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Volume2 Issue5
S
upporting
Y
our
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ractice
Sendusyourcomments
orclinicalquestions.
oruse the
.
AntibioticTherapy in
Revascularization/Revitalization
Theuseof antibioticmixtures as intracanal
medicaments tocleanseand “sterilize” the
canal hasbecome increasinglypopular.
Thenecrotic tooth is commonlyfilled
withacombinationofmetronidazole,
ciprofloxacinandminocycline. After
3months, thecanal is accessedagain,
bleeding is induced tofill thecanalwith
blood, and thecanal is sealedwitha
collagenplug,MTAand thenamalgam.
Thebloodclot creates abiological scaffold
toaid in thegrowthof new tissuewithin
thecanal space. Additionally, thegrowth
anddifferentiation factorswithin theblood
clot support thehealingprocess.More
recently, some techniquesutilizeblood that
isdrawn from thepatient andcentrifuged
to isolateplatelet-richplasma (PRP) or
plasma-richgrowth factor (PRGF),which is
then injected into thecanal. Although the
treated toothappears radiographically to
developa typical root shape, animal studies
suggest that thenew tissues arenot dentin
andpulpbut rather cementumwithbony
islands andconnective tissue (see
➌
,
➍
).
a
Theviewsexpressedarethoseoftheauthorsanddonotnecessarilyreflectthe
opinionsorofficialpoliciesoftheCanadianDentalAssociation.
References
1.BansalR,JainA,MittalS,KumarT,KaurD.Regenerativeendodontics:
aroad lesstravelled.JClinDiagnRes.2014;8(10):ZE20-4.
2.BakhtiarH,VatanpourM,RayaniA,NaviF,Asna-AshariE,AhmadiA.,et
al.Theplasma-rich ingrowth factorasasuitablematrix inregenerative
endodontics:acaseseries.NYStateDentJ.2014;80(4):49-53.
3.CemGüngörHC,UysalS,AltayN.Aretrospectiveevaluationofcrown-
fracturedpermanentteethtreated inapediatricdentistryclinic.Dent
Traumatol.2007;23:211-7.
4.ShabahangS.Treatmentoptions:apexogenesisandapexification.Pediatr
Dent.2013;35(2):125-8.
5.ThibodeauB,TropeM.Pulprevascularizationofanecrotic infected
immaturepermanenttooth:casereportandreviewofthe literature.Pediatr
Dent.2007;29(1):47-50.
6.Cvek,M.Treatmentofnon-vitalpermanent incisorswithcalcium
hydroxide. I.Follow-upofperiapicalrepairandapicalclosureof immature
roots.OdontolRevy.1972;23(1):27-44.
7.WangX,Thibodeau,B,TropeM,LinHM,HuangGT.Histologic
characterizationofregeneratedtissues incanalspaceafterthe
revitalization/revascularizationprocedureof immaturedogteethwith
apicalperiodontitis.JEndod.2010;36(1):56-63.
THEAUTHORS
Dr.MichaelCasas
Dr.Casas is anassociate
professor in the faculty of
dentistryat theUniversity
ofTorontoanddirector
of dentistry clinics at
TheHospital forSick
Children.
Dr.SuhamAlexander
Dr.Alexander is in
private practice inOttawa
and is a clinical editor
forOasisDiscussions at
CDA.
Radiographicviewat 18months
follow-up, demonstrating
narrowingof root canal in the
apical thirdand thickeningof
the lateralwalls. Anormal bony
architectureat theperiradicular
region isevident.
Radiographicviewafter intracanal
applicationof calciumhydroxide
paste; periradicular radiolucencies
areevident inboth roots.
➌
➍
Case2
