Gami KS et al. Revascularization procedures for the management of immature, non-vital, infected permanent teeth.

Journal of Advanced Medical and Dental Sciences Research

@Society of Scientific Research and Studies NLM ID: 101716117

Journal home page: www.jamdsr.com doi: 10.21276/jamdsr Index Copernicus value = 85.10

(e) ISSN Online: 2321-9599; (p) ISSN Print: 2348-6805

Original Research
Efficacy of revascularization procedures for the management of immature,
non-vital, infected permanent teeth

Kumar Shresth Gami1, Siddharth Shahi2, Shresth Kumar Bhagat3, Mrigank Shekhar Jha4, Abhishek Siddhartha5,
Karn Singh6

1
Senior lecturer, Department of Conservative Dentistry and Endodontics, Sarjug dental college and hospital,
Darbhanga, Bihar;
2
Reader, Department of Conservative Dentistry and Endodontics, Sarjug dental college and hospital, Darbhanga,
Bihar;
3
Reader, Department of Conservative Dentistry and Endodontics, Sarjug dental college and hospital, Darbhanga,
Bihar;
4
Senior lecturer, Department of Orthodontics, Sarjug dental college and hospital, Darbhanga, Bihar;
5
Reader, Department of Conservative Dentistry and Endodontics, DR. B.R. Ambedkar Dental College, Patna,
Bihar;
6
Senior Resident, Department of Dentistry Darbhanga Medical College and Hospital, Darbhanga, Bihar

ABSTRACT:
Background: The present study was conducted evaluate the efficacy of revascularization procedures for the management of
traumatized immature, nonvital, infected permanent teeth. Materials & Methods: The present study was conducted on 40
immature, nonvital maxillary anterior teeth presenting with or without signs and/or symptoms of periapical pathology. In all
teeth, endodontic treatment was initiated, and after infection control, revascularization was performed. The access cavity was
sealed with glass ionomer cement. The cases were followed up at regular intervals of 3 months. Results: Out of 40 patients,
males were 22 and females were 18. Narrowing of the wide apical opening was evident in 38 (94.7%). Thickening of apical
dentinal walls was seen in 6 (15%) and lateral dentinal walls was evident in 45% (12) of cases. Increased root length was
observed in 70% (28) of cases. Healing of periapical lesions was seen in 34 (85%). None of the cases presented with pain.
Conclusion: Authors found that revascularization procedures in immature nonvital, infected permanent teeth found to be
effective.
Key words: revascularization, Non vital, periapical pathology.

Received: September 22, 2020 Accepted: October 20, 2020

Corresponding author: Dr. Kumar Shresth Gami, Senior lecturer, Department of Conservative Dentistry and Endodontics,
Sarjug dental college and hospital, Darbhanga, Bihar, India

This article may be cited as: Gami KS, Shahi S, Bhagat SK, Jha MS, Siddhartha A, Singh K. Efficacy of revascularization
procedures for the management of immature, non-vital, infected permanent teeth. J Adv Med Dent Scie Res 2020;8(11):156-
158.

INTRODUCTION injury causes cessation of tooth development. Because

Trauma to the anterior teeth, commonly found among the root development takes place for almost 2 years
young children, accounts for one third of all traumatic after the tooth has erupted into the oral cavity, an
injuries in boys and one fourth of all injuries in girls. 1 incompletely formed apex is one of the most common
Tooth fracture constitutes 4%–5% and luxation features seen in traumatized teeth.3 Management of
injuries 30%–44% of all dental trauma injuries. immature non vital teeth poses a great challenge to the
Because of their position, the anterior teeth tend to clinician. Most of the clinicians rely on traditional
bear the brunt of many impact injuries. The injuries calcium hydroxide apexification.4 Calcium hydroxide
vary from avulsion to intrusion, lateral displacement, induced apexification has its own limitations such as
fracture, or just a concussion.2 In many cases, the long term therapy for barrier formation; and,

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strengthening or reinforcing of the thin fragile MATERIALS & METHODS

blunderbuss canals is not achieved. Instead, its long The present study was conducted in the department of
term therapy has shown to make the tooth brittle due Endodontics from November 2019 to October 2020. It
to its hygroscopic and proteolytic properties. Even comprised of 40 immature, non-vital maxillary
after apexification procedure, the clinician has to go anterior teeth presenting with or without signs and/or
for conventional root canal obturation as the barrier symptoms of periapical pathology. The study was
formed is often porous and not continuous. 5 approved from institutional ethical committee. All
Obturation of wide canal systems requires precise patients were informed regarding the study and their
fabrication of a customized gutta-percha cone, and consent was obtained.
there is danger of splitting of the root during lateral Demographic profile such as name, age, gender etc.
condensation. Many blunderbuss canals with flaring was recorded. In all teeth, endodontic treatment was
walls cannot be obturated and sealed by orthograde initiated, and after infection control, revascularization
methods and might require apical surgery and was performed. The access cavity was sealed with
retrograde sealing of the canal. Endodontic glass ionomer cement. The cases were followed up at
management of such teeth includes surgery and regular intervals of 3 months. An intraoral radiograph
retrograde sealing, calcium hydroxide–induced apical was taken for a baseline record to be compared with
closure (apexification), and, more recently, placement follow- up radiographs to be taken at intervals of
of an apical plug of mineral trioxide aggregate (MTA) every 6 months. Results thus obtained were subjected
and gutta-percha obturation.6 The present study was to statistical analysis. P value less than 0.05 was
conducted evaluate the efficacy of revascularization considered significant.
procedures for the management of traumatized
immature, nonvital, infected permanent teeth.

RESULTS
Table I Distribution of patients
Total- 40
Gender Males Females
Number 22 18
Table I shows that out of 40 patients, males were 22 and females were 18.
Table II Assessment of parameters
Parameters Number Percentage
Narrowing of apical opening 38 94.7%
Thickening of apical dentinal walls 6 15%
Thickening of lateral dentinal walls 18 45%
Increased root length 28 70%
Healing of periapical lesions 34 85%
Pain 0 0
Table II, graph I shows that narrowing of the wide apical opening was evident in 38 (94.7%). Thickening of
apical dentinal walls was seen in 6 (15%) and lateral dentinal walls was evident in 45% (12) of cases. Increased
root length was observed in 70% (28) of cases. Healing of periapical lesions was seen in 34 (85%). None of the
cases presented with pain.

Graph I Assessment of parameters

Chart Title
50

40 94.70%
85%
30 70%
20 38 45% 34
28
10 18
15%
6
0 0
Narrowing of apical Thickening of apical Thickening of lateral Increased root Healing of periapical Pain
opening dentinal walls dentinal walls length lesions

Number Percentage

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DISCUSSION histologically examined. Histopathological sections

The concept of pulp regeneration was first noted in revealed new tissue formation consisting of pulp,
traumatic avulsed and replanted immature interglogular dentin, and cementum and periodontal
teeth. Rule documented root development and apical ligament (PDL) fibers. This led to the belief that
barrier formation in cases of pulpal necrosis.7 The regeneration of dental tissues was possible. Since then
authors emphasized on the importance of sterile blood various clinical studies had demonstrated the efficacy
clot and granulomatous tissue within the pulpal of Ca (OH) 2 in apexification. However, all the case
cavity. Various possible explanations have been given reports and studies have documented only apical
to explain why apexogenesis/maturogenesis can occur closure. There was no root elongation or maturation
in these infected immature permanent teeth.8 These and all cases required subsequent root canal
include the presence of mesenchymal stem cells obturation. Ca (OH) 2 therapy was also shown to pose
residing in the apical papilla, also known as stem cells a threat of root fracture in 77% of immature teeth.
of apical papilla (SCAP), which are the multi-potent
dental pulp stem cells, and resistant to CONCLUSION
necrosis/infection. The exact etiology, pathogenesis Authors found that revascularization procedures in
or histo-pathological events that occur in this immature nonvital, infected permanent teeth found to
regenerative process are still not known. 9 The present be effective.
study was conducted evaluate the efficacy of
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