Thursday, June 1, 2017

Emerging Therapies for the Management of Traumatized Immature Permanent Incisors

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Amir Yavari                                                                                   Date: 06/01/2017

Article Title:  
Emerging Therapies for the Management of Traumatized Immature Permanent Incisors
Author(s): Miller E.K., et all
Journal: Journal of Pediatric Dentistry
Date: 2012
Type of Article: Case Report
Main Purpose: Report the revascularization of an immature permanent maxillary central incisor that had evidence of external root resorption.
Summary:
Early loss of immature permanent teeth due to pulpal necrosis secondary to trauma can have dire consequences for a child's growth and development.
The treatment alternatives include:
-       Surgical endodontics, traditional calcium hydroxide apexification
-       Mineral trioxide aggregate (MTA) apexification
These options pose potential complications, including: arrest of root development; weakened dentinal walls and increased potential for fracture.
Revascularization of the dentin-pulp complex is a new approach that involves disinfecting the root canal system followed by tissue repair and regeneration while allowing for continued root development and thickening of the lateral dentinal walls through deposition of new hard tissue.
The purpose of this report was to present the revascularization of an immature permanent maxillary central incisor that had evidence of external root resorption.
A healthy 9 year-old male presented to the ED Pediatric Dental Service with dental trauma. Cursory dental exam revealed multiple abrasions, swellings, and contusions and avulsion of the permanent maxillary right central incisor. The tooth had been placed in cold milk within 3 minutes of the trauma. The patient was anesthetized using 0.9 ml of 3% mepivicaine without epinephrine. Because topical antibiotic treatment reduces micro-abscesses in the pulpal lumen, reduces contamination of the root surface and pulp space, and helps facilitate a biological environment that aids revascularization, the tooth was placed in a 1% doxycycline/sterile saline solution for 5 minutes. The tooth was replanted with digital pressure and splinted using a titanium trauma splint. Prescriptions were given for a chlorhexidine rinse twice daily and doxycycline 150 mg for 7 days, because administration of systemic antibiotics has been shown to prevent or inhibit external root resorption.

Regenerative endodontic peocedure was done at week 8.
Six months later, internal bleaching was performed to remove cervical discoloration from the triple antibiotic paste.
At 18 months, the tooth remained vital and had evidence of continued root development.



Assessment of Article:  Level of Evidence/Comments: II-3

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