Department of Restorative and Reconstructive Dentistry, School of Dentistry, University of Sydney, Camperdown, New South Wales, Australia.
Fujian Key Laboratory of Oral Diseases, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China.
Dent Traumatol. 2024 Dec;40(6):618-635. doi: 10.1111/edt.12979. Epub 2024 Jul 11.
Pulp necrosis is the most common complication following dental trauma and is often associated with apical periodontitis. The management of these teeth is challenging in terms of large root canals, open apices, thin dentinal walls, and short roots. Over decades the conventional treatment for these teeth was calcium hydroxide apexification, a time-consuming procedure despite high success rates. Subsequently after the introduction of mineral trioxide aggregate and hydraulic calcium silicate materials single visit apical plug procedures became increasingly practiced with comparable success rates to the conventional apexification. The search continued afterward for a clinical procedure that may stimulate further root development and apical closure to avoid the long-term complication of root fracture after apexification. Regenerative procedures using stem cells derived from the apical papilla and blood clots as scaffolds were then introduced for the management of immature teeth, with variable protocols and success rates. This review will cover the evidence available and current position of regenerative endodontic procedures in traumatized immature teeth with apical periodontitis, in terms of clinical protocols, outcome, and potential prognostic factors.
牙髓坏死是牙外伤后最常见的并发症，常伴有根尖周炎。这些牙齿的根管较大、根尖开口、牙本质壁薄、牙根短，处理起来具有挑战性。几十年来，这些牙齿的传统治疗方法是氢氧化钙根尖诱导成形术，尽管成功率很高，但这是一个耗时的过程。随后，随着三氧化矿物聚合体和水合硅酸钙材料的引入，单次就诊的根尖堵塞术越来越多地被应用，其成功率与传统的根尖诱导成形术相当。此后，人们一直在寻找一种临床方法，以刺激进一步的牙根发育和根尖闭合，从而避免根尖诱导成形术后根折的长期并发症。然后，使用来源于根尖乳头的干细胞和血凝块作为支架的再生程序被引入到未成熟牙的治疗中，其方案和成功率各不相同。本文将综述在伴有根尖周炎的外伤性未成熟牙中，再生性牙髓治疗程序的现有证据和当前状况，包括临床方案、结果和可能的预后因素。
