Revascularization of Non-vital Permanent Teeth with Open Apices: A New Treatment Modality

Objective: To determine increase in root(s) length and thickness and closure of apical foramen in patients undergoing revascularization of immature, permanent, necrotic teeth Material and Methods: This study was conducted at outpatient department of Operative Dentistry, Pakistan institute of medical sciences (PIMS), Islamabad, from 22 January 2011 to 22 January 2013. All the patients were assessed with the detailed history and clinical examination. On the first visit, pulp chambers of the teeth were opened followed by minimal instrumentation. Disinfection of the root canal was done with 2.5% sodium hypochlorite (NaOCl), saline, and 2% chlorhexidine (CHX). Then triple antibiotic paste (TAP) was placed in the canal till next visit. In the next visit, in the absence of clinical signs and symptoms, under local anesthesia without vasoconstrictor, bleeding was induced in the root canal. Blood clot was allowed to form beyond the level of cementoenamel junction (CEJ) which was then covered with non-setting formulation of calcium hydroxide{Ca(OH)2}and bacteria tight coronal seal with glass ionomer cement or composite was made. Patients were evaluated clinically and radiographically at 0, 3, 6, 12, 18 till 24 months. Results: Efficacy of revascularization was measured on 24 months follow up of patients having immature, permanent and necrotic teeth. Out of 36 teeth, 34 (94.4%) showed increase in root length and whereas only 2 (5.6%) teeth showed no increase in root length. Similarly, 33 (91.7%) teeth showed increase in root thickness and 3 (8.3%) patients showed no increase in root thickness. Conclusion: On the basis of follow-up period of at least 24 months, the present study demonstrates favorable outcome of the revascularization procedure in terms of increase in root length and thickness in immature permanent necrotic maxillary anterior teeth. The cases remained successful even with the use of non-setting formulation of Ca(OH)2 in place of mineral trioxide aggregate(MTA).