Background and objectives: Regenerative treatment of immature teeth leads to continued root maturation thereby restores the physiologically functional pulp-dentin complex. The present systematic review is conducted to evaluate the efficacy of regenerative endodontic treatment by induced periapical bleeding (IPB) in the regeneration of immature necrosed permanent teeth with an open apex.
Materials and methods: This review was conducted in adherence to PRISMA standards and was registered in PROSPERO with registration number CRD42018091574. We graded the methodological quality of the studies using Cochrane's tool of risk of bias in nonrandomized studies–of interventions (ROBINS-I).
Results: In total, 200 studies were identified for screening, and nine studies were eligible. The quality assessment rated one study as strong, three studies (33.3%) as fair, and five studies (55.6%) as poor. The number of study participants ranged from 17 to 118 (total n = 394), with a mean of 43.8. Four studies showed 100% clinical success with IPB. The radiographic success ranged from 60 to 100%.
Conclusion: All of the included studies showed IPB treatment resulted in increased root length, progressive thickening of the dentinal walls, and narrowing of the canal space. Induced periapical bleeding is the best treatment of choice for immature permanent teeth with pulpal necrosis.
Flanagan TA. What can cause the pulps of immature, permanent teeth with open apices to become necrotic and what treatment options are available for these teeth. Aust Endod J 2014;40(3):95–100. DOI: 10.1111/aej.12087.
Agrafioti A, Giannakoulas DG, Filippatos CG, et al. Analysis of clinical studies related to apexification techniques. Eur J Paediatr Dent 2017;18(4):273–284. DOI: 10.23804/ejpd.2017.18.04.03.
Lin JC, Lu JX, Zeng Q, et al. Comparison of mineral trioxide aggregate and calcium hydroxide for apexification of immature permanent teeth: a systematic review and meta-analysis. J Formos Med Assoc 2016;115(7):523–530. DOI: 10.1016/j.jfma.2016.01.010.
Belli S, Eraslan O, Eskitaşcıoglu G. Effect of different treatment options on biomechanics of immature teeth: a finite element stress analysis study. J Endod 2018;44(3):475–479. DOI: 10.1016/j.joen.2017.08.037.
Demiriz L, Bodrumlu EH. Severe unintentional extrusion of mineral trioxide aggregate during apexification. Indian J Dent Res 2017;28(3):341–343. DOI: 10.4103/ijdr.IJDR_365_16.
Anitua E, Sanchez M, Orive G. Potential of endogenous regenerative technology for in situ regenerative medicine. Adv Drug Deliv Rev 2010;15(62):741–752. DOI: 10.1016/j.addr.2010.01.001.
Mao JJ, Kim SG, Zhou J, et al. Regenerative endodontics: barriers and strategies for clinical translation. Dent Clin North Am 2012;56(3):639–649. DOI: 10.1016/j.cden.2012.05.005.
Huang GT. Pulp and dentin tissue engineering and regeneration: current progress. Regen Med 2009;4(5):697–707. DOI: 10.2217/rme.09.45.
Bezgin T, Sonmez H. Review of current concepts of revascularization/revitalization. Dent Traumatol 2015;31(4):267–273. DOI: 10.1111/edt.12177.
Hilkens P, Meschi N, Lambrechts P, et al. Dental stem cells in pulp regeneration: near future or long road ahead? Stem Cells Dev 2015;24(14):1610–1622. DOI: 10.1089/scd.2014.0510.
Alobaid AS, Cortes LM, Lo J, et al. Radiographic and clinical outcomes of the treatment of immature permanent teeth by revascularization or apexification: a pilot retrospective cohort study. J Endod 2014;40(8):1063–1070. DOI: 10.1016/j.joen.2014.02.016.
Shivashankar VY, Johns DA, Maroli RK, et al. Comparison of the effect of PRP, PRF and induced bleeding in the revascularization of teeth with necrotic pulp and open apex: a triple blind randomized clinical trial. J Clin Diagn Res 2017;11(6):ZC34–ZC39. DOI: 10.7860/JCDR/2017/22352.10056.
Silujjai J, Linsuwanont P. Treatment outcomes of apexification or revascularization in nonvital immature permanent teeth: a retrospective study. J Endod 2017;43(2):238–245. DOI: 10.1016/j.joen.2016.10.030.
Bukhari S, Kohli MR, Setzer F, et al. Outcome of revascularization procedure: a retrospective case series. J Endod 2016;42(12):1752–1759. DOI: 10.1016/j.joen.2016.06.021.
Chan EK, Desmeules M, Cielecki M, et al. Longitudinal cohort study of regenerative endodontic treatment for immature necrotic permanent teeth. J Endod 2017;43(3):395–400. DOI: 10.1016/j.joen.2016.10.035.
Li L, Pan Y, Mei L, et al. Clinical and radiographic outcomes in immature permanent necrotic evaginated teeth treated with regenerative endodontic procedures. J Endod 2017;43(2):246–251. DOI: 10.1016/j.joen.2016.10.015.
Estefan BS, El Batouty KM, Nagy MM, et al. Influence of age and apical diameter on the success of endodontic regeneration procedures. J Endod 2016;42(11):1620–1625. DOI: 10.1016/j.joen.2016.06.020.
Saoud TM, Zaazou A, Nabil A, et al. Clinical and radiographic outcomes of traumatized immature permanent necrotic teeth after revascularization/revitalization therapy. J Endod 2014;40(12):1946–1952. DOI: 10.1016/j.joen.2014.08.023.
Jeeruphan T, Jantarat J, Yanpiset K, et al. Mahidol study 1: comparison of radiographic and survival outcomes of immature teeth treated with either regenerative endodontic or apexification methods: a retrospective study. J Endod 2012;38(10):1330–1336. DOI: 10.1016/j.joen.2012.06.028.
Bose R, Nummikoski P, Hargreaves K. A retrospective evaluation of radiographic outcomes in immature teeth with necrotic root canal systems treated with regenerative endodontic procedures. J Endod 2009;35(10):1343–1349. DOI: 10.1016/j.joen.2009.06.021.
El Ashiry EA, Farsi NM, Abuzeid ST, et al. Dental pulp revascularization of necrotic permanent teeth with immature apices. J Clin Pediatr Dent 2016;40(5):361–366. DOI: 10.17796/1053-4628-40.5.361.
Nagy MM, Tawfik HE, Hashem AA, et al. Regenerative potential of immature permanent teeth with necrotic pulps after different regenerative protocols. J Endod 2014;40(2):192–198. DOI: 10.1016/j.joen.2013.10.027.
Ding RY, Cheung GS, Chen J, et al. Pulp revascularization of immature teeth with apical periodontitis: a clinical study. J Endod 2009;35(5):745–749. DOI: 10.1016/j.joen.2009.02.009.
Chen X, Bao ZF, Liu Y, et al. Regenerative endodontic treatment of an immature permanent tooth at an early stage of root development: a case report. J Endod 2013;39(5):719–722. DOI: 10.1016/j.joen.2012.12.023.
Chueh LH, Ho YC, Kuo TC, et al. Regenerative endodontic treatment for necrotic immature permanent teeth. J Endod 2009;35(2):160–164. DOI: 10.1016/j.joen.2008.10.019.
Wigler R, Kaufman AY, Lin S, et al. Revascularization: a treatment for permanent teeth with necrotic pulp and incomplete root development. J Endod 2013;39(3):319–326. DOI: 10.1016/j.joen.2012.11.014.
Kahler B, Mistry S, Moule A, et al. Revascularization outcomes: a prospective analysis of 16 consecutive cases. J Endod 2014;40(3):333–338. DOI: 10.1016/j.joen.2013.10.032.
Tawfik H, Abu-Seida AM, Hashem AA, et al. Regenerative potential following revascularization of immature permanent teeth with necroticpulps. Int Endod J 2013;46(10):910–922. DOI: 10.1111/iej.12079.
Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 2009;62(10):1006–1012. DOI: 10.1016/j.jclinepi.2009.06.005.
Sterne JA, Hernán MA, Reeves BC. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016;355:i4919 Albuquerque MTP, Nagata J, Bottino MC, et al. Antimicrobial efficacy of triple antibiotic-eluting polymer nanofibers against multispecies biofilm. J Endod 2017;43(9S):S51–S56. DOI: 10.1136/bmj.i4919.
Albuquerque MT, Valera MC, Nakashima M, et al. Tissue-engineering-based strategies for regenerative endodontics. J Dent Res 2014;93(12):1222–1231. DOI: 10.1177/0022034514549809.