• 대한치과의사협회지
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• 제54권8호
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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.

• 대한소아치과학회지
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• 제39권2호
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• pp.192-198
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• 2012

치수 재혈관화 술식은 항생제를 이용하여 근관 내 감염된 조직을 무균 상태로 만들면 치근단에 존재하는 자가 재생 능력과 다분화 능력을 가진 줄기 세포가 미완성 치근을 가진 미성숙 영구치의 치수 재생을 유도한다는 개념이 적용된 것이다. 이 술식은 치근의 길이와 두께가 증가하며 치근단의 폐쇄가 이루어진다. 비정상적으로 근관이 얇거나 만곡이 심해 전통적인 근관 치료시 어려움이 예상되는 경우, 전신 질환 등으로 인해 진정 요법을 시행하기 어려운 경우, 그리고 장애인와 같이 협조를 구하기 어려운 경우에서 치근단 치주염을 가진 미성숙 대구치의 치수 재혈관화 술식을 고려해 볼 수 있다. 본 증례는 우식으로 인해 감염된 미성숙 제1대구치의 근관 내에 ciprofloxacin, metronidazole, minocycline의 3종의 항생제를 적용하여 치수 재혈관화 술식을 시도하여 양호한 결과를 보였기에 이를 보고하고자 한다.

• Restorative Dentistry and Endodontics
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• 제44권4호
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• pp.35.1-35.10
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• 2019

Pulp revascularization is an alternative treatment in immature traumatized teeth with necrotic pulp. However, this procedure has not been reported in horizontal root fractures. This is a case report of a 9-year-old patient with multiple horizontal root fractures in 2 upper central incisors that were successfully treated with pulp revascularization. The patient presented for treatment 2 years after the initial trauma, and revascularization was attempted after the initial treatment with calcium hydroxide had failed. Prior to pulp revascularization, cone-beam computed tomography and autoradiograms demonstrated multiple horizontal fractures in the middle and apical thirds of the roots of the 2 affected teeth. Revascularization was performed in both teeth; platelet-rich plasma (PRP) was used in one tooth (#11) and the conventional method (blood clot) was used in the other tooth (#21). Clinical and radiographic follow-up over 4 years demonstrated pulp calcification in the PRP-treated tooth. Neither of the 2 teeth were lost, and the root canal calcification of tooth #11 was greater than that of tooth #21. This case suggests that PRP-based pulp revascularization may be an alternative for horizontal root fractures.

• 대한치과보존학회:학술대회논문집
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• 대한치과보존학회 2003년도 제120회 추계학술대회 제 5차 한ㆍ일 치과보존학회 공동학술대회
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• pp.586-586
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• 2003

In the infected immature tooth with periapical involvement, the pulp is considered to hardly exist in the canal and periapical area. Such a tooth receives apexification procedure, because revascularization of the pulp chamber is in principle not expected. Apexification is beneficial to induce further development of an apex to close the foramina, but does not promote the thickness of the entire canal wall dentin. It may be possible for the pulp to be only partially necrotic and infected when an extremely large communication from the pulp space to the periapical tissues exists with a very young tooth. If this were the case, vital pulp in the apical part of the canal could proliferate new pulp into the coronal pulp space by the successful removal and disinfection of the necrotic infected coronal pulp.(omitted)

• 대한소아치과학회지
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• 제49권2호
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• pp.158-169
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• 2022

본 연구의 목적은 소구치부에 발생한 치외치의 치료방법, 결과, 시기, 각 치료방법의 실패시 임상 증상과 징후 등에 대해 분석하는 것이다. 연구에는 151명의 환자와 417개의 치아가 포함되었다. 치료방법에는 예방적 치료인 레진 수복, 직접 치수복조와 근관 치료인 치수 재혈관화, 치근단 형성술, 전통적인 근관치료가 포함되었다. 예방적 레진 수복은 치외치 결절이 온전한 상태에서 성공적인 결과를 보였으며, 결절이 파절된 경우에도 효과적이었다. 직접 치수복조는 치근단 병소 없이 저작통만 존재할 때 임상 증상의 해소와 치근 성장을 보였다. 치수 재혈관화, 치근단 형성술, 전통적인 근관치료 시 가장 많이 나타난 치료 전 상태는 치근단 병소이었다. 치수 재혈관화는 대부분에서 성공적인 결과를 보였다. 하지만 일부에서 치근 길이 또는 치근벽 두께 증가가 나타나지 않은 경우가 있었다. 치근단 형성술과 전통적인 근관치료는 모두 효과적이었다. 치외치의 예방적 치료 성공률을 높이기 위해 치외치가 교합력을 받지 않을 때이거나 온전한 결절이 존재하는 상태에서 레진 수복이 시행되어야 한다. 결절이 파절된 경우 성공적인 치료를 위해서는 치근발육단계와 치수 상태가 고려되어야 한다.

• International Journal of Oral Biology
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• 제41권3호
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• pp.155-161
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• 2016

Dental pulp is a highly vascularized tissue with high regenerative potential. Revascularization of severed vasculature in the tooth is required for pulp healing during avulsed tooth treatment. In this study, the relative expression of angiogenesis-related proteins was determined in human dental pulp cells using a human angiogenesis proteome profiler array. The proteome profiler array detected differentially expressed angiogenesis-related factors under conditions of hypoxia, which enhances the angiogenic potential of dental pulp cells. We confirmed that hypoxia regulates the mRNA expression of angiogenesis-related factors, including CXCL16 in dental pulp cells. Furthermore, conditioned media of hypoxic pulp cells induced tube-like structures of vascular endothelial cells, which were reduced by the neutralization of CXCL16 function. In conclusion, our data show that angiogenesis-related factors are differentially expressed by hypoxia in dental pulp cells and suggest that CXCL16 may involve in the revascularization of hypoxic dental pulp.

• 대한치과의사협회지
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• 제51권10호
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• pp.542-550
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• 2013

The immature teeth with apical periodontitis present considerable challenges to clinicians. Therefore, new treatment protocols have been suggested to overcome the problems encountered in traditional methods. Regenerative treatment (revascularization) is one of such methods. Many case reports on the revascularization of infected immature teeth have been published, and in most of them, immature teeth with even a periapical abscess continued root formation after the disinfection of the root canal system. We now believe that this continued root formation is not an exceptional incident. As a result, it appeared that apexification has been giving way to a revascularization technique, which is a new option, in treating necrotic immature teeth. These new methods appear to be based on the healing potential of stem cells. The potential of healing or regeneration of stem cells, which are located around teeth, seems to be greater than we thought before. This review summarizes the current techniques for considering regenerative endodontic treatment procedures in treating the immature permanent tooth with pulp necrosis.

• Restorative Dentistry and Endodontics
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• 제38권3호
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• pp.178-181
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• 2013

Traumatic injuries to an immature permanent tooth may result in cessation of dentin deposition and root maturation. Endodontic treatment is often complicated in premature tooth with an uncertain prognosis. This article describes successful treatment of two traumatized maxillary central incisors with complicated crown fracture three months after trauma. The radiographic examination showed immature roots in maxillary central incisors of a 9-year-old boy with a radiolucent lesion adjacent to the right central incisor. Apexogenesis was performed for the left central incisor and revascularization treatment was considered for the right one. In 18-month clinical and radiographic follow-up both teeth were asymptomatic, roots continued to develop, and periapical radiolucency of the right central incisor healed. Considering the root development of these contralateral teeth it can be concluded that revascularization is an appropriate treatment method in immature necrotic teeth.

• 대한소아치과학회지
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• 제26권4호
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• pp.688-702
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• 1999

치아 재식 후 시간경과에 따른 치수조직의 재혈관화와 신경재지배의 변화를 관찰하기위해 생후 35일 된 흰쥐 (Sprague dawley) 56마리를 대상으로 상악우측 제 1대구치를 발치 즉시 재식한 후 1일, 2일, 3일, 1주, 2주, 4주, 6주 간격으로 희생시켜 먹물을 이용한 혈관조영술과 CGRP를 이용한 면역조직화학적방법으로 각기 시행하여 다음과 같은 결론을 얻었다. 1. 재혈관화와 CGRP 면역반응신경섬유의 재지배는 재식후 1일에서 근심측 치수조직에서는 이미 이루어졌으나 원심측은 미약했다. 재식후 2일에 전치수조직에서 재혈관화와 신경재지배가 이루어졌으며 이후 6주까지 시간경과에 따라 분포밀도가 증가하였으나 대조군에 비해서는 약하게 나타났다. 2. 재식후 1주에서부터 술후 상아질이 형성되기 시작하였으며 재식후 6주에서는 대조군에 비해 상대적으로 치수강이 좁아진 양상을 보였다. 3. 재혈관화와 신경재지배는 거의 같은 시기에 이루어지는 것으로 나타났으며 밀접한 관련성이 있는 것으로 보인다.

• 대한치과의사협회지
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• 제48권11호
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• pp.803-812
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• 2010

Regenerative endodontic procedure (REP) is a treatment option to replace damaged pulp tissue with the viable tissue which restores the normal function of the pulp-dentin complex. Possible reason for doing REP is not clearly known, however, clinicians perform REP in order to recover the histological structure as well as function of the traumatized and diseased tooth so that this tooth can restore its original root shape and thickness. This REP can be explained by the concept of revascularization or revitalization after induction of blood clot formation in the canal space. For this purpose, several treatment strategies have been suggested. In this regard, the rationale for the application of triantibiotics, calcium hydroxide or mineral trioxide aggregate is discussed in this paper. As a result, we will try to find the best method for REP by reviewing each available technique and their advantages and disadvantages.