Iranian Center for Endodontic Research, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J Endod. 2012 Oct;38(10):1428-34. doi: 10.1016/j.joen.2012.06.025. Epub 2012 Jul 28.
Endodontic treatment of immature necrotic teeth is challenging. Recently a biologically based treatment called regenerative endodontic treatment was introduced. Although regenerative endodontic treatment causes root development, there are several drawbacks and unfavorable outcomes that should be addressed. This article describes regenerative endodontic treatment of 2 maxillary central incisors with poor root development outcomes.
A healthy 14-year-old female patient was referred. The patient had history of an impact trauma 6 years before the first visit. Clinical and radiographic examinations revealed that maxillary central incisors were immature and necrotic with symptomatic apical periodontitis. After local anesthesia, rubber dam isolation, and access cavity preparation each tooth was irrigated with 20 mL of NaOCl 5.25% and received triple antibiotic dressing (ciprofloxacin, metronidazole, minocycline) for 4 weeks. In the next visit, after eliminating antibiotic dressing, bleeding was induced inside the canals, and then the coronal thirds of the canals were sealed with mineral trioxide aggregate. A week later, both teeth were permanently restored.
In clinical and radiographic follow-ups, both teeth were functional, periapical lesions were healed, and the apices formed. However, the roots were not developed. After 6 years, because of moderate discoloration and caries, both teeth received root canal therapy and were permanently restored with casting dowel core and full crown restorations.
Criteria for case selection in regenerative endodontic treatments should be determined.
未成熟恒牙的牙髓治疗具有挑战性。最近，一种名为再生性牙髓治疗的基于生物学的治疗方法被引入。尽管再生性牙髓治疗可引起牙根发育，但存在一些需要解决的缺点和不良后果。本文描述了 2 例上颌中切牙因牙根发育不良而行再生性牙髓治疗的病例。
一位 14 岁的健康女性患者前来就诊。患者在首次就诊前 6 年前有过一次撞击性外伤史。临床和影像学检查显示，上颌中切牙未成熟且坏死，伴有症状性根尖周炎。局部麻醉、橡皮障隔离和制备开髓腔后，每颗牙用 20 毫升 5.25%次氯酸钠冲洗，并接受三联抗生素敷料（环丙沙星、甲硝唑、米诺环素）治疗 4 周。在下次就诊时，在消除抗生素敷料后，在根管内诱导出血，然后用三氧化矿物聚合体封闭根管的冠三分之一。一周后，对两颗牙齿进行永久性修复。
在临床和影像学随访中，两颗牙齿均功能正常，根尖病变愈合，根尖形成。然而，牙根没有发育。6 年后，由于中度变色和龋坏，两颗牙齿均接受根管治疗，并通过铸造桩核和全冠修复进行永久性修复。
应确定再生性牙髓治疗的病例选择标准。
