMed  Google Scholar 

  • Ramezani M, Sanaei-rad P, Hajihassani N. Revascularization and vital pulp therapy in immature molars with necrotic pulp and irreversible pulpitis: a case report with 2-year follow-up. Clin Case Rep. 2019. https://doi.org/10.1002/ccr3.2614.

    Article  PubMed  PubMed Central  Google Scholar 

  • Roghanizadeh L, Fazlyab M. Revascularization and apical plug in an immature molar. Iran Endod J. 2018;13:139–42.

    PubMed  PubMed Central  Google Scholar 

  • Saoud TM, Zaazou A, Nabil A, Moussa S, Lin LM, Gibbs JL. Clinical and radiographic outcomes of traumatized immature permanent necrotic teeth after revascularization/revitalization therapy. J Endod. 2014;40:1946–52.

    PubMed  PubMed Central  Google Scholar 

  • Satyaprasad S, Kishore S, Krisnamoorthy SH, Zhoor N. Revascularization of an immature permanent molar with necrotic pulp and apical periodontitis using MTA: a case report. Int J Oral Health Dent. 2016;2:114–8.

    Google Scholar 

  • Schmoeckel J, Mourad MS, Splieth CH, Santamaria RM. Management of an immature, partially necrotic permanent molar by pulp revascularization: 2-year follow-up. Quintessence Int. 2017;48:309–13.

    PubMed  Google Scholar 

  • Silujjai J, Linsuwanont P. Treatment outcomes of apexification or revascularization in nonvital immature permanent teeth: a retrospective study. J Endod. 2017;43:238–45.

    PubMed  Google Scholar 

  • Sindi AS. Management of bilaterally immature permanent teeth using various treatment modalities. Saudi Endod J. 2018;8:222–7.

    Google Scholar 

  • Song M, Cao Y, Shin SJ, et al. Revascularization-associated intracanal calcification: assessment of prevalence and contributing factors. J Endod. 2017;43:2025–33.

    PubMed  Google Scholar 

  • Sönmez IS, Akbay Oba A, Erkmen AM. Revascularization/regeneration performed in immature molars: case reports. J Clin Pediatr Dent. 2013;37:231–4.

    PubMed  Google Scholar 

  • Subash D, Shoba K, Aman S, Bharkavi SK. Revitalization of an immature permanent mandibular molar with a necrotic pulp using platelet-rich fibrin: a case report. J Clin Diagn Res. 2016;10:ZD21–ZD23.

    PubMed  PubMed Central  Google Scholar 

  • Topçuoğlu G, Topçuoğlu HS. Regenerative endodontic therapy in a single visit using platelet-rich plasma and biodentine in necrotic and asymptomatic immature molar teeth: a report of 3 cases. J Endod. 2016;42:1344–6.

    PubMed  Google Scholar 

  • Torabinejad M, Nosrat A, Verma P, Udochukwu O. Regenerative endodontic treatment or mineral trioxide aggregate apical plug in teeth with necrotic pulps and open apices: a systematic review and meta-analysis. J Endod. 2017;43:1806–20.

    PubMed  Google Scholar 

  • Torabinejad M, Alexander A, Vahdati SA, Grandhi A, Baylink D, Shabahang S. Effect of residual dental pulp tissue on regeneration of dentin-pulp complex: an in vivo investigation. J Endod. 2018;44:1796–801.

    PubMed  Google Scholar 

  • Tzanetakis GN. Management of intruded immature maxillary central incisor with pulp necrosis and severe external resorption by regenerative approach. J Endod. 2018;44:245–9.

    PubMed  Google Scholar 

  • Vashisth P, Vatsala V, Naik S, Naik S, Singh MG. Revascularization of a necrotic, infected, immature permanent molar with apical periodontitis: a case report. J Dent Spec. 2015;3:180–2.

    Google Scholar 

  • Wigler R, Kaufman AY, Lin S, Steinbock N, Hazan-Molina H, Torneck CD. Revascularization: a treatment for permanent teeth with necrotic pulp and incomplete root development. J Endod. 2013;39:319–26.

    PubMed  Google Scholar 

  • Wongwatanasanti N, Jantarat J, Sritanaudomchai H, Hargreaves KM. Effect of bioceramic materials on proliferation and odontoblast differentiation of human stem cells from the apical papilla. J Endod. 2018;44:1270–5.

    PubMed  Google Scholar 

  • Zhujiang A, Kim SG. Regenerative endodontic treatment of an immature necrotic molar with arrested root development by using recombinant human platelet-derived growth factor: a case report. J Endod. 2016;42:72–5.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to G. N. Tzanetakis.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tzanetakis, G.N., Giannakoulas, D.G., Papanakou, S. et al. Regenerative endodontic therapy of immature permanent molars with pulp necrosis: a cases series and a literature review. Eur Arch Paediatr Dent 22, 515–525 (2021). https://doi.org/10.1007/s40368-020-00550-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40368-020-00550-w

Keywords

Navigation