Pulp revascularization on an adult mandibular right second premolar:A case report

BACKGROUND Pulp revascularization has become a new method for the treatment of periapical diseases in young permanent teeth in recent years.Through root canal flushing and disinfection,avoiding mechanical preparation,guiding apical stem cells into the root canal and promoting the continuous development of tooth roots,it has achieved good clinical curative effects.But in adult patients with chronic periapical periodontitis with immature roots and open apices,apical barrier technology is often used to treat these teeth.CASE SUMMARY Pulp revascularization of a 26-year-old patient's tooth was performed using cefaclor instead of minocycline and iRoot BP instead of mineral trioxide aggregate as intracanal medication.The case was followed up for 36 mo.Observations showed evidence of regression of clinical signs and symptoms,resolution of apical periodontitis and no discolouration of affected teeth.CONCLUSION For adult patients with chronic periapical periodontitis with immature roots and open apices,pulp revascularisation showed favourable results in treating these teeth.

Hypoxia-Mediated Upregulation of Semaphorin 3A during Pulp Revascularization

Semaphorin 3A could be involved in angiogenesis and also enhanced bone formation was investigated in many researches. In our current study, we firstly investigated that canal obliteration might be present in some regenerative endodontic procedures cases clinically. After the establishment of the model of apical periodontitis in the maxillary first molars of rats, pulp revascularization was performed in mesial root canal. Histological sections showed that most of the tissues growing into the root canal were not real pulp tissue, but cementoid, osteoid and periodontal-like membrane. Moreover, we detected that the expression of Semaphorin 3A increased in the mesial root canal. When we used CoCl2 to induce hypoxic environment, the expression of genes and proteins, Hypoxia inducible factor-1α, Vascular endothelial growth factor, and Semaphorin 3A in dental pulp stem cells were both upregulated. In conclusion, hypoxia mediated the high expression of Semaphorin 3A in DPSC might be involved tissue regeneration during pulp vascularization.

Pulp Revascularization: Future Therapy of Tooth with Open Apex

Introduction: The endodontic management of necrotic permanent immature teeth is a challenge for the practitioner. These teeth are treated by apexification. However, because of the complications associated with this treatment, researchers have developed other therapies. Currently, a new technique called pulp revascularization has emerged. This technique allows the continuation of root completion thanks to a healthy tissue newly formed at the intra root canal level. Material and method: A literature search of articles dealing with pulp revascularization of immature permanent teeth was conducted using two types of search strategy, a literature search using keywords on databases and then a manual “bottom-up” search of references of previously identified articles. Results: 112 articles were identified based on inclusion and exclusion criteria. Discussion: This work showed that pulp revascularization is a new therapy that aims to restart root development on an immature permanent tooth. It is based on the principle of tissue engineering and uses the differentiation potential of stem cells. Conclusion: Currently, the literature values revascularization as it allows root development, sidewall thickening, apical closure and a decrease in periapical lesion and ensures a good sealing. Clinical and radiographic success rates appear to be encouraging, except that factors influencing treatment must be taken into consideration.

Different endodontic treatments induced root development of two nonvital immature teeth in the same patient:A case report

BACKGROUND Pulp revascularization is a novel way to treat immature teeth with periapical disease,and the technique has become increasingly well established in recent years.By puncturing the periapical tissue,bleeding is induced,and a blood clot is formed in the root canal.The blood clot acts as a natural bioscaffold onto which mesenchymal stem cells from periapical tissue can be seeded and restore pulp vascularity,thus promoting root development as well as apical closure.Although the effect of pulp revascularization is ideal,there are certain requirements for the apical condition of the teeth.The apical barrier technique and apexification are still indispensable for teeth that cannot achieve ideal blood clot formation.In addition,a meta-analysis of several clinical studies concluded that pulp revascu-larization has no significant advantages over other treatments.CASE SUMMARY A 10-year-old girl complained of pain in the right upper and lower posterior teeth for 2 d.Clinical and radiological examinations revealed that both the right maxillary and mandibular second premolars were immature with periapical radiolucency.The right maxillary second premolar was treated by pulp revascu-larization,while the right mandibular second premolar was treated by conven-tional apical barrier surgery after revascularization failed.The purpose of this report is to compare the different root maturation processes induced by the pulp revascularization and apical barrier techniques in the same patient in homonymous teeth from different jaws.Twelve months of follow-up showed that the apical foramen of both teeth presented a clear tendency to close;however,the tooth treated with pulp revascularization showed a significant increase in root length as well as root canal wall thickness.CONCLUSION For the treatment of nonvital immature teeth,pulp revascularization showed a superior therapeutic effect in comparison with the apical barrier technique.