Article
The management of immature permanent teeth with a necrotic pulp has always been a challenge within the field of endodontics. Teeth with incomplete root development have short roots with thin root walls predisposing them to a high risk of fracture. Regenerative Endodontic Therapy (RET) has been proposed to facilitate root development in immature teeth with necrotic pulps and has the capacity to overcome the limitations of conventional endodontic treatment in these teeth.
This review critically appraised the literature on using RET and assessed clinical and radiographic outcomes. The authors searched a variety of electronic databases for English language studies, however, the search terms were not specified, nor were the specifics on study selection. Study quality was assessed independently by two reviewers. Fourteen studies were included (5 RCTs, 2 cohorts, 1 case-control and 6 uncontrolled prospective studies). Meta-analyses using a random effects model were performed to combine the results of the 5 RCTs.
In total, 411 teeth were analysed, with the majority of these teeth being incisors (9/411 were molar teeth). The loss of vitality was mainly reported as a result of trauma; however, 8 studies reported other causes, including caries and developmental abnormalities. Two main regenerative techniques were used which include blood clot (BC) and platelet-rich plasma (PRP) technique. Where possible, these were compared to a control (conventional treatment) within the included studies.
Overall tooth survival was 100% in all but 2 studies and resolution of clinical signs and symptoms was high, irrespective of the intervention or control group.
The results of the study would suggest improved outcomes using the RET in the form of success rates for tooth survival and resolution of periapical pathosis. However, results for apical closure and continued root development were inconsistent (demonstrated in the meta-analysis), which is the most desirable outcome of RET. Another issue raised in the review was the high rate of internal tooth discoloration after RET treatment, which was reported in 50% of studies (this being attributed to minocycline, bismuth oxide and/or MTA usage during treatment).
This review would suggest that RET is a promising endodontic technique. However, the review is limited by the lack of studies reporting outcomes beyond 18 months of follow-up. Additionally, the authors reported a lack of understanding with regards to the treatment sequencing and timing of treatment and the effect that this could have on the overall outcome of using the RET technique.
The authors concluded that ‘As more evidence becomes available, modification of RET techniques and its advocacy will evolve. It is the clinician's role to help ensure that the new protocols advocated are both clinically practical and acceptable to the young patient.’