years, 100 percent of teeth treated with this technique showed healing, which was signifi- cantly more than teeth treated with apexi- fication. Moreover, the teeth also showed greater increases in root width and length¹³.
THE FUTURE
Time will tell what the future holds for this procedure. Some speculate it eventually may replace traditional endodontics for all teeth. It already has been successfully used to treat avulsed permanent teeth in adults¹⁴. Researchers currently are evaluating new ways to deliver stem cells and scaffolds to mature teeth¹⁵. In fact, the American Associa- tion of Endodonists Foundation recently awarded $2.5 million to fund further research on regenerative endodontics. For the time being, it allows patients like little Suzie to keep teeth that might otherwise have been lost (figure 3). f
DR. STEVEN RAPHAEL is an endodontist at 417 Endodontics in Springfield, Mo. He graduated from UMKC in 2007 and finished his residency at the University of Illinois at Chicago in 2011. He uses cutting-edge technology to provide high-quality endodontic treatment to patients.
In addition to pulpal regeneration, non-surgical and surgical endodontics, he also provides oral and IV sedation when necessary for anxious patients. He can be reached at
sraphael@417endodontics.com.
REFERENCES
1. Trope M. Treatment of the immature tooth with a non- vital pulp and apical periodontitis, Dent Clin North Am 2010;54:313-24.
2. Cvek M. Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with gutta-percha. A retrospective clinical study, Endod Dent Traumatol 1992;8:45-55.
3. Frank AL. Therapy for the divergent pulpless tooth by con- tinued apical formation, J Am Dent Assoc 1966;72:87-93.
4. El-Meligy OA, Avery DR. Comparison of apexification with mineral trioxide aggregate and calcium hydroxide, Pediatr Dent 2006;28:248-53.
5. Murray PE, Garcia-Godoy F, Hargreaves KM. Regenera- tive endodontics: a review of current status and a call for action, J Endod 2007;33:377-90.
6. Nygaard-Östby B. The role of the blood clot in endodontic therapy. An experimental histologic study, Acta Odontol Scand 1961;19:324-53.
7. Iwaya SI, Ikawa M, Kubota M. Revascularization of an immature permanent tooth with apical periodontitis and sinus tract, Dent Traumatol 2001;17:185-8.
8. Hargreaves KM, Diogenes A, Teixeira F. Treatment op- tions: biological basis of regenerative endodontic procedures, J Endod 2013;39(3 Suppl):S30-43.
9. Law A. Considerations for regeneration procedures, J Endod 2013;39(3 Suppl):S44-56.
10. Windley III W, Teixeira F, Levin L, et al. Disinfection of immature teeth with a triple antibiotic paste, J Endod 2005;31:439-43.
11. Huang GT, Sonoyama W, Liu Y, et al. The hidden treasure in apical papilla: the potential role in pulp/dentin re- generation and bioroot engineering, J Endod 2008;34:645-51.
12. Geisler TM. Clinical considerations for regenerative end- odontic procedures, Dent Clin North Am 2012;56:603-26.
13. Jeeruphan T, Jantarat J, Yanpiset K, et al. Mahidol study 1: comparison of radiographic and survival outcomes of immature teeth treated with either regenerative endodontic or apexification methods: a retrospective study, J Endod 2012;38:1330-6.
14. Chen X, et al. Regenerative Endodontic Treatment of an Immature Permanent Tooth at an Early Stage of Root Devel- opment: A Case Report, J Endod 2013; 39: 719-22.
15. Huang GT, Gronthos S, Shi S. Mesenchymal stem cells derived from dental tissues vs. those from other sources: their biology and role in regenerative medicine, J Dent Res 2009;88:792-806.
16. Shah N, et al. Efficacy of Revascularization to Induce Apexification/Apexogensis in Infected, Nonvital, Immature Teeth: A Pilot Clinical Study, J Endod 2008; 34: 919-25.
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