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. 2021 Jun;22(3):311-340.
doi: 10.1007/s40368-020-00575-1. Epub 2021 Jan 8.

What is the best long-term treatment modality for immature permanent teeth with pulp necrosis and apical periodontitis?

A Wikström  1   2   3 , M Brundin  4 , M F Lopes  5   6 , M El Sayed  7 , G Tsilingaridis  7   5
Affiliations

What is the best long-term treatment modality for immature permanent teeth with pulp necrosis and apical periodontitis?

A Wikström et al. Eur Arch Paediatr Dent. 2021 Jun.

Abstract

Purpose: To evaluate and assess the current knowledge about apexification and regenerative techniques as a meaningful treatment modality and to map the scientific evidence for the efficacy of both methods for the management of traumatised immature teeth with pulp necrosis and apical periodontitis.

Methods: This systematic review searched five databases: PubMed, Web of Science, Cochrane Library, Ovid (Medline), and Embase. Published articles written in English were considered for inclusion. The following keywords were used: Regenerative endodontic treatment OR regenerat* OR revital* OR endodontic regeneration OR regenerative endodontics OR pulp revascularization OR revasculari* OR 'traumatized immature teeth'. Only peer-reviewed studies with a study size of at least 20 cases followed up for 24 months were included. Eligibility assessment was performed independently in a blinded manner by three reviewers and disagreements were resolved by consensus. Subgroup analyses were performed on three clinical outcomes: survival, success, and continued root development.

Results: Seven full texts out of 1359 citations were included and conventional content analysis was performed. Most of the identified citations were case reports and case series.

Conclusions: In the present systematic review, the qualitative analysis revealed that both regenerative and apexification techniques had equal rates of success and survival and proved to be effective in the treatment of immature necrotic permanent teeth. Endodontic regenerative techniques appear to be superior to apexification techniques in terms of stimulation of root maturation, i.e. root wall thickening and root lengthening. Knowledge gaps were identified regarding the treatment and follow-up protocols for both techniques.

Keywords: Children; Immature teeth; Open apices; Pulp necrosis; Pulp regeneration; Regenerative endodontics.

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Conflict of interest statement

Author AW declares that she has no conflict of interest. Author MB declares that she has no conflict of interest. Author MFL declares that he has no conflict of interest. Author MS declares that he has no conflict of interest. Author GT declares that he has no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA 2009 flow diagram
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References

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