The Efficacy Of Pulp Revascularization In Immature Permanent Teeth And The Influence Of Scaffold Materials To It: A Retrospective Study

Objective: The aim of this retrospective study is to evaluate the therapeutic effect of pulp revascularization in immature permanent teeth with apical periodontitis,and compare the efficacy of two scaffold materials in depth.Methods: The study was performed at the Department of Endodontics,the Affiliated Stomatology Hospital,Zhejiang University School of Medicine,from November,2015 to November,2019.In this study,we reviewed totally 85 immature permanent teeth with apical periodontitis of 74 patients,and collected the basic information(gender,age,tooth position,etiology and diagnosis),detailed treatment regimens,as well as clinical and radiographic follow-up records.The clinical survival rate,clinical success rate,adverse event incidence rate,and developmental condition of tooth root in all the cases were statistically calculated and analyzed.According to the matching elements,including etiology,tooth developmental stage and diagnosis,we further selected 16 comparable pairs from “induced bleeding” group and “venous blood” group.And then,we compared the clinical survival rate,clinical success rate,adverse event incidence rate,and developmental condition of tooth root between these two groups.Results: In the observation period of(13.54±8.82)months,the clinical survival rate of 85 cases was up to 100%,the clinical success rate was 94.74%,the mild adverse event incidence rate was 20.00%,the moderate was 4.71%,and the severe was 0%.Among 81 successful cases,39.51% achieved type I tooth root development,35.80% achieved type II,7.41% achieved type III,7.41% was type IV,6.17% was type V,and the rest 3.70% didn’t show any hard tissue deposition.Quantitative evaluation demonstrated that the tooth root increasing rate was(7.97±9.85)%,the diameter of apical foramen decreasing rate was(41.46±29.00)%,the radiographic root area(RRA)increasing rate was(7.00±12.65)%,and the radiographic canal area(RCA)decreasing rate was(22.40±21.99)%.Moreover,there were no significant differences in the following indicators between the “induced bleeding” group and the “venous blood” group: the clinical survival rate(100%vs100%),the clinical success rate(100%vs87.5%),the mild(31.25%vs6.25%),the moderate(0%vs12.5%),and the severe(0%vs0%)adverse event incidence rate,the proportion of type I(56.25%vs35.71%),type II(25.00%vs28.57%),type III(0%vs7.14%),type IV(6.25%vs7.14%),and type V(12.50%vs21.43%)tooth root development,the tooth root increasing rate [(4.27±6.89)%vs(7.59±9.47)%],the diameter of apical foramen decreasing rate [(49.04±29.03)%vs(35.21±29.75)%],and the RRA increasing rate [(4.09±12.32)%vs(10.53±12.43)%].Whereas,the RCA decreasing rate of “induced bleeding” group was significantly higher than that of the “venous blood” group [(30.26±20.68)% vs(12.07±17.37)%,P=0.015].Conclusion: Pulp revascularization could promote desirable clinical outcomes in immature permanent teeth with apical periodontitis.And in the situation of inadequate induced bleeding,we can consider “venous blood” as an alternative.