José Francisco Gaviño Orduña1, Javier Caviedes-Bucheli2, María C Manzanares Céspedes3, Esther Berástegui Jimeno4, Benjamín Martín Biedma5, Juan José Segura-Egea6, José López-López7. 1. Department of Odonto-Stomatology, School of Dentistry, Barcelona, Spain. Electronic address: dr.gavino@gmail.com. 2. Centro de Investigaciones Odontologicas (CIO) Pontificia Universidad Javeriana, Bogota, Colombia. 3. Faculty of Dentistry, University of Barcelona, Barcelona, Spain. 4. Department of Odonto-Stomatology, School of Dentistry, Barcelona, Spain. 5. Unit of Dental Pathology and Therapeutics II School of Medicine and Dentistry University of Santiago de Compostela, Santiago de Compostela, Spain. 6. Department of Stomatology, School of Dentistry, University of Seville, Seville, Spain. 7. School of Dentistry, Barcelona University/Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute), IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
Abstract
INTRODUCTION: Regenerative endodontic procedures (REP) are a promising alternative for necrotic immature teeth in adolescents and children, but very little evidence is available on this alternative in long-lasting necrotic teeth with open apices in adults. REPs are designed to replace damaged structures of the pulp-dentin complex, but no regeneration has been obtained in any of the cases described in necrotic immature permanent teeth with apical periodontitis with histologic results. The results are limited to periapical tissue repair with increasing root length, thickening of the root walls, and apical closure in young patients. In this series of cases, we report on the outcomes of the adjuvant use of autologous platelet-rich plasma (PRP) in endodontic therapy in adults by monitoring periapical tissue healing with periodic periapical radiographs and cone-beam computed tomographic scanning. METHODS: Three teeth with apical periodontitis and open apices in 3 different patients from 21 to 35 years-old were evaluated. An REP was performed with the adjuvant use of PRP. RESULTS: At controls, complete disappearance of the radiolucent lesions and the presence of calcified structures forming bridges occupying the pulp lumen were observed but not an ostensible thickening of root walls with a regeneration of pulp-dentin complex. CONCLUSIONS: The repair of periapical tissues with REPs of open apex teeth with apical periodontitis and in nonsurgical endodontic retreatment appears to be feasible in adults, but no regeneration was obtained in any of the present cases. The use of PRP may be a good choice as an autologous matrix because of its stability and induction; it contains growth factors and bioactive molecules like transforming growth factor beta, bone morphogenic proteins, insulinlike growth factors, and angiogenetic growth factors, which stimulate collagen production, angiogenesis, and cell differentiation. Anti-inflammatory and antibacterial properties have also been reported for this preparation, which are involved in all processes of repair.
INTRODUCTION: Regenerative endodontic procedures (REP) are a promising alternative for necrotic immature teeth in adolescents and children, but very little evidence is available on this alternative in long-lasting necrotic teeth with open apices in adults. REPs are designed to replace damaged structures of the pulp-dentin complex, but no regeneration has been obtained in any of the cases described in necrotic immature permanent teeth with apical periodontitis with histologic results. The results are limited to periapical tissue repair with increasing root length, thickening of the root walls, and apical closure in young patients. In this series of cases, we report on the outcomes of the adjuvant use of autologous platelet-rich plasma (PRP) in endodontic therapy in adults by monitoring periapical tissue healing with periodic periapical radiographs and cone-beam computed tomographic scanning. METHODS: Three teeth with apical periodontitis and open apices in 3 different patients from 21 to 35 years-old were evaluated. An REP was performed with the adjuvant use of PRP. RESULTS: At controls, complete disappearance of the radiolucent lesions and the presence of calcified structures forming bridges occupying the pulp lumen were observed but not an ostensible thickening of root walls with a regeneration of pulp-dentin complex. CONCLUSIONS: The repair of periapical tissues with REPs of open apex teeth with apical periodontitis and in nonsurgical endodontic retreatment appears to be feasible in adults, but no regeneration was obtained in any of the present cases. The use of PRP may be a good choice as an autologous matrix because of its stability and induction; it contains growth factors and bioactive molecules like transforming growth factor beta, bone morphogenic proteins, insulinlike growth factors, and angiogenetic growth factors, which stimulate collagen production, angiogenesis, and cell differentiation. Anti-inflammatory and antibacterial properties have also been reported for this preparation, which are involved in all processes of repair.