Successful Regenerative Endodontic Therapy of a Dens Evaginatus Mandibular Second Premolar with an Acute Apical Abscess and Extensive Periapical Bone Loss: A Case Report

Overview

Journal Eur J Dent

Publisher Thieme

Specialty Dentistry

Date 2024 Oct 11

PMID 39393801

Authors

Francesco J DeMayo

Jackson T Seagroves

Takashi Komabayashi

Affiliations

Soon will be listed here.

Abstract

Regenerative endodontics is a rapidly growing field within dentistry that aims to replace damaged tooth structures and cells of the pulp-dentin complex. This case report presents the successful management of an immature permanent second mandibular premolar with an acute apical abscess and extensive apical bone loss caused by a dens evaginatus. This tooth was unexpectedly treated with long-term calcium hydroxide (Ca(OH)) that was replenished several times over 6 months. During the treatment process, this tooth became reinflamed developing a chronic apical abscess after resolution of the initial acute apical abscess, which resulted in the replacement and prolonged use of Ca(OH). The final regenerative procedures were completed using a bioceramic fast set putty placed directly over the blood clot and an occlusal composite restoration. At the 6-month follow-up, the patient was asymptomatic with a fully healed radiographic lesion, new periodontal ligament, and the apex closed with thickening of the mesial and distal aspects of the root. At the 15-month follow-up, the patient remained asymptomatic with continued evidence of radiographic development of the apical aspect of this tooth, displaying root end closure and thickening. This is a unique case report of the management of a complex infection process in an immature tooth with regenerative techniques with repeated and long-term use of Ca(OH). This novel report provides dental practitioners with a new potential protocol for the management of these immature cases with advanced periapical infections that require extensive disinfection to have successful outcomes.

References

NYGAARD-OSTBY B, Hjortdal O . Tissue formation in the root canal following pulp removal. Scand J Dent Res. 1971; 79(5):333-49. DOI: 10.1111/j.1600-0722.1971.tb02019.x. View

Galler K, DSouza R, Federlin M, Cavender A, Hartgerink J, Hecker S . Dentin conditioning codetermines cell fate in regenerative endodontics. J Endod. 2011; 37(11):1536-41. DOI: 10.1016/j.joen.2011.08.027. View

Kahler S, Shetty S, Andreasen F, Kahler B . The Effect of Long-term Dressing with Calcium Hydroxide on the Fracture Susceptibility of Teeth. J Endod. 2017; 44(3):464-469. DOI: 10.1016/j.joen.2017.09.018. View

Estefan B, El Batouty K, Nagy M, Diogenes A . 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. View

Iwaya S, Ikawa M, Kubota M . Revascularization of an immature permanent tooth with apical periodontitis and sinus tract. Dent Traumatol. 2001; 17(4):185-7. DOI: 10.1034/j.1600-9657.2001.017004185.x. View

Lenzi R, Trope M . Revitalization procedures in two traumatized incisors with different biological outcomes. J Endod. 2012; 38(3):411-4. DOI: 10.1016/j.joen.2011.12.003. View

Huang G . A paradigm shift in endodontic management of immature teeth: conservation of stem cells for regeneration. J Dent. 2008; 36(6):379-86. DOI: 10.1016/j.jdent.2008.03.002. View

Nagata J, Soares A, Souza-Filho F, Zaia A, Ferraz C, Almeida J . Microbial evaluation of traumatized teeth treated with triple antibiotic paste or calcium hydroxide with 2% chlorhexidine gel in pulp revascularization. J Endod. 2014; 40(6):778-83. DOI: 10.1016/j.joen.2014.01.038. View

Banchs F, Trope M . Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol?. J Endod. 2004; 30(4):196-200. DOI: 10.1097/00004770-200404000-00003. View

10.

Liu H, Lu J, Jiang Q, Haapasalo M, Qian J, Tay F . Biomaterial scaffolds for clinical procedures in endodontic regeneration. Bioact Mater. 2022; 12:257-277. PMC: 8897058. DOI: 10.1016/j.bioactmat.2021.10.008. View

11.

Lin L, Rosenberg P . Repair and regeneration in endodontics. Int Endod J. 2011; 44(10):889-906. DOI: 10.1111/j.1365-2591.2011.01915.x. View

12.

Althumairy R, Teixeira F, Diogenes A . Effect of dentin conditioning with intracanal medicaments on survival of stem cells of apical papilla. J Endod. 2014; 40(4):521-5. DOI: 10.1016/j.joen.2013.11.008. View

13.

Diogenes A, Ruparel N, Shiloah Y, Hargreaves K . Regenerative endodontics: A way forward. J Am Dent Assoc. 2016; 147(5):372-80. DOI: 10.1016/j.adaj.2016.01.009. View

14.

Lovelace T, Henry M, Hargreaves K, Diogenes A . Evaluation of the delivery of mesenchymal stem cells into the root canal space of necrotic immature teeth after clinical regenerative endodontic procedure. J Endod. 2011; 37(2):133-8. DOI: 10.1016/j.joen.2010.10.009. View

15.

Sjogren U, Figdor D, Spangberg L, Sundqvist G . The antimicrobial effect of calcium hydroxide as a short-term intracanal dressing. Int Endod J. 1991; 24(3):119-25. DOI: 10.1111/j.1365-2591.1991.tb00117.x. View

16.

Manguno C, Murray P, Howard C, Madras J, Mangan S, Namerow K . A survey of dental residents' expectations for regenerative endodontics. J Endod. 2012; 38(2):137-43. DOI: 10.1016/j.joen.2011.10.028. View

17.

Miller A, Takimoto K, Wealleans J, Diogenes A . Effect of 3 Bioceramic Materials on Stem Cells of the Apical Papilla Proliferation and Differentiation Using a Dentin Disk Model. J Endod. 2018; 44(4):599-603. DOI: 10.1016/j.joen.2017.12.018. View

18.

Ruparel N, Teixeira F, Ferraz C, Diogenes A . Direct effect of intracanal medicaments on survival of stem cells of the apical papilla. J Endod. 2012; 38(10):1372-5. DOI: 10.1016/j.joen.2012.06.018. View

19.

Fang Y, Wang X, Zhu J, Su C, Yang Y, Meng L . Influence of Apical Diameter on the Outcome of Regenerative Endodontic Treatment in Teeth with Pulp Necrosis: A Review. J Endod. 2017; 44(3):414-431. DOI: 10.1016/j.joen.2017.10.007. View

20.

Hoshino E, Sato I, Uematsu H, Sato M, Kota K, Iwaku M . In-vitro antibacterial susceptibility of bacteria taken from infected root dentine to a mixture of ciprofloxacin, metronidazole and minocycline. Int Endod J. 1996; 29(2):125-30. DOI: 10.1111/j.1365-2591.1996.tb01173.x. View