Pulp revascularization of necrotic bilateral bicuspids using a modified novel technique to eliminate potential coronal discolouration: a case report

• Published in: International endodontic journal 2009-01, Vol.42 (1), p.84-92
• Main Authors: Reynolds, K., Johnson, J. D., Cohenca, N.
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - administration & dosage; Anti-Infective Agents - administration & dosage; Bicuspid - abnormalities; Bicuspid - pathology; Child; Ciprofloxacin - administration & dosage; crown discoloration; Dental Fistula - therapy; Dental Pulp - blood supply; Dental Pulp Necrosis - therapy; Dentistry; Drug Combinations; Female; Follow-Up Studies; Humans; immature permanent tooth; Metronidazole - administration & dosage; Minocycline - administration & dosage; Neovascularization, Physiologic - physiology; open apex; Periapical Periodontitis - therapy; pulp revascularization; Root Canal Irrigants - therapeutic use; Root Canal Preparation - methods; Root Canal Therapy - methods; Tooth Discoloration - prevention & control; vital pulp therapy
• ISSN: 0143-2885; 1365-2591
• DOI: 10.1111/j.1365-2591.2008.01467.x

Aim  To present a case report in which the pulp of two bilateral mandibular premolars with dens evaginatus were revascularized using a modified novel technique to avoid undesired crown discolouration. Summary  Recently, regeneration of necrotic pulps has become an alternative conservative treatment option for young permanent teeth with immature roots and is a subject of great interest in the field of endodontics. This novel procedure exploits the full potential of the pulp for dentine deposition and produces a stronger mature root that is better able to withstand the forces than can result in fracture. However, the current protocol has potential clinical and biological complications. Amongst them, crown discolouration, development of resistant bacterial strains and allergic reaction to the intracanal medication. In the case presented, a modified technique to avoid undesired crown discolouration was applied sealing the dentinal tubules of the chamber, thus avoiding any contact between the tri‐antibiotic paste and the dentinal walls. Key learning points  • Sealing the dentinal tubules of the chamber prevents the undesirable crown discolouration produced by tri‐antibiotic medication whilst maintaining the revascularization potential of the pulp. • Further research is warranted to seek an alternative infection control protocol capable of preventing possible allergic reactions and development of resistant strains of bacteria, as well as a biological material capable of inducing angiogenesis and allow a more predictable scaffold and tissue regeneration.