Injuries to Permanent Dentition Symposium
Considerations for Regeneration Procedures

https://doi.org/10.1016/j.joen.2012.11.019Get rights and content

Abstract

When pulp tissue becomes necrotic in immature teeth, the prognosis of the teeth is compromised. Disinfection of the root(s) presents several challenges including difficulties in cleaning and shaping large canals with open apices, obturation of canals with open apices, and potential root fractures caused by thin and/or weakened root walls. Regenerative endodontic procedures may increase the prognosis of the compromised immature tooth by re-establishment of a functional pulp tissue that fosters continued root development and immune competency. This article reviews the literature related to and discuss considerations for regenerative endodontic procedures and how these procedures may increase the prognosis for immature teeth with necrotic pulp tissue.

Section snippets

Case Selection

The AAE considerations case selection suggests that regenerative procedures be used for teeth with necrotic pulp and an immature apex in which pulp space is not needed for post/core and the patient is compliant. The etiology for pulp necrosis does not appear to be a factor in case selection because case studies have included teeth with pulps that became necrotic secondary to trauma (17), dental anomalies (8), and decay (33). The recommendation for selecting teeth that do not need post space

Conclusions

Regenerative endodontic procedures hold the promise of restoring the pulp/dentin complex in teeth with immature roots and necrotic pulps. REPs have the potential advantages versus traditional treatment procedures of increasing root wall thickness and root length while maintaining immunecompetency and nociception. This article has discussed several considerations for REPs. The rapidly evolving field of regenerative endodontics will undoubtedly reshape the way practitioners approach REPs.

Acknowledgments

The author would like to thank Jean Lind for her generous support and help in editing this article.

The author denies any conflicts of interest related to this study.

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    This article is being published concurrently in Pediatric Dentistry 2013;35(2). The articles are identical. Either citation can be used when citing this article.

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    Copyright © 2013 American Academy of Pediatric Dentistry and American Association of Endodontists. Published by Elsevier Inc. All rights reserved.