The Application Of Concentrated Growth Factors In Inflamed Vital Pulp Therapy In Immature Permanent Teeth With Apical Periodontitis:a Case Report

Objective: The treatment of immature permanent teeth with infected pulp remains a challenging clinical problem.It is generally agreed that vital pulp therapy should be performed only in teeth with healthy pulp or reversible pulpitis.On the other hand,apexification,apical barrier or regenerative endodontic procedure should be used in those with irreversible pulpitis or apical periodontitis.However,with deepening research on pulp biology and the progress in materials and technology,researchers have found that retention of vital inflamed pulp tissue in immature permanent teeth could promote the root physiological development after control infection.Therefore,this technique was defined as inflamed vital pulp therapy(IVPT)and paid great attention.Nevertheless,it is difficult to place the pulp capping materials in cases with insufficient residual vital pulp.Concentrated growth factor(CGF)is an autogenous platelet concentrate,which can be used as a natural scaffold to facilitate clinical operation.Thus,we adopted IVPT using CGF in a case series of immature permanent teeth affected with apical periodontitis,and evaluated their follow-up results to provide a reference for optimizing IVPT.Methods: This study was conducted at the Department of Pediatric Dentistry,School and Hospital of Stomatology,China Medical University.Four immature permanent teeth with the diagnosis of apical periodontitis and the remnant vital pulp tissue located in the middle or lower portion of the canal were included.IVPT was performed with informed consent based on preoperative and intraoperative pulp status assessments.Bleeding color and time after pulp exposure were recorded.The pulp chamber and canal were irrigated with 1.5% sodium hypochlorite(20 m L/canal)to remove the necrotic pulp tissues.After root dressing with calcium hydroxide paste for2–3 weeks,CGF extracted from venous blood by centrifugation was then placed above the vital pulp tissue.The i Root BP Plus was used for sealing the canal orifice.The access cavity was sealed with glass ionomer cement and composite resin.Regular oral and radiographic examination were performed after treatment to evaluate the clinical efficacy.The percentage changes in root length,root wall thickness and apical diameter were measured at the last visit.A 20% change was considered as a cutoff for a clinically significant change.Results: All four cases showed no clinical symptoms and achieved periapical healing at 9–15 months after treatment.At the last visit,the apical diameter significantly decreased in case 1;the root wall thickness significantly increased in case 2;the root length significantly increased and root wall significantly thickened,and the apical diameter significantly decreased in case 3;the root length significantly increased and root wall significantly thickened,and apical diameter significantly decreased(apical closure)in case 4.Conclusion: In this case report,we combined applied of CGF in IVPT in immature permanent teeth with periapical periodontitis and insufficient residual vital pulp.At the 9–15 months follow-up visits,clinical examinations revealed all four cases were asymptomatic.Radiographs revealed resolution of periapical lesions and varying degrees of continued root development.This case report suggested that the CGF may be a promising scaffold in IVPT of immature permanent teeth with periapical periodontitis.