Lin Louis M, Kim Sahng G, Martin Gabriela, Kahler Bill
Department of Endodontics, College of Dentistry, New York University, New York, New York, USA.
Division of Endodontics, College of Dental Medicine, Columbia University, New York, New York, USA.
Aust Endod J. 2018 Dec;44(3):292-299. doi: 10.1111/aej.12252. Epub 2018 Jan 16.
Three immature permanent teeth with pulp necrosis and apical periodontitis were treated with regenerative endodontic therapy (RET), which included root canal disinfection with sodium hypochlorite irrigation, intra-canal medication with calcium hydroxide paste, 17% EDTA rinse, induction of periapical bleeding into the canal, collagen matrix and MTA coronal seal, and composite resin restoration of access cavities. After different periods of follow-up, it was observed that continued root maturation, especially apical closure occurred despite persistent apical periodontitis of immature permanent teeth after failed RET. This finding is of interest as the secondary goal of further root maturation occurred despite failure of the primary goal of elimination of clinical symptom/sign and periapical inflammation. The possible biological mechanisms that could allow for further root maturation to occur in spite of persistent root canal infection of immature permanent teeth are discussed. Based on these observations, the biology of wound healing of immature permanent teeth after injury is not fully understood and should be further investigated. This case report demonstrates that whilst further root maturation is considered a successful outcome for teeth treated with RET, the primary objective must be the resolution of the signs and symptoms of apical periodontitis.
对三颗患有牙髓坏死和根尖周炎的未成熟恒牙采用了再生性牙髓治疗（RET），治疗方法包括用次氯酸钠冲洗进行根管消毒、用氢氧化钙糊剂进行根管内用药、17%乙二胺四乙酸（EDTA）冲洗、诱导根尖周出血进入根管、胶原基质和矿物三氧化物凝聚体（MTA）冠部封闭，以及用复合树脂修复进入腔。经过不同时期的随访，观察到尽管再生性牙髓治疗失败后未成熟恒牙根尖周炎持续存在，但牙根仍持续发育成熟，尤其是根尖闭合。这一发现很有意思，因为尽管消除临床症状/体征和根尖周炎症这一主要目标未达成，但仍实现了牙根进一步发育成熟这一次要目标。本文讨论了尽管未成熟恒牙根管感染持续存在，但仍能使牙根进一步发育成熟的可能生物学机制。基于这些观察结果，未成熟恒牙受伤后伤口愈合的生物学机制尚未完全明了，应进一步研究。本病例报告表明，虽然牙根进一步发育成熟被认为是再生性牙髓治疗牙齿的成功结果，但主要目标必须是解决根尖周炎的体征和症状。
