Article Data

  • Views 1948
  • Dowloads 717

Systematic reviews

Open Access

Pulp Revascularization or Apexification for the Treatment of Immature Necrotic Permanent Teeth: Systematic Review and Meta-Analysis

  • Gabriel Ferreira Nicoloso1,5
  • Gabriela Maltz Goldenfum2
  • Tatiane da Silva Dal Pizzol3
  • Roberta Kochenborger Scarparo4
  • Francisco Montagner4
  • Jonas de Almeida Rodrigues2
  • Luciano Casagrande2,*,

1Federal University of Rio Grande do Sul (UFRGS), Porto Alegre–RS, Brazil

2School of Dentistry, Post-Graduate Program in Pediatric Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre–RS, Brazil

3Faculty of Medicine, Post-Graduate Program in Epidemiology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre–RS, Brazil

4Faculty of Dentistry, Post-Graduate Program in Endodontics, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre–RS, Brazil

5School of Dentistry, Inedi College - CESUCA, Cachoeirinha, RS, Brazil

DOI: 10.17796/1053-4625-43.5.1 Vol.43,Issue 5,September 2019 pp.305-313

Published: 01 September 2019

*Corresponding Author(s): Luciano Casagrande E-mail: luciano.casagrande@ufrgs.br luciano.casagrande@gmail.com

Abstract

This systematic review and meta-analysis assessed clinical, radiographic and functional retention outcomes in immature necrotic permanent teeth treated either with pulp revascularization or apexification after a minimum of three months to determine which one provides the best results. The literature was screened via PubMed/MEDLINE and Embase databases up to June 2017 to select observational studies that compared pulp revascularization and apexification treatments assessing clinical, radiographic and functional retention outcomes. Two reviewers independently performed screening and evaluation of articles. A total of 231 articles were retrieved from databases, wherein only four articles were selected for full-text analyses. After exclusion criteria, three studies remained in quantitative and qualitative analyses. Pooled-effect estimates were obtained comparing clinical and radiographic outcomes (‘overall outcome’) and functional retention rates between apexification and pulp revascularization treatment. The meta-analysis comparing apexification vs. revascularization for ‘overall outcome’ (Z=0.113, p=0.910, RR=1.009, 95%CI:0.869-1.171) and functional retention rates (Z=1.438, p=0.150, RR=1.069, 95%CI:0.976-1.172) showed no statistically significant differences between the treatments. All studies were classified as high quality. The current literature regarding the clinical, radiographic and functional retention outcomes in immature necrotic permanent teeth treated either with pulp revascularization or apexification is limited. Based on our meta-analysis, the results do not favor one treatment modality over the other.

Keywords

Pulp revascularization; Apexification; Immature necrotic permanent teeth

Cite and Share

Gabriel Ferreira Nicoloso,Gabriela Maltz Goldenfum,Tatiane da Silva Dal Pizzol,Roberta Kochenborger Scarparo,Francisco Montagner,Jonas de Almeida Rodrigues,Luciano Casagrande. Pulp Revascularization or Apexification for the Treatment of Immature Necrotic Permanent Teeth: Systematic Review and Meta-Analysis. Journal of Clinical Pediatric Dentistry. 2019. 43(5);305-313.

References

1. Jeeruphan T, Jantarat J, Yanpiset K, Suwannapan L, Khewsawai P, Hargreaves KM. Mahidol study 1: comparison of radiographic and survival outcomes of immature teeth treated with either regenerative endodontic or apexification methods: a retrospective study. J Endod; 38 (10): 1330-1336. 2012.

2. Silujjai J, Linsuwanont P. Treatment outcomes of apexification or revascularization in nonvital immature permanent teeth: a retrospective study. J Endod; 43 (2): 238-245. 2017.

3. Simon S, Rilliard F, Berdal A, Machtou P. The use of mineral trioxide aggregate in one-visit apexification treatment: a prospective study. Int Endod J; 40 (3): 186-197. 2007.

4. Nagy MM, Tawfik HE, Hashem AA, Abu-Seida AM. Regenerative potential of immature permanent teeth with necrotic pulps after different regenerative protocols. J Endod; 40 (2): 192-198. 2014.

5. Cvek M. Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with gutta-percha. A retrospective clinical study. Endod Dent Traumatol; 8 (2): 45-55. 1992.

6. Alobaid AS, Cortes LM, Lo J et al. Radiographic and clinical outcomes of the treatment of immature permanent teeth by revascularization or apexification: a pilot retrospective cohort study. J Endod; 40 (8): 1063-1070. 2014.

7. Bonte E, Beslot A, Boukpessi T, Lasfargues JJ. MTA versus Ca(OH)2 in apexification of non-vital immature permanent teeth: a randomized clinical trial comparison. Clin Oral Investig; 19 (6): 1381-1388. 2015.

8. Galler KM, Krastl G, Simon S et al. European Society of Endodontology position statement: Revitalization procedures. Int Endod J; 49 (8): 717-723. 2016.

9. American Association of Endodontics. AAE Guide to Clinical Endodontics. Available at: http://www.aae.org/clinical-resources/aae-guide-to-clinical-endodontics.aspx. Accessed: 2017-06-27.

10. Conde MC, Chisini LA, Sarkis-Onofre R, Schuch HS, Nör JE, Demarco FF. A scoping review or root canal revascularization: relevant aspects for clinical success and tissue formation. Int Endod J; 50 (9): 860-874. 2017.

11. Nicoloso GF, Pötter IG, Rocha RO, Montagner F, Casagrande L. A comparative evaluation of endodontic treatments for immature necrotic permanent teeth based on clinical and radiographic outcomes: a systematic review and meta-analysis. Int J Paediatr Dent; 27 (3): 217-227. 2017.

12. Van de Sande FH, Collares K, Correa MB, Cenci MS, Demarco FF, Opdam N. Restoration survival: revisiting patients’ risk factors through a systematic literature review. Oper Dent; 41 (S7): S7–S26. 2016.

13. Stroup DF, Berlin JA, Morton SC et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA; 283 (15): 2008- 2012. 2000.

14. Wells GA, Shea B, O’Connell D et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed: 2017-06-27.

15. Chen SJ, Chen LP. Radiographic outcome of necrotic immature teeth treated with two endodontic techniques: a retrospective analysis. Biomed J; 39 (5): 366-371. 2016.

16. Damle SG, Bhattal H, Loomba A. Apexification of anterior teeth: a comparative evaluation of mineral trioxide aggregate and calcium hydroxide paste. J Clin Pediatr Dent; 36 (3): 263-268. 2012.

17. El-Meligy OA, Avery DR. Comparison of apexification with mineral trioxide aggregate and calcium hydroxide. Pediatr Dent; 28 (3): 248-253. 2006.

18. Pradhan DP, Chawla HS, Gauba K, Goyal A. Comparative evaluation of endodontic management of teeth with unformed apices with mineral trioxide aggregate and calcium hydroxide. J Dent Child (Chic); 73 (2): 79-85. 2006.

19. Narang I, Mittal N, Mishra N. A comparative evaluation of the blood clot, platelet-rich plasma, and platelet-rich fibrin in regeneration of necrotic immature permanent teeth: a clinical study. Contemp Clin Dent; 6 (1): 63-68. 2015.

20. Bezgin T, Yilmaz A D, Celik BN, Kolsuz ME, Sonmez H. Efficacy of platelet-rich plasma as a scaffold in regenerative endodontic treatment. J Endod; 41 (1): 36-44. 2015.

21. Jadhav G, Shah N, Logani A. Revascularization with and without platelet-rich plasma in nonvital, immature anterior teeth: a pilot clinical study. J Endod; 38 (12): 1581-1587. 2012.

22. Diogenes AR, Ruparel NB, Teixeira FB, Hargreaves KM. Translational science in disinfection for regenerative endodontics. J Endod; 40 (4 Suppl): S52–S57. 2014.

23. Martin G, Ricucci D, Gibbs JL, Lin LM. Histological findings of revascularized/revitalized immature permanent molar with apical periodontitis using platelet-rich plasma. J Endod; 39 (1): 138-144. 2013.

24. Becerra P, Ricucci D, Loghin S, Gibbs JL, Lin LM. Histologic study of a human immature permanent premolar with chronic apical abscess after revascularization/revitalization. J Endod; 40 (1): 133-139. 2014.

25. Kim JH, Kim Y, Shin SJ, Park JW, Jung IY. Tooth discoloration of immature permanent incisor associated with triple antibiotic therapy: a case report. J Endod; 36 (6): 1086-1091. 2010.

26. Gelman R, Park H. Pulp revascularization in an immature necrotic tooth: a case report. Pediatr Dent; 34 (7): 496-499. 2012.

27. Geisler TM. Clinical considerations for regenerative endodontic procedures. Dent Clin North Am; 56 (3): 603-626. 2012.

28. Marciano MA, Costa RM, Camilleri J, Mondelli RF, Guimarães BM, Duarte MA. Assessment of color stability of white mineral trioxide aggregate angelus and bismuth oxide in contact with tooth structure. J Endod; 40 (8): 1235-1240. 2014.

29. Nosrat A, Seifi A, Asgary S. Regenerative endodontic treatment (revascularization) for necrotic immature permanent molars: a review and report of two cases with a new biomaterial. J Endod; 37 (4): 562-567. 2011.

30. Andreasen JO, Farik B, Munskgaard EC. Long-term calcium hydroxide as root canal dressing may increase risk of root fracture. Dent Traumatol; 18 (3): 134-137. 2002.

31. Batur YB, Erdemir U, Sancakli HS. The long-term calcium hydroxide application on dentin fracture strength of endodontically treated teeth. Dent Traumatol; 29 (6): 461-464. 2013.

32. Moher D, Pham B, Klassen TP et al. What contributions do languages other than English make on the results of meta-analyses? J Clin Epidemiol; 53 (9): 964-972. 2000.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

PubMed (MEDLINE) PubMed comprises more than 35 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full text content from PubMed Central and publisher web sites.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Scopus: CiteScore 2.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Submission Turnaround Time

Conferences

Top