15 November 2021

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Endodontic regeneration in traumatized immature permanent teeth: single or multiple visits?

Lara Figini

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Frequently  in dentistry there is the necessity to perform non-surgical treatments to regenerate the damaged dental pulp. Clinical success is based on the correct removal of organic tissues, infected debris, microorganisms and their by-products, from the root canal system by mechanical instrumentation and by the use of irrigants for disinfection. Some authors in the literature highlight the importance of an inter-appointment dressing to reduce the levels of bacterial load and endotoxins, while others argue that completing the treatment with a single visit approach avoids reinfection of root canals during the inter-appointment interval. There is currently no consensus on the subject in the literature.

Materials and methods
In a clinical study, published in the Journal of Endodontics , October 2021, the authors compared the clinical and radiographic outcomes of regenerative endodontic (REP) treatments performed in multiple appointments, with intermediate root canal dressings, compared to those performed in a single visit. Twenty young patients presenting with immature teeth traumatized with pulp necrosis were divided into 2 groups. The treatments were performed with 6% sodium hypochlorite and 2% chlorhexidine irrigation in addition to 17% EDTA. In the group in which an inter-appointment dressing was performed (n = 11), calcium hydroxide with 2% chlorhexidine gel was used for 21 days before the final filling. In the single visit group (n = 9), the pulp regenerative treatment and obturation were performed in a single session. Patients were followed up for 24 months. Pimary, secondary and tertiary outcomes were evaluated by 3 independent examiners. Preoperative and follow-up radiographs were analyzed for quantitative measurements of apical diameter, root width, and root length using the Mann-Whitney t test or U test. Categorical variables were evaluated with the G test and Fisher's exact test and continuous variables with the Mann-Whitney U test. Statistical significance was set at 5%.

Results
In only one tooth  the infection persisted. No difference was observed between the two groups in primary, secondary and tertiary outcomes (P. .05) and in radiographic  parameters (P. .05).

Conclusions
From the data of this study, which must be confirmed in other similar studies, it can be concluded that REP pulp regenerative treatments completed in multiple appointments with intermediate dressing or in single visit have similar clinical and radiographic outcomes. A single visit REP protocol using 6% sodium hypochlorite, 2% chlorhexidine and 17% EDTA allows satisfactory results in necrotic immature permanent teeth.

Clinical implications
Dentists can perform endodontic regenerative procedures in a single visit, which has clinical, managerial and patient benefits, as this approach offers similar results to those obtained in multiple appointments using the intermediate dressing.

For additional information: Clinical and Radiographic Outcomes of Regenerative Endodontic Procedures in Traumatized Immature Permanent Teeth: Interappointment Dressing or Single-Visit?