Endodontics, Warwick Dentistry/Athens Dental School, Kalithea, Atiki, Greece.
J Endod. 2018 Mar;44(3):432-437. doi: 10.1016/j.joen.2017.11.008. Epub 2018 Jan 4.
Although regenerative treatment approaches in teeth with incomplete root formation and pulp necrosis have become part of the suggested therapeutic endodontic spectrum, little is known about the effect of orthodontic movement in the tissue that has been regenerated. Furthermore, as the number of adults undergoing orthodontic treatment increases, there is an increasing need to investigate the changes that these tissues may undergo during orthodontic movement. Here we describe the alterations observed after the application of orthodontic forces in a case of an apically root-fractured necrotic immature root that had been managed with regenerative endodontic procedures in the past.
A 9-year-old male patient was referred after suffering the third incidence of trauma in the anterior maxilla. Radiographic evaluation revealed a periapical rarefaction associated with an apically root-fractured immature central incisor. Clinical evaluation revealed a buccal abscess and grade 3 tooth mobility. Periodontal probing was within normal limits. The tooth was accessed and disinfected by using apical negative pressure irrigation of 6% NaOCl. Intracanal dentin conditioning was achieved by using 17% EDTA for 5 minutes. A blood clot was induced from the periapical area, and calcium silicate-based cement was placed in direct contact with the blood clot at the same visit. The composite resin restoration was accomplished in the same appointment.
Recall radiographic examination after 24 months revealed healing of the periapical lesion and signs of continuous root development despite the apical root fracture. Clinical evaluation revealed normal tooth development, normal mobility, and a resolving buccal infection. The tooth was subjected to orthodontic treatment because of Class II division 1 malocclusion with an overjet of 11 mm. After completion of the orthodontic treatment, 5.5 years after the initial intervention, the radiographic image revealed marked remodeling of the periapical tissues and repair of the apical fractures, and the buccal infection had resolved completely.
尽管在不完全形成根和牙髓坏死的牙齿中进行再生治疗方法已成为建议的治疗性牙髓治疗范围的一部分，但对于再生组织中的正畸运动的影响知之甚少。此外，随着接受正畸治疗的成年人数量的增加，越来越需要研究这些组织在正畸运动过程中可能发生的变化。在这里，我们描述了过去曾接受过再生性牙髓治疗的根尖根折坏死未成熟根进行正畸治疗后所观察到的改变。
一名 9 岁男性患者在前上颌遭受第三次创伤后被转诊。放射影像学评估显示根尖区稀疏，伴有根尖根折的未成熟中切牙。临床评估显示颊侧脓肿和 3 度牙齿松动。牙周袋探诊在正常范围内。通过使用 6%次氯酸钠的根尖负压冲洗对牙齿进行处理和消毒。通过使用 17% EDTA 进行 5 分钟的根管内牙本质调理。从根尖区诱导血凝块，并在同一就诊时将硅酸钙基水泥直接置于血凝块上。在同一就诊时完成复合树脂修复。
24 个月后的复查放射影像学检查显示根尖病变愈合，并且尽管有根尖根折，但仍有连续根发育的迹象。临床评估显示牙齿发育正常，松动度正常，颊侧感染减轻。由于存在 11mm 的 II 类 1 分类错颌和 11mm 的覆颌，该牙齿需要进行正畸治疗。在初始干预后 5.5 年完成正畸治疗后，放射影像学图像显示根尖周围组织明显重塑和根尖骨折修复，颊侧感染完全消退。
