Home Print this page Email this page Users Online: 785
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
LETTER TO EDITOR
Year : 2014  |  Volume : 4  |  Issue : 1  |  Page : 40-41

New treatment protocol for revascularization of young permanent tooth with an incompletely developed root


Department of Conservative Dentistry and Endodontics, Mahatma Gandhi Mission's Dental College and Hospital, Navi Mumbai, Maharashtra, India

Date of Web Publication28-Feb-2014

Correspondence Address:
Rahul Kumar
Shop no. G2, Queensgate CHS, Hiranandani Estate, Patlipada, Thane (W) - 400 607, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1658-5984.127987

Rights and Permissions

How to cite this article:
Kumar R. New treatment protocol for revascularization of young permanent tooth with an incompletely developed root. Saudi Endod J 2014;4:40-1

How to cite this URL:
Kumar R. New treatment protocol for revascularization of young permanent tooth with an incompletely developed root. Saudi Endod J [serial online] 2014 [cited 2019 Sep 19];4:40-1. Available from: http://www.saudiendodj.com/text.asp?2014/4/1/40/127987

Sir,

I read the article entitled "Revascularization of an impacted, immature dilacerated permanent maxillary central incisor associated with odontoma and a supernumerary tooth" authored by Subramaniam et al., which has been published in your esteemed journal {2013;3:132-8} with great interest. I appreciate the author's attempts in giving details related to the revascularization of a permanent maxillary central incisor.

I have a few queries to the authors and also would like to share my suggestions pertaining to this particular case. I do not agree with the treatment plan decided by the authors. The described treatment plan included surgical removal of both odontoma and mesiodens, followed by reimplantation of the permanent central incisor. The tooth was immediately reimplanted. The surgical wound was closed primarily with sutures and the tooth was stabilized for 3-4 weeks, using a semirigid splint. Within 10 days, the patient was recalled for initiation of root end closure by revascularization. Till splinting, the treatment procedure looks fine.

But after splinting I do not think any endodontic procedure was required for revascularization. Numerous literatures are available regarding revascularization of immature root without any endodontic procedure. Since 1990, extensive research has been done on revascularization, the healing of periodontal tissues and prevention of dental root resorption, resulting in increased transplant success rate that is drawing new clinical interest. Andreasen et al., [1] who investigated the long-term prognosis of autotransplanted premolars for upto 13 years, reported 95 and 98% survival rates for teeth with incomplete and complete root formation, respectively. The developmental stage of the tooth highly determines the potential of pulpal repair after transplantation. Andreasen et al. [2] found that to obtain pulp vitality in an autotransplanted or replanted tooth, the apical foramen should not be smaller than 1 mm in diameter. But recently, Laureys et al. [3] found that revascularization may be possible with foramina smaller than 1 mm, indicating that the width of the apical diameter may not be the most important parameter to allow revascularization in teeth after transplantation. I have also authored an article which was regarding revascularization and complete closure of apex in transplanted tooth without any endodontic procedure. [4]

Few other authors have also succeeded in revascularization without any endodontic procedure. [5] Moreover, endodontic therapy is not expected to result in continued dentin formation in these circumstances. Thus, there is continued need to develop biologically based treatment regimens that offer the potential for continued hard tissue formation of the young permanent tooth with an incompletely developed root.

In this particular case, the authors have mentioned 10 days after replantation; the patient was recalled for initiation of root end closure by revascularization. Conventional endodontic treatment along with an intracanal medicated dressing of metronidazole, ciprofloxacin, and minocycline was placed. The revascularization process was then carried out. This is an essential pre-requisite, especially in infected and necrotic root canal not in a sterile canal as in your case. I think, in your case if tooth was carefully extracted, keeping the radicular part intact and untouched, and was transplanted to the recipient site without extraoral storage keeping the extraoral time minimal and then if the tooth was firmly inserted into the recipient site followed by stabilization with sutures and splint and if the patient was followed up initially at regular intervals, it was possible to obtain excellent results without any endodontic intervention as far as revascularization was concerned.

 
  References Top

1.Andreasen JO, Paulsen HU, Yu Z, Ahlquist R, Bayer T, Schwartz O. A long-term study of 370 autotransplanted premolars. Part I. Surgical procedures and standardized techniques for monitoring healing. Eur J Orthod 1990;12:3-13.  Back to cited text no. 1
    
2.Andreasen JO, Paulsen HU, Yu Z, Bayer T, Schwartz O. A long-term study of 370 autotransplanted premolars. Part II. Tooth survival and pulp healing subsequent to transplantation. Eur J Orthod 1990;12:14-24.  Back to cited text no. 2
    
3.Laureys WG, Cuvelier CA, Dermaut LR, De Pauw GA. The critical apical diameter to obtain regeneration of the pulp tissue after tooth transplantation, replantation, or regenerative endodontic treatment. J Endod 2013;39:759-63.  Back to cited text no. 3
    
4.Kumar R, Khambete N, Priya E. Successful immediate autotransplantation of tooth with incomplete root formation: Case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;115:e16-21.  Back to cited text no. 4
    
5.Cardona JL, Caldera MM, Vera J. Autotransplantation of a premolar: A long-term follow-up report of a clinical case. J Endod 2012;38:1149-52.  Back to cited text no. 5
    




 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
References

 Article Access Statistics
    Viewed1597    
    Printed47    
    Emailed0    
    PDF Downloaded391    
    Comments [Add]    

Recommend this journal