Keinan David, Nuni Eyal, Bronstein Rainus Meital, Ben Simhon Tal, Dakar Aaron, Slutzky-Goldberg Iris
Endodontics, Tel Aviv University, Tel Aviv, ISR.
Endodontics, Galilee College of Dental Sciences, Nahariya, ISR.
Cureus. 2024 Dec 5;16(12):e75147. doi: 10.7759/cureus.75147. eCollection 2024 Dec.
Introduction Regenerative endodontic therapy (RET) has been suggested for treating immature necrotic teeth, and failures after RET may be observed during follow-up examinations, even two years after the initial treatment. The study aimed to examine the outcomes of RET and suggest a decision-making guide for the retreatment of failed cases. Methods Around 414 endodontically treated immature teeth from patients aged six and 17 were screened to identify eight patients who presented with a failed RET. Data, including patients' ages, sex, medical, and dental history, were collected. Results The timing of failure varied significantly. Only one tooth showed failure at the three-month initial follow-up, while the remaining five teeth exhibited failures between two and seven years post-RET completion. Notably, in most instances, failure occurred after the periapical lesion had healed and root development had continued. Six teeth underwent retreatment using various approaches: repeated RET (two teeth), conventional root canal retreatment with or without an apical plug (two teeth), and surgical retreatment (two teeth). All retreatment interventions resulted in favorable outcomes. Conclusion Despite initial RET failure, the subsequent process of maturogenesis that followed the primary treatment led to an improved crown-to-root ratio. This resulted in a better outcome for the secondary treatment and increased patient cooperation during subsequent treatments. The study presents guidelines to aid in treatment decision-making for similar cases.
引言 再生性牙髓治疗（RET）已被建议用于治疗未成熟坏死牙，即使在初始治疗两年后的随访检查中，也可能观察到RET治疗失败的情况。本研究旨在检查RET的治疗结果，并为失败病例的再治疗提出决策指南。方法 对414颗6至17岁患者接受牙髓治疗的未成熟牙进行筛选，以确定8例RET治疗失败的患者。收集包括患者年龄、性别、病史和牙科病史等数据。结果 失败时间差异显著。仅1颗牙在3个月的首次随访时出现失败，而其余5颗牙在RET完成后2至7年出现失败。值得注意的是，在大多数情况下，失败发生在根尖周病变愈合且牙根继续发育之后。6颗牙采用多种方法进行再治疗：重复RET（2颗牙）、有或无根尖充填物的传统根管再治疗（2颗牙）以及外科再治疗（2颗牙）。所有再治疗干预均取得了良好效果。结论 尽管初始RET治疗失败，但初次治疗后随后的成熟化过程导致冠根比改善。这使得二次治疗取得更好的结果，并增加了患者在后续治疗中的配合度。本研究提出了有助于类似病例治疗决策的指南。
