Murray P. E. (2023). Review of guidance for the selection of regenerative endodontics, apexogenesis, apexification, pulpotomy, and other endodontic treatments for immature permanent teeth. International endodontic journal, 56 Suppl 2, 188–199.
Regenerative endodontic treatment (RET)
A procedure that may be suggested for immature teeth with a necrotic pulp and irreversible pulpitis. It involves debriding the root canal, disinfecting the root canal and instrumenting the open root apical foramen. This encourages bleeding into the canal to revascularise it and promote vital tissue formation, which in turn continues the growth of roots of immature teeth.
However, as with any treatment option, there are benefits and limitations to RET. The key advantage of regenerative endodontics is the ability to potentially save fragile immature permanent teeth over the long term and prevent children and young adults requiring space maintenance as result of loss of permanent teeth.
Treatment planning for RET
When deciding when to complete RET, there is precise case selection. This figure below represents a summary of a case selection criteria to consider before performing RET on immature permanent teeth.
Other endodontic treatments for immature teeth:
Apexification
Apexification is the process of debriding the necrotic pulp from immature permanent teeth, disinfecting the root canal and then obturating with calcium hydroxide, MTA or bioceramic root repair material to induce calcified barrier. The indication for this treatment would be immature teeth with a necrotic pulp where the root dentinal walls are already thick enough to withstand fracture.
Apexogenesis
This is a treatment for vital teeth by debriding the coronal injured pulp from root canal. This is completed to prevent spread of necrosis/infection/irreversible pulpitis to remaining vital pulp and allow survival of vital pulp to continue root maturation and thickening.
Cvek partial pulpotomy
Cvek partial pulpotomy is a vital pulp treatment where 2 mm of the coronal injured pulp is debrided. This allows the remaining vital pulp to continue to maturation. It is similar to apexogenesis other than the specific amount of vital pulp removed.
Conventional non-surgical root canal treatment
This is the gold standard treatment for most mature teeth with painful and/or necrotic pulp.
Conclusion
This review is a guidance for treatment options for immature permanent teeth. The outcomes of RET are highly variable and there is still a lack of high-quality studies, thus, limitations of RET are still being discovered. However, it is important to consider endodontic treatment when treating immature teeth as they can be just as successful.
Research Summary Written By: Erika Fernandez, University of Plymouth – BDS Year 4