• Journal of the korean academy of Pediatric Dentistry
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• v.45 no.2
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• pp.250-256
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• 2018

Dental avulsion, defined as the complete displacement of a tooth from the alveolar bone with consequent loss of the blood and nerve supply, was reported as one of the most severe dental injuries. Avulsion can cause tissue ischemia, which leads to pulp necrosis. Apexification is a conventional treatment method that induces an apical calcified barrier in immature roots with pulp necrosis. However, root development characterized by an increase in the root thickness and length cannot be achieved by apexification. The purpose of this case report was to describe the radiographic and clinical outcomes of regenerative endodontic treatment for the avulsed and necrosed permanent tooth with an immature root after replantation in a 5-year-old girl; the treatment was performed using a mixture of ciprofloxacin, metronidazole and cefaclor, CollaTape and Biodentine.

• Journal of the korean academy of Pediatric Dentistry
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• v.42 no.2
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• pp.197-202
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• 2015

Numerous challenges in treating permanent dentition are encountered, especially in treating immature teeth with pulp necrosis. Historically, calcium hydroxide application during long periods of time was used to induce the formation of a calcific barrier across the open apex. In 2004, a new treatment modality for the management of the open apex was introduced. This treatment was named as 'revascularization' and gained acceptance among dentists. The protocol was different from the traditional apexification techniques in that the canal was irrigated and disinfected with a combination of three antibiotics (ciprofloxacin, metronidazole and minocycline). At the next appointment, bleeding was induced and the canal was sealed with MTA. Successful regenerative endodontic treatment of necrotic immature permanent teeth can provide continued root development, increased thickness in the dentinal walls and apical closure. These developments of a functional pulp-dentin complex have a promising impact on retaining the natural teeth, the goal of the dental health care.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.12 no.2
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• pp.72-76
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• 2016

Traumatic dental injury (TDI) is a common problem in children and adolescent. The prevalence of dental trauma among children with disability as compared to healthy children. The TDI of an immature permanent tooth can lead to the loss of pulp vitality and arrested root development. Traditionally, the treatment of choice for necrotic immature tooth is apexification, which is induction of hard tissue barrier at the apex to produce more favorable conditions for conventional root canal filling. This case report describes the treatment of a necrotic immature permanent central incisor with complicated crown fracture. The patient had multiple disabilities (cerebral palsy, congenital heart disease, developmental delay, and gait disturbance) and suffered from She was suffered from repetitive traumatic injury. Apexification and resin restoration was performed under general anesthesia, and favorable clinical results were achieved.

• Restorative Dentistry and Endodontics
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• v.35 no.4
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• pp.238-245
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• 2010

Numerous cases about additional growth of roots or pulp tissue regeneration by using various intracanal medicaments in immature permanent teeth with periapical or pulpal disease have been reported. The underlying mechanism has not been clearly delineated, but it has been widely accepted that undifferentiated mesenchymal cells and stem cells are involved. Moreover, the growth and deposition of osteoid or cementoid tissues have been observed in regenerated pulp and roots. This new and non-invasive treatment has brightened the future of endodontics, and enlarged the vision of regenerative root canal treatment with multi-potent stem cells and various tissue engineering techniques.

• Journal of the korean academy of Pediatric Dentistry
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• v.36 no.2
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• pp.305-309
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• 2009

Dens evaginatus is a dental anomaly most commonly seen in premolar teeth in which a tubercle or protuberance projects from either the center of the occlusal surface or the buccal triangular ridge. These tubercles are easily fractured from mastication as the tooth erupts and frequently leads to pulp necrosis as a common complication. To prevent these sequelae, prophylactic treatment soon after the tooth starts erupting is essential. These preventive treatments include, selective grinding and protection of the tubercle by pit and fissure sealant. When the tooth does shows signs of pulp necrosis and apical periodontitis, endodontic procedures are needed. Apexification and apexogenesis are usually the treatment of choice for the affected teeth which have immature apices. Apexogenesis is a vital pulp therapy procedure performed to encourage continued physiological development and formation of the root end. It involves removal of the inflamed pulp and the placement of calcium hydroxide on the remaining healthy pulp tissue. This case report describes an atypical apexogenesis of a mandibular premolar which showed to be a dens evaginatus. The tooth which was treated with calcium hydroxide shows good results and is planned for permanent root canal filling.

• Journal of dental hygiene science
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• v.16 no.4
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• pp.317-322
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• 2016

Mineral trioxide aggregate (MTA) is widely used in endodontic therapy as a pulp-capping material, root or furcal perforation repair material, and for apexification and obturation of the root canal system. The purpose of this study was to formally document cases of MTA application in South Korean children and adolescents. Through this research, the practice of using MTA will be introduced and familiarized to the clinical practitioners. This study involved endodontic treatment using MTA for fractured crowns in 11- and 12-year-old. The children were followed up for 12 months until the pulp vitality was confirmed; in young permanent teeth with immature roots, the pulp is integral to the process of apexogenesis. These observational results regarding the use of MTA as an apexification material in non-vital immature permanent incisors appear to provide promising results in the search for new materials to meet existing endodontic needs.

• Journal of the korean academy of Pediatric Dentistry
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• v.31 no.2
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• pp.267-272
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• 2004

This case report describes an uncommon treatment method for crown-root fractured incisor with immature root. A 7-year-old girl was referred for treatment of crown-root fractured maxillary central incisor. The fracture line extended to 1/2 of the total tooth length with incomplete root formation. The prognosis of crown-root fracture is usually poor and extraction is usually undertaken. But, in the mixed dentition, extraction of maxillary permanent incisor results in many complications, such as resorption of alveolar bone, poor esthetics, pronunciation and mastication. Conservative therapy in the permanent dentition comprises of few treatment modalities; supragingival restoration, gingivectomy, orthodontic extraction of apical fragment, surgical extrusion of apical fragment with or without rotational replantation. However, in this case, these indications are not applicable, so intentional replantation with adhesive resin system is the treatment of choice. The tooth was followed-up for 12 months. Currently, there are no symptoms. Since this modality adopts the respective advantages of both intentional replantation and adhesive treatment, it might be the treatment of choice in cases of vertical crown-root fracture.

• Journal of the korean academy of Pediatric Dentistry
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• v.34 no.3
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• pp.454-460
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• 2007

Traumatic dental injuries in childhood and adolescent occurred more frequently than in adult. The time between the accident and the treatment is one of the most critical factors to prognosis, and because of the limited time available to examine and treat patients with traumatic dental injuries, if not treat appropriately, the result would be critical for the patient. In the previous studies, the prevalence and incidence of traumatic injuries were the most frequent at the age of 8 to 10 years, the majority of dental injuries involve the anterior teeth, especially the maxillary incisors, and males were more prevalent than females in an approximated proportion of 2:1. As the mean age of complete root formation is 10 years old, the maxillary permanent incisor involved in the most affected age group is usually immature, and the possibility of pulpal healing through excellent revascularization exists, more positive prognosis for pulp vitality would be expected. These are treatment cases of the immature maxillary permanent central incisor involved in the traumatic injury, and reports for progress and results of preserving the pulp vitality through the conservative treatment instead of the conventional endodontic root therapy.

• Journal of the korean academy of Pediatric Dentistry
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• v.39 no.1
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• pp.43-50
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• 2012

The concept of revascularization of necrotic pulps regained interest and became an alternative conservative treatment option for young permanent teeth with immature roots. Revascularization of immature teeth with apical periodontitis depends mainly on disinfection of the canal. Since the infection of the root canal system is considered to be polymicrobial, a combination of drugs would be needed to treat the diverse flora. A triple antibiotic mixture of metronidazole, ciprofloxacin, and minocycline was used as an intracanal medicament. However, discoloration was developed after applying the triple antibiotic mixture. It is believed that the marked discoloration is related to the use of minocycline. The aim of this article was to present cases of coronal discoloration after triple antibiotic therapy in immature tooth and was treated with bleaching technique to control coronal discoloration. In conclusion, revascularization by using triple antibiotics promotes a paradigm shift in treating endodontically involved permanent teeth. However, we should understand that triple antibiotics containing minocycline induces tooth discoloration. Further research to prevent coronal discoloration should be investigated and suggested for the safe use of triple antibiotics.

• The Journal of the Korean dental association
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• v.54 no.8
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• pp.658-665
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• 2016

Treatment of immature permanent teeth with irreversibly damaged pulp has been challenging in dental practice because of the lack of apical constriction, thin dentinal walls, and short roots. This may lead to the extrusion of filling materials, and fracture of the root due to its more fragile feature during shaping of the root canal. Apexification with calcium hydroxide or MTA is one of the treatment options for these cases. Although favorable results of apexification have been reported, these treatment procedures do not guarantee the increase of root length and/or width even after a long term period. Thus, treated teeth are still prone to fractures. Recently, pulp revascularization has been proposed as an alternative treatment for immature teeth with necrotic pulp and periapical pathosis. Pulp revascularization allows the stimulation of the apical development and the root maturation. There have been many treatment protocols using various materials such as antibiotics and calcium hydroxide medicament. In this case report, literature review about pulp revascularization and two related cases are presented.