Division of Endodontics, University of Minnesota School of Dentistry, Minneapolis, MN 55455, USA.
J Endod. 2010 Mar;36(3):536-41. doi: 10.1016/j.joen.2009.10.006. Epub 2009 Dec 6.
An immature tooth with pulpal necrosis and apical periodontitis presents a unique challenge to the endodontist. Endodontic treatment options consist of apexification, apical barriers, or more recently, revascularization. The purpose of this case series is to report three cases that used revascularization protocol as described by Banchs and Trope. Each case presented its own special circumstances and challenges. The lessons learned from each case provided guidance for more predictable outcomes on subsequent cases.
Six immature teeth with apical periodontitis (in three patients) were treated via the revascularization protocol using irrigants, a triple antibiotic paste, and a coronal seal of mineral trioxide aggregate and composite.
For follow-up, all six teeth showed resolution of periapical radiolucencies, whereas three of six teeth showed continued root development. Two teeth displayed a positive response to vitality testing.
Results from this case series show that revascularization is a technically challenging but effective treatment modality for the immature tooth with apical periodontitis. Based on this case series, the following recommendations are made to help with the revascularization technique: (1) clinicians should consider the use of an anesthetic without a vasoconstrictor when trying to induce bleeding, (2) a collagen matrix is useful for the controlled placement of MTA to a desired and optimal level, (3) patients/parents should be informed about the potential for staining, especially in anterior teeth when the paste contains minocycline, and (4) patient/parent compliance with the necessary multiple appointment treatment plan may be significant for case selection.
患有牙髓坏死和根尖周炎的未成熟牙给牙髓病医生带来了独特的挑战。牙髓病治疗方案包括根尖诱导成形术、根尖屏障术或最近的血运重建术。本病例系列报告了三例采用 Banchs 和 Trope 描述的血运重建方案的病例。每个病例都有其特殊情况和挑战。从每个病例中吸取的经验教训为后续病例提供了更可预测的结果指导。
通过使用冲洗剂、三联抗生素糊剂以及 MTA 和复合树脂的冠方密封剂，对 3 名患者的 6 颗根尖周炎未成熟牙进行了血运重建方案治疗。
随访时，所有 6 颗牙的根尖周透影区均消失，其中 3 颗牙的牙根继续发育。2 颗牙对活力测试有阳性反应。
本病例系列的结果表明，血运重建术是治疗根尖周炎未成熟牙的一种具有挑战性但有效的治疗方法。基于本病例系列，提出以下建议以帮助血运重建技术的应用：（1）当试图诱导出血时，临床医生应考虑使用不含血管收缩剂的麻醉剂；（2）胶原基质可用于将 MTA 控制放置到所需的最佳水平；（3）应告知患者/家长可能出现染色的情况，尤其是当糊剂中含有米诺环素时位于前牙；（4）患者/家长对必要的多次预约治疗计划的依从性可能对病例选择有重要影响。
