Clinical, radiographic and pulp sensibility assessment of necrotic mature permanent teeth with moderate to large periapical lesions using a modified revascularization therapy: A series of five cases

Abstract

Aim : The aim of this case series was to demonstrate the possibility of  modified regenerative endodontic procedures (REPs) in necrotic mature permanent teeth for the resolution of periapical radiolucencies and regaining pulp sensibility by using a combination of  platelet-rich fibrin and induction of bleeding in root canals as scaffolds.

Methods: This case series included 5 patients who had necrotic pulps with apical periodontitis, either symptomatic or asymptomatic.  Patients ranged in age from 20 to 25 years old. A modified regenerative protocol was used to treat 5 anterior necrotic permanent teeth. During first treatment visit, the canals of the teeth were thoroughly chemomechanically debrided, and  the canals were medicated with calcium hydroxide paste. At the following appointment, periapical bleeding into the canals was generated by inserting a hand #20 or #25 K-file into the periapical tissues beyond the apical foramen with the tip having a slight curve. Over the blood clot (BC) and platelet-rich fibrin (PRF) scaffold, the coronal canals were filled with a 3-mm layer of  bio dentine. Composite resin was used to fill the access cavities.

Results: The 5 teeth had follow-up examinations at 6 and 18 months. At  follow-up visits over time, there were no clinical signs or symptoms in all teeth. At the end of follow-up period, all teeth showed complete healing of periapical lesions and 3 teeth responded to cold and electric pulp tests.

Conclusions:   Combination approach of PRF with BC could eliminate periapical radiolucent lesions, clinical signs or / symptoms and regaining of sensibility which indicates the presence of host’s own pulplike vital tissue.