Pulp Necroses Clinical Trial
Official title:
Clinical and Radiographic Evaluation of Calcium Hydroxide and Bi-antibiotic Paste as Anti-microbial Dressing in Revascularization of Non Vital Immature Permanent Anterior Teeth: A Randomized Clinical Trial
The object of this study is to compare the effect of Calcium Hydroxide and Di-antibiotic paste as intracanal disinfectants in the 1st visit of revascularization of necrotic immature permanent anterior teeth.
Dental trauma is common in children and it is the main cause of loss of pulp vitality in
immature permanent anterior teeth with prevalence rate of 11% and about of 27% of traumatized
anterior teeth are left untreated.
Dentists face many challenges during the treatment of infected immature permanent teeth. This
is mainly due to the thin dentinal walls of the root and blunderbuss apices that make these
teeth susceptible to fracture during and after treatment.
Traditionally, Calcium Hydroxide apexification has been the only method for managing these
cases.. however, it was found that this technique caused additional reduction in root
strength due to the long-term application of Calcium Hydroxide which may end in fracture of
the tooth. The time needed for complete apexification using Calcium Hydroxide was reported to
be variable ranging from 5 to 20 months, with failure rate 0f 30% . Therefore, this technique
is no longer recommended for the treatment of such cases.
A recently proposed technique for the treatment of immature necrotic permanent teeth is
revascularization regenerative endodontic therapy (RET). It is a biologically based technique
that allow the continuation of root development and thickening of dentinal walls. This is
achieved through proper disinfection o the root canal system, creation of scaffold and
perfect coronal seal.
For proper disinfection of the root canal system, antibiotic paste was applied as intracanal
dressing for 2-3 weeks. However, the recent recommendations by the European society of
Endodontology advices the use of Calcium Hydroxide as intracanal medication instead of
intracanal antibiotics. This is because of some concerns regarding the use of antibiotics
which include: cytotoxicity to stem cells needed for the revascularization process, risk of
antibiotic resistance and the risk of sensitization. Calcium Hydroxide on the other hand is
widely used as intracanal disinfectant and some studies were found supporting its use in the
revascularization technique, [9, 10]. However, the data available is not sufficient regarding
the effectiveness of Calcium Hydroxide in revascularization of necrotic pulp.
Besides, more trials are needed to evaluate the clinical effectiveness of RET in management
of immature necrotic permanent teeth as the evidence of using this technique is still weak.
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