IADR Abstract Archives
The Brittle Balance After a Regenerative Endodontic Procedure
Objectives: This case report describes and evaluates the ten-year follow-up and long-term outcome of a regenerative endodontic procedure (REP).
Methods: An eight-year old girl presented with a history of a subluxated right central upper incisor combined with an uncomplicated enamel-dentin fracture. After two months, clinical signs of pulp necrosis were evident on tooth 11. Cone-Beam CT (CBCT) revealed an apical radiolucency and open apex. A REP with Pro-Root MTA (Dentsply Sirona, Baillaigues, Switzerland) was performed according to the European Society of Endodontology position statement: Revitalization procedures. Two years later, the tooth remained asymptomatic and CBCT evaluation confirmed satisfactory periodontal healing, no ankylosis, apical closure, intracanal deposition of mineralized tissue, lengthening and thickening of the root canal walls.
Five years post-trauma, a second subluxation occurred on the same tooth. During follow-up, a new radiolucency could be noticed. An apexification with Pro-Root MTA (Dentsply Sirona, Baillaigues, Switzerland), with disruption of the formed dentin bridge, was performed.
Four years later, nine years after the first trauma, the patient presented with a pulsating pain in her tooth. Endodontic microsurgery was conducted showing remaining biofilm as well as reparative dentin. After this intervention, the tooth remained asymptomatic.
Results: Tooth discoloration after REP could have been avoided by using a calciumsilicate cement without bismuthoxide. A REP is a biological-based treatment of a necrotic immature permanent teeth resulting in continued root development, increased thickness in the dentinal walls and apical closure. Any intervention after a REP or a second trauma, could disturb an existing brittle balance between healing and some controlled residual infection. Tooth extraction and replacement with a prosthetic device or an implant should be postponed as long as possible.
Conclusions: This case report illustrates the brittle balance after a REP of a traumatized tooth and emphasizes the need for long-term follow-up after dental trauma.
Methods: An eight-year old girl presented with a history of a subluxated right central upper incisor combined with an uncomplicated enamel-dentin fracture. After two months, clinical signs of pulp necrosis were evident on tooth 11. Cone-Beam CT (CBCT) revealed an apical radiolucency and open apex. A REP with Pro-Root MTA (Dentsply Sirona, Baillaigues, Switzerland) was performed according to the European Society of Endodontology position statement: Revitalization procedures. Two years later, the tooth remained asymptomatic and CBCT evaluation confirmed satisfactory periodontal healing, no ankylosis, apical closure, intracanal deposition of mineralized tissue, lengthening and thickening of the root canal walls.
Five years post-trauma, a second subluxation occurred on the same tooth. During follow-up, a new radiolucency could be noticed. An apexification with Pro-Root MTA (Dentsply Sirona, Baillaigues, Switzerland), with disruption of the formed dentin bridge, was performed.
Four years later, nine years after the first trauma, the patient presented with a pulsating pain in her tooth. Endodontic microsurgery was conducted showing remaining biofilm as well as reparative dentin. After this intervention, the tooth remained asymptomatic.
Results: Tooth discoloration after REP could have been avoided by using a calciumsilicate cement without bismuthoxide. A REP is a biological-based treatment of a necrotic immature permanent teeth resulting in continued root development, increased thickness in the dentinal walls and apical closure. Any intervention after a REP or a second trauma, could disturb an existing brittle balance between healing and some controlled residual infection. Tooth extraction and replacement with a prosthetic device or an implant should be postponed as long as possible.
Conclusions: This case report illustrates the brittle balance after a REP of a traumatized tooth and emphasizes the need for long-term follow-up after dental trauma.