| Objective:Teeth that first erupt into the oral cavity are not fully developed in both their forms and structures and are called immature permanent teeth.Caries,fracture of abnormal central cusp or trauma may all lead to pulp infection or necrosis.With the recent development in the field of tissue engineering,pulp revascularization has emerged as a new solution to this problem.According to relevant studies,teeth treated with pulp revascularization are expected to have their roots grown,dentinal walls thickened and apical foramina closed.Some think trauma may affect apical blood supply as well as the success of a revascularization treatment.By applying the treatment to immature permanent teeth with unclosed apical foramina that were either:(i)not promptly treated after trauma; or(ii)with pulp necrosis or periapical periodontitis after a failed vital pulp conservative treatment,this study tries to delve into its effects in terms of how infected teeth recover from their periapical lesions and whether their roots grow further,thus to investigate the potentiality of pulp revascularization in treating indications.Methods:Four immature permanent maxillary central incisors with pulp necrosis or periapical periodontitis due to crown fracture and pulp exposure after trauma, collected between March to December,2014,were used in this study.Tooth 11 in Case 1 had a history of mesiodistal oblique crown fracture and pulp exposure for over 8 months;Tooth 11 in Case 2 had a history of mesiodistal oblique crown fracture and pulp exposure for over 6 months;Tooth 11 in Case 3 had mesiodistal oblique crown fracture for over 3 months;Tooth 21 in Case 4 had mesiodistal oblique crown fracture for over 3 months.Case 3 and Case 4 are based upon a same patient, with both their pulps necrotic before treatment.;They were in Stage 8 by Nolla dental age assessment.Use drugs as irrigation;use triple antibiotic paste as intracanal medicament;after periapical periodontitis disappeared or improved,give stimuli to periapical tissues in aseptic conditions for the formation of a blood clot and seal the root canal orifice from the crown with MTA.Use glass ionomer cement as temporary restoration,and replace it with composite resin one week later if no discomfort occurs.Take follow-up radiological examination after treatment to evaluate the further development of the roots.Results:After pulp revascularization,no subjective symptom was found in follow-up clinical examinations of all four cases.As demonstrated by radiological tests,most of the shadows indicating periapical lesions in Case 1 disappeared one month later;the apical foramen was beginning to close and the root significantly lengthened after 6 months; and after 18 months, the foramen was completely closed. In Case 2,shadows in the periapicalzone faded mostly in the inflected tooth 11 one month later;after 6 months there was a tendency of growth in its root and root continued to grow and its apical foramen was to close in the 18 t h months after treatment.In Case 3,shadows in the periapicalzone faded mostly in the inflected tooth 11 one month later; after 6 months there was a tendency of growth in its root as well as the closing of the apical foramen;its apical foramen was to close in the 18 t h months after treatment.As for Case 4,the inflected tooth 21 had its apical lesions healed in respectively 1st, 6th and 18 t h month after treatment, though no apparent image of hard tissue sedimentation in dentinal walls and the apical zone was observed.Conclusion:Among the four immature permanent teeth, after pulp revascularization, three were cured and another one improved, making all four accounted as effective cases. It is implied clearly from the results of this study that pulp revascularization is able to heal trauma- induced periapical periodontitis and promote, to a more or less extent, the hard tissue sedimentation in dentinal walls and apical zones and the further growth of the tooth root. |
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