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Innovative Paradigms and Established Strategies in Tooth Revitalization: A Review Ahmad Shah Khan Zahid Mehmood Khan Palwasha Ishaque Muhammad Zubair Syeda Fatima Tu Zahra Sana Ashfaq Dental Update 2024 51:8, 707-709.
Authors
Ahmad ShahKhan
Postgraduate Resident, Operative Dentistry and Endodontics, Armed Forces Institute of Dentistry, Rawalpindi, Pakistan
Revitalization has emerged as an innovative treatment approach for immature permanent teeth with necrotic pulp. This article presents a comprehensive analysis of revitalization, focusing on its principles, clinical protocols and outcomes. The article highlights the importance of thorough diagnosis and assessment of the pulp and peri-apical condition to determine the suitability of revitalization. Various factors influencing the success of revitalization, such as the use of scaffolds, growth factors and stem cells, are discussed. Additionally, a case that was treated with a PRP scaffold is also presented. Overall, revitalization shows promise in promoting pulp regeneration and improving treatment outcomes in selected cases of pulp necrosis.
CPD/Clinical Relevance: To introduce research-based knowledge to GDPs about the procedure and prognosis of tooth revitalization.
Article
The natural mechanism of crown and root development of a tooth is a complex process that consists of three distinct stages: bud, cap and bell stage. Hertwig's epithelial root sheath, a double layer of cells derived from ectoderm, provides guidance for root development when the crown is about to be completed. On average, it takes 1.5–3.5 years for the root to completely form after tooth eruption.1 During this time, the tooth is susceptible to damage by trauma or caries, which may have a detrimental effect on the pulp, sometimes resulting in pulp necrosis. This inhibits the flow of blood, adequate nutrients and growth factors, which are required by the developing root to fully mature and form an apex.2
Patients presenting with necrotic pulp and an immature root apex have historically been treated by apexification, by using calcium hydroxide. Although more convenient than other treatment protocols, the end results are not always favourable. The osteo-dentine barrier formed at the apex is often porous with thin dentinal walls, often resulting in root fractures and loss of the tooth.3 Calcium silicate-based cements, such as mineral trioxide aggregate (MTA), have been recommended as a root-end filling material. Although MTA provides a better apical seal, it still does not provide strength to the partially developed root.3
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