Int J Stomatol ›› 2020, Vol. 47 ›› Issue (4): 445-451.doi: 10.7518/gjkq.2020078

• Reviews • Previous Articles     Next Articles

Treatment options for young permanent teeth with pulp necrosis

Li Mei,Wen Ningning,Zhao Yuan()   

  1. Dept. of Cariology and Endodontics, Hospital of Stomatology, Lanzhou University, Lanzhou 730000, China
  • Received:2019-11-30 Revised:2020-03-21 Online:2020-07-01 Published:2020-07-10
  • Contact: Yuan Zhao E-mail:zhaoy@lzu.edu.cn
  • Supported by:
    This study was supported by Western China Clinical Research Foundation for Oral Health Promotion and Development of Chinese Stomatological Association(CSA-W2015-09);Gansu Province Longyuan Innovative Talents Project. 20180033

Abstract:

The retention of young permanent teeth with pulp necrosis is seriously affected because the root is not fully developed. At present, three main treatments used for young permanent teeth with pulp necrosis are apexification, apical barrier techniques, and revascularization. This article reviews the principles, advantages, disadvantages, and selection factors of each treatment to help dentists in choosing possible treatment options.

Key words: young permanent teeth, pulp necrosis, apexification, apical barrier techniques, revascularization

CLC Number: 

  • R781.05

TrendMD: 

Tab 1

Common treatment methods for young permanent teeth with pulp necrosis and their advantages and disadvantages"

评价项目 根尖诱导成形术 根尖屏障术 牙髓血运重建术
根尖周病变愈合率/%[4,25-26,42-43] 77~100 68~94 76~100
牙根进一步发育[43] 长度增加比/% 0.4 6.1 14.9
宽度增加比/% 1.5 0 28.2
牙髓组织再生[41] 部分组织再生
并发症概率/% [33] 14 0 42
就诊次数/次[7,23] 3~8 2~3 2~3
随访时间[3] 每3个月1次,直至钙化屏障形成 术后0~2年,每6个月1次;术后2~4年,每年1次 术后0~2年,每6个月1次;术后2~7年,每年1次
技术敏感性[44] 较高
失败后可选择的治疗方式[28,29] 二次根尖诱导成形术或根尖屏障术 根尖手术 二次血运重建术或根尖诱导成形术或根尖屏障术

Tab 2

Factors for choosing treatment for young permanent teeth with pulp necrosis"

评价项目 根尖诱导成形术 根尖屏障术 牙髓血运重建术
牙根发育情况[47,49] 牙根长度 >根长2/3 >根长2/3 <根长2/3
根尖孔直径/mm <1 <1 >1
病变范围[52,53] 无影响 伴有根尖周病变则成功率降低 尚不明确
病变时间[51,56] 无影响 无影响 超过6个月成功率降低
牙髓坏死的病因[26] 无影响 无影响 龋病、发育畸形患牙较外伤患牙效果更佳
患者年龄[9,49] 6~18岁 6~18岁 7~18岁均可,13岁以下效果更佳
患者全身情况[64,65] 良好 良好 良好且无影响组织愈合的系统性疾病
患者依从性[64,65]
距患牙永久修复的时间[64,65] 较长 较长
[1] 葛立宏. 儿童口腔医学[M]. 4版. 北京: 人民卫生出版社, 2015: 41-43.
Ge LH. Pediatric dentistry[M]. 4th ed. Beijing: People’s Medical Publishing House, 2015: 41-43.
[2] Diogenes A, Henry MA, Teixeira FB, et al. An up-date on clinical regenerative endodontics[J]. Endod Topics, 2013,28(1):2-23.
[3] 凌均棨, 林家成. 牙髓血运重建术治疗进展[J]. 口腔医学, 2019,39(10):865-872.
Ling JQ, Lin JC. Research progress of regenerative endodontics[J]. Stomatology, 2019,39(10):865-872.
[4] Silujjai J, Linsuwanont P. Treatment outcomes of apexification or revascularization in nonvital immature permanent teeth: a retrospective study[J]. J Endod, 2017,43(2):238-245.
doi: 10.1016/j.joen.2016.10.030 pmid: 28132710
[5] Kareem AMK, Rasha MA. Managements of imma-ture apex: a review[J]. Mod Res Dent, 2017,1(1):1-21.
[6] Rafter M. A pexification: a review[J]. Dent Traumatol, 2005,21(1):1-8.
doi: 10.1111/j.1600-9657.2004.00284.x pmid: 15660748
[7] Agrafioti A, Giannakoulas DG, Filippatos EG, et al. Analysis of clinical studies related to apexification techniques[J]. Eur J Paediatr Dent, 2017,18(4):273-284.
doi: 10.23804/ejpd.2017.18.04.03 pmid: 29380612
[8] Mohammadi Z, Dummer PM. Properties and app-lications of calcium hydroxide in endodontics and dental traumatology[J]. Int Endod J, 2011,44(8):697-730.
doi: 10.1111/j.1365-2591.2011.01886.x
[9] Bonte E, Beslot A, Boukpessi T, et al. MTA versus Ca(OH)2 in apexification of non-vital immature per-manent teeth: a randomized clinical trial comparison[J]. Clin Oral Invest, 2015,19(6):1381-1388.
doi: 10.1007/s00784-014-1348-5
[10] Lin JC, Lu JX, Zeng Q, et al. Comparison of mineral trioxide aggregate and calcium hydroxide for apexi-fication of immature permanent teeth: a systematic review and meta-analysis[J]. J Formos Med Assoc, 2016,115(7):523-530.
doi: 10.1016/j.jfma.2016.01.010 pmid: 26911724
[11] Trope M. Treatment of the immature tooth with a non-vital pulp and apical periodontitis[J]. Dent Clin North Am, 2010,54(2):313-324.
doi: 10.1016/j.cden.2009.12.006 pmid: 20433980
[12] Felippe WT, Felippe MCS, Rocha MJC. The effect of mineral trioxide aggregate on the apexification and periapical healing of teeth with incomplete root formation[J]. Int Endod J, 2006,39(1):2-9.
doi: 10.1111/j.1365-2591.2005.01037.x pmid: 16409322
[13] Sarkar NK, Caicedo R, Ritwik P, et al. Physico-chemical basis of the biologic properties of mineral trioxide aggregate[J]. J Endod, 2005,31(2):97-100.
doi: 10.1097/01.don.0000133155.04468.41 pmid: 15671817
[14] Parirokh M, Torabinejad M. Mineral trioxide aggre-gate: a comprehensive literature review: part Ⅲ: clinical applications, drawbacks, and mechanism of action[J]. J Endod, 2010,36(3):400-413.
doi: 10.1016/j.joen.2009.09.009 pmid: 20171353
[15] Torabinejad M, Parirokh M, Dummer PMH. Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview—part Ⅱ: other clinical applications and complications[J]. Int Endod J, 2018,51(3):284-317.
doi: 10.1111/iej.12843 pmid: 28846134
[16] Asgary S, Fazlyab M, Nosrat A. Regenerative endo-dontic treatment versus apical plug in immature teeth: three-year follow-up[J]. J Clin Pediatr Dent, 2016,40(5):356-360.
doi: 10.17796/1053-4628-40.5.356 pmid: 27617375
[17] Tuloglu N, Bayrak S. Comparative evaluation of mineral trioxide aggregate and bioaggregate as apical barrier material in traumatized nonvital, immature teeth: a clinical pilot study[J]. Niger J Clin Pract, 2016,19(1):52-57.
doi: 10.4103/1119-3077.164332 pmid: 26755219
[18] Vidal K, Martin G, Lozano O, et al. Apical closure in apexification: a review and case report of apexifica-tion treatment of an immature permanent tooth with biodentine[J]. J Endod, 2016,42(5):730-734.
doi: 10.1016/j.joen.2016.02.007 pmid: 26994597
[19] Martens L, Rajasekharan S, Cauwels R. Endodontic treatment of trauma-induced necrotic immature teeth using a tricalcium silicate-based bioactive cement. A report of 3 cases with 24-month follow-up[J]. Eur J Paediatr Dent, 2016,17(1):24-28.
pmid: 26949235
[20] Asgary S, Fayazi S. Endodontic surgery of a sympto-matic overfilled MTA apical plug: a histological and clinical case report[J]. Iran Endod J, 2017,12(3):376-380.
doi: 10.22037/iej.v12i3.17689 pmid: 28808469
[21] Murray PE, Garcia-Godoy F, Hargreaves KM. Re-generative endodontics: a review of current status and a call for action[J]. J Endod, 2007,33(4):377-390.
doi: 10.1016/j.joen.2006.09.013 pmid: 17368324
[22] Xuan K, Li B, Guo H, et al. Deciduous autologous tooth stem cells regenerate dental pulp after im-plantation into injured teeth[J]. Sci Transl Med, 2018, 10(455): eaaf3227.
doi: 10.1126/scitranslmed.aaf3227 pmid: 30135248
[23] 黄定明, 杨懋彬, 周学东. 牙髓再生治疗的临床操作管理及疗效评价[J]. 中华口腔医学杂志, 2019,54(9):584-590.
Huang DM, Yang MB, Zhou XD. Clinical manage-ment and prognosis evaluation of pulp regeneration therapy[J]. Chin J Stomatol, 2019,54(9):584-590.
[24] 凌均棨, 毛剑. 牙髓再生的研究现状与发展前景[J]. 中华口腔医学杂志, 2018,53(6):361-366.
Ling JQ, Mao J. State of the art and perspective of pulp regeneration[J]. Chin J Stomatol, 2018,53(6):361-366.
[25] Kahler B, Rossi-Fedele G, Chugal N, et al. An evi-dence-based review of the efficacy of treatment ap-proaches for immature permanent teeth with pulp ne-crosis[J]. J Endod, 2017,43(7):1052-1057.
doi: 10.1016/j.joen.2017.03.003 pmid: 28511779
[26] Lin JC, Zeng Q, Wei X, et al. Regenerative endodontics versus apexification in immature permanent teeth with apical periodontitis: a prospective randomized controlled study[J]. J Endod, 2017,43(11):1821-1827.
doi: 10.1016/j.joen.2017.06.023 pmid: 28864219
[27] Zhou RH, Wang YM, Chen YM, et al. Radiographic, histologic, and biomechanical evaluation of com-bined application of platelet-rich fibrin with blood clot in regenerative endodontics[J]. J Endod, 2017,43(12):2034-2040.
doi: 10.1016/j.joen.2017.07.021 pmid: 29032818
[28] Chaniotis A. Treatment options for failing regenera-tive endodontic procedures: report of 3 cases[J]. J Endod, 2017,43(9):1472-1478.
doi: 10.1016/j.joen.2017.04.015 pmid: 28712637
[29] Žižka R, Buchta T, Voborná I, et al. Root maturation in teeth treated by unsuccessful revitalization: 2 case reports[J]. J Endod, 2016,42(5):724-729.
doi: 10.1016/j.joen.2016.02.004 pmid: 26960577
[30] Lv H, Chen YM, Cai ZY, et al. The efficacy of plate-let-rich fibrin as a scaffold in regenerative endodon-tic treatment: a retrospective controlled cohort study[J]. BMC Oral Health, 2018,18(1):139.
doi: 10.1186/s12903-018-0598-z pmid: 30103724
[31] Bezgin T, Yilmaz AD, Celik BN, et al. Efficacy of platelet-rich plasma as a scaffold in regenerative endodontic treatment[J]. J Endod, 2015,41(1):36-44.
doi: 10.1016/j.joen.2014.10.004 pmid: 25459571
[32] Ding RY, Cheung GS, Chen J, et al. Pulp revascu-larization of immature teeth with apical periodontitis: a clinical study[J]. J Endod, 2009,35(5):745-749.
doi: 10.1016/j.joen.2009.02.009 pmid: 19410097
[33] Alobaid AS, Cortes LM, Lo J, et al. Radiographic and clinical outcomes of the treatment of immature permanent teeth by revascularization or apexifica-tion: a pilot retrospective cohort study[J]. J Endod, 2014,40(8):1063-1070.
doi: 10.1016/j.joen.2014.02.016 pmid: 25069909
[34] Kahler B, Rossi-Fedele G. A review of tooth discolo-ration after regenerative endodontic therapy[J]. J Endod, 2016,42(4):563-569.
doi: 10.1016/j.joen.2015.12.022 pmid: 26852148
[35] Lin LM, Kim SG, Martin G, et al. Continued root maturation despite persistent apical periodontitis of immature permanent teeth after failed regenerative endodontic therapy[J]. Aust Endod J, 2018,44(3):292-299.
doi: 10.1111/aej.12252 pmid: 29336522
[36] Kahler B, Kahler SL, Lin LM. Revascularization-associated intracanal calcification: a case report with an 8-year review[J]. J Endod, 2018,44(12):1792-1795.
doi: 10.1016/j.joen.2018.08.009 pmid: 30487078
[37] 江义笛, 汪成林, 叶玲. 再生性牙髓治疗的并发症[J]. 国际口腔医学杂志, 2019,46(1):73-77.
Jiang YD, Wang CL, Ye L. Complications of regene-rative endodontics[J]. Int J Stomatol, 2019,46(1):73-77.
[38] Meschi N, Hilkens P, Lambrichts I, et al. Regenera-tive endodontic procedure of an infected immature permanent human tooth: an immunohistological study[J]. Clin Oral Investig, 2016,20(4):807-814.
doi: 10.1007/s00784-015-1555-8 pmid: 26250796
[39] Nosrat A, Kolahdouzan A, Hosseini F, et al. Histo-logic outcomes of uninfected human immature teeth treated with regenerative endodontics: 2 case reports[J]. J Endod, 2015,41(10):1725-1729.
doi: 10.1016/j.joen.2015.05.004 pmid: 26259646
[40] Peng CF, Zhao YM, Wang WJ, et al. Histologic fin-dings of a human immature revascularized/regene-rated tooth with symptomatic irreversible pulpitis[J]. J Endod, 2017,43(6):905-909.
doi: 10.1016/j.joen.2017.01.031 pmid: 28416306
[41] Digka A, Sakka D, Lyroudia K. Histological assess-ment of human regenerative endodontic procedures (REP) of immature permanent teeth with necrotic pulp/apical periodontitis: a systematic review[J]. Aust Endod J, 2019. doi: 10.1111/aej.12371.
doi: 10.1111/aej.12388 pmid: 31846176
[42] Torabinejad M, Nosrat A, Verma P, et al. Regenerative endodontic treatment or mineral trioxide aggregate apical plug in teeth with necrotic pulps and open apices: a systematic review and meta-analysis[J]. J Endod, 2017,43(11):1806-1820.
doi: 10.1016/j.joen.2017.06.029 pmid: 28822564
[43] Jeeruphan T, Jantarat J, Yanpiset K, et al. Mahidol study 1: comparison of radiographic and survival outcomes of immature teeth treated with either re-generative endodontic or apexification methods: a retrospective study[J]. J Endod, 2012,38(10):1330-1336.
doi: 10.1016/j.joen.2012.06.028 pmid: 22980172
[44] Nazzal H, Tong H, Nixon P, et al. Regenerative en-dodontic therapy for managing immature non-vital teeth: a national survey of UK paediatric dental specialists and trainees[J]. Br Dent J, 2018,224(4):247-254.
doi: 10.1038/sj.bdj.2018.122 pmid: 29472688
[45] Cvek M. Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with gutta-percha. A retrospective clinical study[J]. Endod Dent Traumatol, 1992,8(2):45-55.
doi: 10.1111/j.1600-9657.1992.tb00228.x pmid: 1521505
[46] Kahler SL, Shetty S, Andreasen FM, et al. The effect of long-term dressing with calcium hydroxide on the fracture susceptibility of teeth[J]. J Endod, 2018,44(3):464-469.
doi: 10.1016/j.joen.2017.09.018 pmid: 29254817
[47] Kim SG, Malek M, Sigurdsson A, et al. Regenerative endodontics: a comprehensive review[J]. Int Endod J, 2018,51(12):1367-1388.
doi: 10.1111/iej.12954 pmid: 29777616
[48] Mendoza AM, Reina ES, García-Godoy F. Evolution of apical formation on immature necrotic permanent teeth[J]. Am J Dent, 2010,23(5):269-274.
pmid: 21207794
[49] Estefan BS, El Batouty KM, Nagy MM, et al. In-fluence of age and apical diameter on the success of endodontic regeneration procedures[J]. J Endod, 2016,42(11):1620-1625.
doi: 10.1016/j.joen.2016.06.020 pmid: 27623497
[50] Fouad AF, Verma P. Healing after regenerative pro-cedures with and without pulpal infection[J]. J Endod, 2014,40(4 Suppl):S58-S64.
doi: 10.1016/j.joen.2014.01.022 pmid: 24698695
[51] Yassen GH, Chin J, Mohammedsharif AG, et al. The effect of frequency of calcium hydroxide dressing change and various pre- and inter-operative factors on the endodontic treatment of traumatized immature permanent incisors[J]. Dent Traumatol, 2012,28(4):296-301.
doi: 10.1111/j.1600-9657.2011.01089.x
[52] Mente J, Leo M, Panagidis D, et al. Treatment out-come of mineral trioxide aggregate in open apex teeth[J]. J Endod, 2013,39(1):20-26.
pmid: 23228252
[53] Fouad AF. Microbial factors and antimicrobial strate-gies in dental pulp regeneration[J]. J Endod, 2017,43(9S):S46-S50.
[54] Almutairi W, Yassen GH, Aminoshariae A, et al. Regenerative endodontics: a systematic analysis of the failed cases[J]. J Endod, 2019,45(5):567-577.
doi: 10.1016/j.joen.2019.02.004 pmid: 30905573
[55] Verma P, Nosrat A, Kim JR, et al. Effect of residual bacteria on the outcome of pulp regeneration in vivo [J]. J Dent Res, 2017,96(1):100-106.
doi: 10.1177/0022034516671499 pmid: 27694153
[56] Nosrat A, Homayounfar N, Oloomi K. Drawbacks and unfavorable outcomes of regenerative endodontic treatments of necrotic immature teeth: a literature review and report of a case[J]. J Endod, 2012,38(10):1428-1434.
pmid: 22980193
[57] Lin LM, Shimizu E, Gibbs JL, et al. Histologic and histobacteriologic observations of failed revascu-larization/revitalization therapy: a case report[J]. J Endod, 2014,40(2):291-295.
doi: 10.1016/j.joen.2013.08.024 pmid: 24461421
[58] Latham J, Fong H, Jewett A, et al. Disinfection ef-ficacy of current regenerative endodontic protocols in simulated necrotic immature permanent teeth[J]. J Endod, 2016,42(8):1218-1225.
doi: 10.1016/j.joen.2016.05.004 pmid: 27372159
[59] Ricucci D, Siqueira JF Jr, Loghin S, et al. Pulp and apical tissue response to deep caries in immature teeth: a histologic and histobacteriologic study[J]. J Dent, 2017,56:19-32.
doi: 10.1016/j.jdent.2016.10.005 pmid: 27744048
[60] Liu C, Xiong H, Chen K, et al. Long-term exposure to pro-inflammatory cytokines inhibits the osteogenic/ dentinogenic differentiation of stem cells from the apical papilla[J]. Int Endod J, 2016,49(10):950-959.
doi: 10.1111/iej.12551 pmid: 26383494
[61] Nazzal H, Duggal MS. Regenerative endodontics: a true paradigm shift or a bandwagon about to be de-railed[J]. Eur Arch Paediatr Dent, 2017,18(1):3-15.
doi: 10.1007/s40368-016-0265-5 pmid: 28092093
[62] Guerrero F, Mendoza A, Ribas D, et al. Apexification: a systematic review[J]. J Conserv Dent, 2018,21(5):462-465.
doi: 10.4103/JCD.JCD_96_18 pmid: 30294103
[63] 叶玲. 再生性牙髓治疗方法的前景[J]. 口腔医学, 2016,36(11):961-967.
Ye L. Prospects for regenerative endodontic proce-dures[J]. Stomatology, 2016,36(11):961-967.
[64] Galler KM, Krastl G, Simon S, et al. European Society of Endodontology position statement: revitalization procedures[J]. Int Endod J, 2016,49(8):717-723.
doi: 10.1111/iej.12629 pmid: 26990236
[65] American Association of Endodontists. AAE clinical considerations for a gegenerative procedure. Revised 6-8-16[R/OL].( 2016-06-24) [2019-05-25]. https://www.aae.org/specialty/clinical-resources/regenera-tive-endodontics/.
[1] revascularization Meta-analysis of the efficacy comparison between endodontic,Zhuanzhuan apexification Li. OSID) [J]. Int J Stomatol, 2023, 50(2): 177-185.
[2] Li Zhuanzhuan,Gegen Tana. Research progress on root canal irrigation and disinfection drugs for pulp revascularization [J]. Int J Stomatol, 2022, 49(5): 569-577.
[3] Zhou Yi,Zhao Yuming. Research progress on various dental pulp regeneration scaffolds [J]. Int J Stomatol, 2022, 49(1): 19-26.
[4] Zhou Yijie,Song Guangtai. Management of the intrusive luxation in young permanent teeth [J]. Int J Stomatol, 2021, 48(2): 135-140.
[5] Yidi Jiang,Chenglin Wang,Ling Ye. Complications of regenerative endodontics [J]. Inter J Stomatol, 2019, 46(1): 73-77.
[6] Lei Qiyin, Chen Ke.. Research progress on the clinical treatment of regenerative endodontics in immature permanent teeth [J]. Inter J Stomatol, 2017, 44(3): 267-272.
[7] Zheng Wenlong, Zou Duohong, Chen Qiaoer. Regulatory effect of macrophages in angiogenesis and tissue engineering [J]. Inter J Stomatol, 2016, 43(1): 108-.
[8] Huang Xiao, Wang Jun. Factors in bonding effects of reattachments of anterior tooth fragments [J]. Inter J Stomatol, 2015, 42(5): 568-571.
[9] He Lu, Guo Jun, Yang Jian. Research progress on dental pulp tissue regeneration based on revascularization and tooth tissue engineering [J]. Inter J Stomatol, 2015, 42(4): 485-491.
[10] Liu Jiajia1, Qin Man2.. Revascularization treatment of immature permanent teeth with necrotic pulp [J]. Inter J Stomatol, 2012, 39(3): 349-352.
[11] YUAN Meng-jiang, WANG Ya, YAO Yao, TANG Xiu-fa, HUA Cheng-ge. Influence of periosteum on revascularization of free bone graft [J]. Inter J Stomatol, 2010, 37(3): 257-257~261.
[12] YAO Lin -jie, WANG Zi, SONG Guang-tai. The short-term effect of mineral trioxide aggregate in one -visit apexification t [J]. Inter J Stomatol, 2009, 36(2): 137-137~139.
[13] ZHONG Xiao-yi, CHEN Wen-xia. The application of revascularization in endodontics [J]. Inter J Stomatol, 2009, 36(2): 183-183~185.
[14] XIE San -xiang, ZHU Sheng -rong. The histological basis about apexification [J]. Inter J Stomatol, 2008, 35(6): 630-630~632.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[2] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[3] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[4] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[5] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[6] . [J]. Foreign Med Sci: Stomatol, 1999, 26(04): .
[7] . [J]. Foreign Med Sci: Stomatol, 1999, 26(04): .
[8] . [J]. Foreign Med Sci: Stomatol, 1999, 26(04): .
[9] . [J]. Foreign Med Sci: Stomatol, 1999, 26(04): .
[10] . [J]. Foreign Med Sci: Stomatol, 1999, 26(04): .