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Tropical Dental Journal - 1st Pan African international dental journal


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Published in English in Tropical Dental Journal Volume 47 - June 2024 pages 5-14

Mademoiselle Emna Garouachi Revascularization versus MTA apexification for the treatment of necrotic permanent immature teeth Revascularization versus MTA apexification for the treatment of necrotic permanent immature teeth  est évalué 1 étoiles par les abonnés Tropical Dental Journal Online

Article Open access

Authors : E. Garouachi, A. Kikly, A. Bouslama, N. Zokkar, N. Douki - Tunisia


Résumé

Introduction : Le traitement endodontique des dents permanentes immatures nécrosées peut varier considérablement entre les endodontistes. Traditionnellement, l’apexification a été privilégiée pour ces cas, mais les techniques régénératives deviennent de plus en plus populaires avec des protocoles plus complexes. Cet article vise à évaluer les critères de choix entre l’apexification à l’MTA et la revascularisation, ainsi que comparer les résultats obtenus avec ces deux techniques.
Cas cliniques : Cet article illustre deux cas de dents permanentes immatures traitées l’une par apexification à l’MTA et l’autre par revascularisation utilisant un caillot sanguin et de la fibrine riche en plaquettes (PRF) comme matrice. Des suivis jusqu’à un an ont montré une guérison péri-apicale significative dans le premier cas et un développement radiculaire continu avec fermeture apicale dans le second cas.
Discussion : Le succès des procédures d’apexification à l’MTA et de revascularisation dépend des critères de sélection de cas préopératoires, permettant à l’endodontiste de choisir le traitement le plus approprié. Ces critères incluent l’âge, l’état de santé et la motivation du patient, ainsi que l’épaisseur radiculaire et le diamètre apical. Les facteurs liés au protocole, tels que le type d’instrumentation, de désinfection, et de médicaments intracanalaires peuvent également influencer les résultats. Bien que les techniques régénératrices montrent de meilleurs résultats en termes de développement radiculaire et de fermeture apicale pour les dents permanentes immatures, en comparaison avec l’apexification à l’MTA, aucune différence significative n’a été observée dans les résultats globaux ou les taux de survie.

Abstract
Revascularization versus MTA apexification for the treatment of necrotic permanent immature teeth

Introduction: Endodontic treatments for necrotic immature permanent teeth, can vary significantly among endodontists. Traditionally, apexification has been the treatment of choice for immature teeth with necrotic pulp. However, regenerative endodontic treatments are gaining popularity and are introducing increasingly complex treatment protocols. This article aims to assess decision-making criteria between MTA apexification and revascularization and compare the outcomes of immature permanent teeth treated with these two techniques.
Case review: This report illustrates two cases of necrotic immature permanent teeth; one managed by MTA apexification and the other by revascularization where blood clot and platelet-rich fibrin (PRF) were used as a scaffold. Through consistent follow-up reports up to one-year, significant periapical healing was observed in the first case, while continued root development was noted in the second case.
Discussion: The prognosis of MTA apexification and revascularization procedures depends on preoperative case selection criteria, allowing the endodontist in choosing the most suitable treatment for each case. These criteria encompass the patient’s age, health status, adherence to treatment, root thickness, and apical diameter. Moreover, protocol-related factors are significant and can impact the outcomes of both treatments. These factors include the type of instrumentation, the disinfection protocol followed, the choice of intracanal medicaments, and the method of MTA placement. Regarding the outcomes of permanent immature teeth, studies have demonstrated better results in terms of root development and apical foramen width, with regenerative procedures. However, there was no significant difference observed in overall outcomes or survival rates.

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