Article Data

  • Views 4873
  • Dowloads 515

Case Reports

Open Access

Separate apical root formation of injured immature teeth: a case series and literature review

  • Minjung Kim1
  • Yujeong Kim1
  • Minju Song1,2,*,

1Department of Conservative Dentistry, College of Dentistry, Dankook University, 31116 Cheonan, Republic of Korea

2Department of Conservative Dentistry, National Health Insurance Service Ilsan Hospital, 10444 Goyang, Republic of Korea

DOI: 10.22514/jocpd.2023.095 Vol.48,Issue 6,November 2024 pp.225-235

Submitted: 15 May 2023 Accepted: 06 July 2023

Published: 03 November 2024

*Corresponding Author(s): Minju Song E-mail: Minju81s@gmail.com

Abstract

This report presents three cases of separated root tip formation following traumatic injury with or without inflammation. The first case showed continued separate apical root formation; however, development of the main root with bony ingrowth was absent. The second case showed that separated root formation continued under the 2-year inflammatory conditions, even after apexification. The third patient showed partially connected root tip formation after apexification. By summarizing previously reported similar cases, we assessed the injury type, prevalence age, treatment performed and pattern of root development. This phenomenon may be elucidated by the special features of the apical papilla (AP). Understanding the capability of AP could help with treatments, such as regenerative endodontic procedures and trauma management for immature permanent teeth.


Keywords

Apical papilla; Hertwig’s epithelial root sheath (HERS); Separated root tip; Trauma; Inflammation


Cite and Share

Minjung Kim,Yujeong Kim,Minju Song. Separate apical root formation of injured immature teeth: a case series and literature review. Journal of Clinical Pediatric Dentistry. 2024. 48(6);225-235.

References

[1] Flores MT, Andersson L, Andreasen JO, Bakland LK, Malmgren B, Barnett F, et al. Guidelines for the management of traumatic dental injuries. II. Avulsion of permanent teeth. Dental Traumatology. 2007; 23: 130–136.

[2] Sonoyama W, Liu Y, Yamaza T, Tuan RS, Wang S, Shi S, et al. Characterization of the apical papilla and its residing stem cells from human immature permanent teeth: a pilot study. Journal of Endodontics. 2008; 34: 166–171.

[3] Kim TH, Bae CH, Lee JC, Ko SO, Yang X, Jiang R, et al. β-catenin is required in odontoblasts for tooth root formation. Journal of Dental Research. 2013; 92: 215–221.

[4] Cate ART. The role of epithelium in the development, structure and function of the tissues of tooth support. Oral Diseases. 1996; 2: 55–62.

[5] Li J, Parada C, Chai Y. Cellular and molecular mechanisms of tooth root development. Development. 2017; 144: 374–384.

[6] Im Y, Kim Y, Kim H, Nam S. Invasion of alveolar bone into root canal after traumatic injury. Journal of the Korean Academy of Pediatric Dentistry. 2011; 38: 399–406.

[7] Driesen RB, Gervois P, Vangansewinkel T, Lambrichts I. Unraveling the role of the apical papilla during dental root maturation. Frontiers in Cell and Developmental Biology. 2021; 9: 665600.

[8] Welbury R, Walton AG. Continued apexogenesis of immature permanent incisors following trauma. British Dental Journal. 1999; 187: 643–644.

[9] Kumar N, Kumari R, Gauba K. An aberrant root development in severely extruded immature young permanent tooth: a case report. Journal of South Asian Association of Pediatric Dentistry. 2020; 3: 84–87.

[10] Jung IY, Kim ES, Lee CY, Lee SJ. Continued development of the root separated from the main root. Journal of Endodontics. 2011; 37: 711–714.

[11] Korolenkova MV, Rakhmanova MS. Phantom root as dental trauma complication in immature teeth (systematic literature and clinical cases review). Stomatologiya. 2021; 100: 53–57. (In Russian)

[12] Andreasen JQ, Ravn JJ. Epidemiology of traumatic dental injuries to primary and permanent teeth in a Danish population sample. International Journal of Oral Surgery. 1972; 1: 235–239.

[13] Lee JE, Kim YJ, Kim HJ, Nam SH. Continued root development after avulsion of immature teeth. Journal of the Korean Academy of Pediatric Dentistry. 2013; 40: 127–132.

[14] Gibson AC. Continued root development after traumatic avulsion of partly-formed permanent incisor. British Dental Journal. 1969; 126: 356–357.

[15] Barker BC, Mayne JR. Some unusual cases of apexification subsequent to trauma. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology. 1975; 39: 144–150.

[16] Arrow P. An unusual healing of a replanted permanent lateral incisor. Australian Dental Journal. 2009; 54: 57–60.

[17] Andreasen JO, Kristerson L, Andreasen FM. Damage of the Hertwig’s epithelial root sheath: effect upon root growth after autotransplantation of teeth in monkeys. Dental Traumatology. 1988; 4: 145–151.

[18] Jiang X, Liu H. An uncommon type of segmental root development after revitalization. International Endodontic Journal. 2020; 53: 1728–1741.

[19] Palma PJ, Martins J, Diogo P, Sequeira D, Ramos JC, Diogenes A, et al. Does apical papilla survive and develop in apical periodontitis presence after regenerative endodontic procedures? Research Journal of Applied Sciences. 2019; 9: 3942.

[20] Wu ZF, Lu LJ, Zheng HY, Tu Y, Shi Y, Zhou ZH, et al. Separated root tip formation associated with a fractured tubercle of dens evaginatus: a case report. World Journal of Clinical Cases. 2021; 9: 2944–2950.

[21] Yang SF, Yang ZP, Chang KW. Continuing root formation following apexification treatment. Dental Traumatology. 1990; 6: 232–235.

[22] Huang GT, Sonoyama W, Liu Y, Liu H, Wang S, Shi S. The hidden treasure in apical papilla: the potential role in pulp/dentin regeneration and bioroot engineering. Journal of Endodontics. 2008; 34: 645–651.

[23] Levitan ME, Himel VT. Dens evaginatus: literature review, pathophysiology, and comprehensive treatment regimen. Journal of Endodontics. 2006; 32: 1–9.

[24] Palma PJ, Ramos JC, Martins JB, Diogenes A, Figueiredo MH, Ferreira P, et al. Histologic evaluation of regenerative endodontic procedures with the use of chitosan scaffolds in immature dog teeth with apical periodontitis. Journal of Endodontics. 2017; 43: 1279–1287.

[25] Tamanna S, Rehman A, Tewari RK, Mishra SK. A segmental root development as an unusual healing response to the revitalization of mandibular second premolar. Journal of Indian Society of Pedodontics and Preventive Dentistry. 2022; 40: 94.

[26] Nair PN. Apical periodontitis: a dynamic encounter between root canal infection and host response. Periodontology 2000. 1997; 13: 121–148.

[27] Smith BE, Thaler MN. Detached root apexogenesis. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology. 1992; 73: 129.

[28] Goel BR, Goel S. Detached root formation following trauma—a case report. Endodontology. 1993; 5: 7–8.

[29] Abirami R, Revathy V, Abharna R. Aberrant root formation—an unreported complication of dental trauma. Journal of Indian Society of Pedodontics and Preventive Dentistry. 2018; 36: 216–219.


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.

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 1.8 (2023) 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