Clinical and radiographic outcomes of regenerative endodontic procedures for traumatized permanent necrotic teeth with apical periodontitis and external root resorption

Abstract

Aim: This clinical study was undertaken to assess the effect of treatment with regenerative endodontic procedures (REPs) on 20 teeth with pulp necrosis, apical periodontitis, and external root resorption (ERR). Methodology: Teeth were treated with REPS utilizing the American Association of Endodontists (AAE) protocol. Quantitative assessment of changes in radiographic root area (RRA) were statistically analysed to assess changes in root dimensions after an average follow-up period of 3 years. Results: All 20 teeth survived, 14 teeth (70%) were classified successful, and only 1 tooth (5%) failed throughout the study period. Based on the radiographic examination, all 20 teeth showed complete repair of the periapical lesions and arrested ERR. However, 5 teeth (25%) subsequently developed replacement resorption. The RRA between baseline and 3-year follow-up showed a significant difference for the total 20 teeth (p =.009). An analysis according to the trauma type and the extra-oral time showed the RRA increase was significantly different in the non-avulsion group (p =.015) and for the avulsion group with an extra-oral time less than 60 min (p =.029). The RRA increase was not statistically significant in the avulsion group of extra-oral time more than 60 min (p =.405). Nine teeth (45%) and 10 teeth (50%) responded to cold and electric pulp testing, respectively. Conclusions: Within the limitations of this study, the favourable outcomes of REPs were further confirmed for traumatized permanent necrotic teeth with ERR in terms of periapical lesion healed and a significant increase in RRA. The study contributes further evidence of the role of REPs in arresting ERR.