Three-dimensional qualitative and quantitative analyses of the effect of periradicular lesions on the outcome of regener
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ORIGINAL ARTICLE
Three-dimensional qualitative and quantitative analyses of the effect of periradicular lesions on the outcome of regenerative endodontic procedures: A prospective clinical study Heeresh Shetty 1,2 & Shishir Shetty 2 & Adesh Kakade 3 & Sayali Mali 3 & Aditya Shetty 2 & Prasanna Neelakantan 4 Received: 11 June 2020 / Accepted: 11 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objectives Qualitative and quantitative evaluation of the outcomes of regenerative endodontic procedure (REP) on human immature necrotic teeth with apical periodontitis using cone-beam computed tomography (CBCT) Materials and methods Immature permanent teeth (n = 50) with necrotic pulp and periradicular pathosis were treated with a cellhoming concept-based REP. Following the procedure, a limited field-of-view CBCT scan was obtained. At each recall session (6, 12, 18 months), clinical tests were performed, and a digital periapical radiograph was taken. When significant radiographic changes were evident in the follow-up, a final CBCT scan was taken for qualitative and quantitative assessment. These initial and follow-up CBCT scans were assessed for quantification of changes in root length, pulp space diameter and periradicular lesion size. The data were statistically analysed using t test, one-way ANOVA, post hoc test and paired t test (P = 0.05). Results Of the teeth, 94.6% were clinically successful based on the lack or regression of signs and symptoms after 48 months followup. REP resulted in a statistically significant increase in root length, decrease in pulp space diameter and periradicular radiolucency (P < 0.05). CBCT images illustrated various patterns of root maturation including an increased thickening of the canal walls and continued root maturation (37.1%), continued root development with the apical foramen remaining open (57.1%), severe calcification (obliteration) of the canal space (2.9%) and hard tissue barrier formation in the canal space between the coronal plug and the root apex (2.9%). Conclusion This study highlighted that the expected outcome of radiographic root development was less predictable when immature permanent teeth with periradicular pathosis were treated with REP. Clinical relevance The size and extent (expansion/destruction of the cortical plate) of periradicular lesions and abscesses influence the outcome of REP. These factors must be taken into consideration during treatment planning. Keywords Cone-beam computed tomography . Cell-homing approach . Immature teeth . Pulp canal calcification . Revascularization Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00784-020-03583-z) contains supplementary material, which is available to authorized users. * Prasanna Neelakantan [email protected] 1
Department of Conservative Dentistry and Endodontics, Nair Hospital Dental College, Mumbai, India
2
Department of Conservative Dentistry and Endodontics, A.B. Shetty Memorial Institute of Dental Sciences, Mangalore, India
3
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