Contemporary Clinical Dentistry
   
  Home | About us | Editorial board | Search
Ahead of print | Current Issue | Archives | Advertise
Instructions | Online submission| Contact us | Subscribe |

 

Login  | Users Online: 976  Print this pageEmail this pageSmall font sizeDefault font sizeIncrease font size 



 
 Table of Contents  
CASE REPORT
Year : 2013  |  Volume : 4  |  Issue : 3  |  Page : 412-415  

Platelet-rich fibrin-mediated revitalization of immature necrotic tooth


1 Department of Conservative Dentistry and Endodontics, All India Institute of Medical Sciences, New Delhi, India
2 Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
3 Department of Conservative Dentistry and Endodontics, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Date of Web Publication18-Sep-2013

Correspondence Address:
Isha Narang
A79, Palam Vihar, Gurgaon, Haryana
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-237X.118379

Rights and Permissions
   Abstract 

Contemporary studies have shown that the regeneration of tissues and root elongation is possible in necrotic immature permanent teeth. The purpose of this case report is to add a new vista in regenerative endodontic therapy by using platelet rich fibrin for revitalization of immature non vital tooth. An 11year old boy with the history of trauma was diagnosed with the pulpal necrosis and symptomatic apical periodontitis in tooth #21. Intra oral periapical radiograph showed open apex and associated immature supernumerary tooth with respect to tooth #21. Access preparation and minimal instrumentation was done to remove necrotic debris under copious irrigation with 2.5% sodium hypochlorite. Triple antibiotic paste was packed in the canal for four weeks. During second visit, 5 mL of whole blood was drawn from the medial cubital vein of the patient and blood was then subjected to centrifugation at 2400 rpm for 12 minutes for the preparation of Platelet rich fibrin (PRF) utilizing Choukroun's method. Triple antibiotic paste was removed and canal was dried. PRF clot was pushed to the apical region of tooth #21 using hand pluggers. Three milimetres of Mineral trioxide (MTA) was placed in cervical part of the root canal and permanent restoration was done three days later. Clinical examination at 6 and 12 months revealed no sensitivity to percussion and palpation in tooth #21and it responded positively to both electric pulp and cold tests. Radiographic examination showed resolution of periapical rarefaction, further root development and apical closure of the tooth #21 and its associated supernumerary tooth. On the basis of successful outcome of the present case it can be stated that PRF clot may serve as a scaffold for regeneration of necrotic immature teeth.

Keywords: Platelet-rich fibrin, revitalization, triple antibiotic paste


How to cite this article:
Mishra N, Narang I, Mittal N. Platelet-rich fibrin-mediated revitalization of immature necrotic tooth. Contemp Clin Dent 2013;4:412-5

How to cite this URL:
Mishra N, Narang I, Mittal N. Platelet-rich fibrin-mediated revitalization of immature necrotic tooth. Contemp Clin Dent [serial online] 2013 [cited 2019 Dec 12];4:412-5. Available from: http://www.contempclindent.org/text.asp?2013/4/3/412/118379


   Introduction Top


The contemporary non-surgical endodontic management of mature teeth has shown favorable outcome rates of 95% in teeth diagnosed with irreversible pulpitis [1] and 85% in necrotic cases. [2] But this management in necrotic immature permanent teeth offers limited predictability and has a questionable prognosis due to thin dentinal walls. [3],[4] Moreover open apex is difficult to seal either by thermo-plasticized or lateral condensation methods. [5] Traditionally such teeth were managed with apexification (Frank AL 1966 and Steiner 1968) which entailed the long-term treatment with calcium hydroxide resulting in formation of porous hard tissue apical barrier [6],[7] but it has been shown that either the short-term (Rosenberg et al., 2007) [8] or long-term (Andreason et al., 2002 and 2006) [9],[10] use of calcium hydroxide can reduce the root strength due to denaturation of collagen. This finding is consistent with the large case series by Cvek M in 1992 which showed that major reason for tooth loss following such apexification was tooth fracture. [3] To overcome the drawbacks of patient compliance and incomplete barrier, Torabinejad [11] in 2000 and Witherspoon et al.,[12] in 2000 pursued the single-step apexification using MTA. Ballesio et al.,[13] and Felippe et al.,[14] in 2006 showed that one-step apexification also does not generally result in further root development and thin dentinal walls still pose a challenge to the clinicians.

The teeth with poor crown root ratio and thin dentinal walls are more susceptible to fracture by secondary injuries and are also poor candidates for the restorative procedures. [4],[15]

Therefore, there was a paradigm shift in the treatment protocol of such teeth from apexification to regenerative procedures. [16],[17] This approach was extrapolated from successful revascularization of avulsed immature permanent teeth after replantation in animals [18] and humans. [19] Hargreaves et al., in 2008 reported that regenerative endodontic procedures are possible by application of the principles of the tissue engineering that requires the spatial orientation of stem cells, signaling molecules, and the scaffold. [20],[21] It has been reported that the remnants of Hertwig's epithelial root sheath or cell rests of Mallasez are resistant to peri-apical infections. [22] Thus, the signaling networks from these remnant cells may stimulate various stem cells like stem cells from apical papilla (SCAP), [23] bone marrow, [24] and multipotent pulp stem cells [25] to form odontoblasts-like cells in non-vital, immature, and non-infected teeth. These newly formed odontoblasts-like cells form dentine which helps in normal root maturation.

Empty canal space does not favor the stem cell proliferation and differentiation. An appropriate scaffolding is necessary to provide a spatially correct position of stem cells with growth factors. Earlier studies on regeneration used blood clot, [26] collagen, [27] and platelet-rich plasma (PRP) [28] as a scaffold. Medline search shows that platelet-rich fibrin (PRF) has never been used for revitalization of immature necrotic permanent teeth. The purpose of this case report is to add a regenerative endodontic case to the existing literature about using PRF as a scaffold.


   Case Report Top


An 11-year-old boy was referred to the department of conservative dentistry and endodontics for evaluation and treatment of left maxillary central incisor. The patient gave the history of bicycle fall 2 years ago. The medical history was non-contributory. The extraoral examination showed no significant changes. The intra-oral examination showed absence of any soft tissue abnormalities. Clinical examination of teeth revealed slight discoloration in tooth #21. It was sensitive to percussion and palpation tests. It did not respond to 1, 1, 1, 2-tetrafluoroethane (Endo-Ice; Hygenic Corp., Akron, OH, USA) and electric pulp test (Analytic Technology, Redmond, WA, USA). The adjacent teeth were caries free, asymptomatic, and tested positively. The periodontal examination of all teeth showed probing depths within normal limits. An intraoral radiograph was taken with paralleling technique using XCP positioner (extension cone paralleling technique) (Dentsply) showed an immature root with periapical pathology and open apex in tooth #21 and an associated immature supernumerary tooth [Figure 1]a. On the basis of clinical and radiographic findings, the pulpal diagnosis of necrotic pulp with symptomatic apical periodontitis was made for tooth #21. Various treatment options were explained and the parents gave the consent for regenerative endodontic procedures with the aid of PRF.

Local anesthesia was obtained by using 2% lignocaine with 1:200000 epinephrine. Access preparation was done in tooth #21 under rubber dam isolation. Minimal instrumentation was done and the canal was irrigated with 10 mL of 2.5% NaOCl. It was dried with paper points. Equal proportions of ciprofloxacin (Bayer, Leverkusen, Germany), metronidazole (Shionogi and Co, Ltd, Osaka, Japan), and minocycline (Aurobindo, Andhra Pradesh, India) were ground and mixed with distilled water to a thick paste consistency. This antibiotic mixture was placed in the canal using an amalgam carrier and packed with large endodontic pluggers. The access cavity was sealed with Cavit (ESPE, Chergy Pontoise, France). After 4 weeks, tooth #21 was asymptomatic and showed no sensitivity to percussion and palpation. A 5 ml of whole blood was collected from the median cubital vein of the patient for the preparation of PRF clot [Figure 2]a. Under rubber dam isolation, temporary restoration was removed. The triple antibiotic mixture was washed out with saline. After drying the canal with paper points, the fibrin membrane was pushed [[Figure 2]b] with Buchanan Hand Plugger Size #2 (Sybron Endo, Orange, CA) 1 mm beyond the confines of working length and coronally to the level of cementoenamel junction. Three millimetres of MTA was placed directly over the PRF clot and tooth was temporarily restored. After 72 hours, permanent restoration was done with composite (Esthet.X HD, Dentsply, UK). The patient was kept on follow-up at 6 and 12 months [[Figure 1]b and c] for re-evaluation. Tooth #21was asymptomatic and was not sensitive to percussion or palpation tests. Sensitivity tests with cold and Electric Pulp Tester elicited a positive response. Radiographic examination showed resolution of the periapical lesion, further root development and continued apical closure in tooth #21 and associated supernumerary tooth.
Figure 1: (a) Preoperative intraoral periapical radiograph. (b) Postoperative intraoral periapical radiograph at 6 months. (c) Postoperative intraoral periapical radiograph at 12 months

Click here to view
Figure 2: (a) Platelet-rich fibrin clot, (b) Platelet-rich fibrin placed in tooth #21

Click here to view



   Discussion Top


Regenerative procedure in immature teeth was introduced in the field of endodontics by Ostby in 1961 [29] and later reintroduced in 1966 by Rule and Winter. [30] It leads to apexogenesis and maturogenesis in necrotic immature permanent teeth. [31] The thickened and convergent dentinal walls add to the long-term prognosis of the tooth by increasing its fracture resistance hence in the present case this novel technique was used.

Successful revitalization of immature teeth can be accomplished after complete disinfection, placement of a matrix in the canal for tissue in-growth and bacterial tight seal of the access opening. Minimal instrumentation and copious irrigation was done with 2.5% NaOCl, to achieve disinfection. Triple antibiotic paste (TAP) [32] a mixture of ciprofloxacin, metronidazole, and minocycline was packed in the canal to achieve further reduction of microbial load.

Appropriate scaffolding is necessary to give correct spatial location to stem cells and to regulate its differentiation, proliferation, and metabolism by different growth factors. Blood clot and platelet concentrates i.e., PRP [33] and PRF [34] serve as natural scaffolds with numerous growth factors. Platelet-derived growth factor (PDGF-AB), transforming growth factor β (TGF-β), and insulin-like growth factors have been evaluated for their ability to guide the stem cells to differentiate into odontoblasts-like cells. [35]

Lance et al., in 2010 reported that platelet concentrates have increased concentration of growth factors and increase the cell proliferation over time when compared to blood clot. [36] There are several in vitro studies which supports that the direct dose-response influence of many growth factors like PDGF on cell migration, proliferation, and matrix synthesis. [37],[38]

Marx in 2009 also emphasized that biologically compromised tissues respond optimally when concentration of growth factors is enhanced. [39]

Choukroun's PRF is defined as an autologous leukocyte- and platelet-rich fibrin (L-PRF) biomaterial. [40],[41],[42] This is prepared by collection of patient's blood in specialized glass test tubes with no anticoagulants and then it is subjected to gentle centrifugation at 2400 rpm for 12 minutes resulting in division of blood sample in three layers: A base of red cells at the bottom, acellular plasma on the top, and a clot of PRF in the middle. [43] No use of anticoagulants, thrombin and calcium chloride activators leads to formation of natural clot. PRF has the characteristic of polymerizing naturally and slowly during centrifugation. This high-density fibrin clot serves as a biological matrix by supporting cell migration and cytokine release. It is advantageous as opposed to synthetic polymers and collagen when cost, inflammation, immune response, and toxicity levels are concerned. PRF produces a 210-fold higher concentration of platelets and fibrin when compared to the initial input whole blood volume. (Lucarelli et al., 2010) [44] PRF is associated with slow and continuous increase in cytokine levels. [45] Leucocytes in PRF act as anti-inflammatory agent and play key role in immune regulation. Leucocytes in clot act as anti-infectious agent, [46] immune response regulator, [47] and provides vasculoendothelial growth factor to promote angiogenesis.

This PRF clot was pressed in between two gauge pieces to form a strong membrane and it was placed in the root canal space.

It has been shown that tissue growth halts where bacteria is found. [48] Various studies have shown that MTA is superior to other materials like glass ionomer, amalgam, and composite resins with respect to marginal adaptation, bacterial leakage, and cytotoxicity. So MTA was used to provide the tight seal coronally.

Surgical contemplation of the supernumerary tooth was not undertaken considering the age of the patient. Apical closure was evident radiographically in this tooth probably due to changed microenvironment by PRF.

The successful clinical outcome in terms of regained vitality and radiographic measures of increased root length, dentinal thickness, and apical closure shows that PRF has ideal properties to be used for regenerative endodontic procedures.


   Conclusions Top


On the basis of short-term results of present case report, it is reported that PRF is potentially an ideal scaffold for regeneration of vital tissue in necrotic immature teeth. Long-term clinical trials and studies are needed to compare its efficacy with PRP and blood clot. If these studies show a significant difference then PRF may prove a boon to regenerative endodontic therapy.

 
   References Top

1.Basmadjian-charles CL, Farge P, Bourgieos DM, Lebrun T. Factors influencing the long term results of endodontic treatment: A review of the literature. Int Dent J 2002;52:81-6.  Back to cited text no. 1
    
2.Chugal N, Clive JM, Spangberg LS. Endodontic infection: Some biologic and treatment factors associated with outcome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96:81-90.  Back to cited text no. 2
    
3.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.  Back to cited text no. 3
[PUBMED]    
4.Trabert KC, Caput AA, Abou-Rass M. Tooth fracture, a comparison of endodontic and restorative treatments. J Endod 1978;4:341-5.  Back to cited text no. 4
[PUBMED]    
5.Kerezoudis NP, Valavanis D, Prountzos F. A method of adapting gutta-percha master cones for obturation of open apex cases using heat. Int Endod J 1999;32:53-60.  Back to cited text no. 5
[PUBMED]    
6.Frank AL. Therapy for the divergent pulpless tooth by continued apical formation. J Am Dent Assoc 1966;72:87-93.  Back to cited text no. 6
[PUBMED]    
7.Steiner JC, Dow PR, Cathey GM. Inducing root end closure of nonvital permanent teeth. J Dent child 1968;35:47-54.  Back to cited text no. 7
[PUBMED]    
8.Rosenberg B, Murray PE, Namerow K. The effect of calcium hydroxide root filling on dentine fracture strength. Dent Traumatol 2007;23:26-9.  Back to cited text no. 8
[PUBMED]    
9.Andreason JO, Farik B, Munksgaard EC. Long term calcium hydroxide as a root canal dressing may increase the risk of root fracture. Dent Traumatol 2002;18:134-7.  Back to cited text no. 9
    
10.Andreason JO, Munksgaard EC, Bakland LK. Comparison of fracture resistance in root canals of immature sheep teeth after filling with calcium hydroxide or MTA. Dent Traumatol 2006;22:154-6.  Back to cited text no. 10
    
11.Shabahang S, Torabinezad M. Treatment of teeth with open apices using mineral trioxide aggregate. Pract Periodontics Aesthet Dent 2000;12:315-20.  Back to cited text no. 11
    
12.Witherspoon DE, Ham K. One visit apexification: Technique for inducing root end barrier formation in apical closures. Pract Proced Aesthet Dent 2001;13:455-60.  Back to cited text no. 12
[PUBMED]    
13.Ballesio I, Marchetti E, Mummolo S, Marzo G. Radiographic appearance of apical closure in apexification: Follow up after 7-13 years. Eur J Paediatr Dent 2006;7:29-34.  Back to cited text no. 13
[PUBMED]    
14.Felippe WT, Felippe MC, Rocha MJ. The effect of mineral trioxide aggregate on the apexification and periapical healing of teeth with incomplete root foramation. Int Endod J 2006;39:2-9.  Back to cited text no. 14
[PUBMED]    
15.Deutsch AS, Musikant BL, Cavallari J, Silverstein L, Lepley J, Ohlen K et al. Root fracture during insertion of prefabricated posts related to root size. J Prosthet Dent 1985;53:786-9.  Back to cited text no. 15
    
16.Iwaya SI, Ikawa M, Kubota M. Revascularization of an immature permanent tooth with apical periodontitis and sinus tract. Dent Traumatol 2001;17:185-7.  Back to cited text no. 16
[PUBMED]    
17.Banchs F, Trope M. Revascularization of immature permanent teeth with apical periodontitis: New treatment protocol? J Endod 2004;30:196-200.  Back to cited text no. 17
[PUBMED]    
18.Cvek M, Cleaton-Jones P, Austin J, Lownie J, Kling M, Fatti P. Effect of topical application of doxycycline on pulp revascularization and periodontal healing in reimplanted monkey incisors. Endod Dent Traumatol 1990;6:170-6.  Back to cited text no. 18
[PUBMED]    
19.Kling M, Cvek M, Mejare I. Rate and predictability of pulp revascularization in therapeutically reimplanted permanent incisors. Endod Dent Traumatol 1986;2:83-9.  Back to cited text no. 19
[PUBMED]    
20.Hargreaves KM, Giesler T, Henry M, Wang Y. Regeneration potential of young permanent tooth: What does the future hold? J Endod 2008;34(7 Suppl):S51-6.  Back to cited text no. 20
    
21.Langer R, Vacanti JP. Tissue engineering. Science 1993;260:920-6.  Back to cited text no. 21
[PUBMED]    
22.Safi L, Ravanshad S. Continued root formation of pulp less permanent incisor following root canal treatment: A case report. Int Endod J 2005;38:489-93.  Back to cited text no. 22
[PUBMED]    
23.Sonoyama W, Liu Y, Fang D, Yamaza T, Seo BM, Zhang C, et al. Mesenchymal stem cell-mediated functional tooth regeneration in swine. PLoS ONE 2006;1:e79.  Back to cited text no. 23
[PUBMED]    
24.Baksh D, Song L, Tuan RS. Adult mesenchymal stem cells: Characterization, differentiation, and application in cell and gene therapy. J Cell Mol Med 2004;8:301-16.  Back to cited text no. 24
[PUBMED]    
25.Gronthos S, Brahim J, Li W, Fisher LW, Cherman N, Boyde A, et al. Stem cell properties of human dental pulp stem cells. J Dent Res 2002;81:531-5.  Back to cited text no. 25
[PUBMED]    
26.Shah N, Logani A, Bhaskar U. Efficacy of revascularization to induce apexificatio/apexogenesis in infected, Nonvital immature teeth: A pilot clinical study. J Endod 2008;34:919-25.  Back to cited text no. 26
    
27.Nevins A, Wrobel W, Valachovic R, Finkelstein F. Hard tissue induction into pulpless open-apex teeth using collagen-calcium phosphate gel. J Endod 1977;3:431-3.  Back to cited text no. 27
[PUBMED]    
28.Torabinezad M, Turman M. Revitalization of tooth with necrotic pulp and open apex by using platelet rich plasma: A case report. J Endod 2011;37:265-8.  Back to cited text no. 28
    
29.Ostby BN. The role of blood clot in endodontic therapy: An experimental histologic study. Acta Odontol Scand 1961;19:324-53.  Back to cited text no. 29
[PUBMED]    
30.Rule DC, Winter GB. Root growth and apical repair subsequent to pulpal necrosis in children. Br Dent J 1966;120:586-90.  Back to cited text no. 30
[PUBMED]    
31.Weisleder R, Benitez CR. Maturogenesis: Is it a new concept? J Endod 2003;29:776-8.  Back to cited text no. 31
[PUBMED]    
32.Hoshino E, Kurihara-Ando N, Sato I, Uematsu H, Sato M, Kota K, et al. In vitro antibacterial susceptibility of bacteria taken from infected root dentine to a mixture of ciprofloxacin, metronidazole and minocycline. Int Endod J 1996;29:125-30.  Back to cited text no. 32
[PUBMED]    
33.Marx R, Carlson E, Eichstaed R. Platelet-rich plasma: Growth factor enhancement for bone grafts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85:638-46.  Back to cited text no. 33
    
34.Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, et al. Platelet-rich fibrin(PRF): A second-generation platelet concentrate. Part I: Technological concepts and evolution. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:e37-44.  Back to cited text no. 34
    
35.Harrison P, Cramer E. "Platelet alpha-granules." Blood Rev 1993;7:52-62.  Back to cited text no. 35
    
36.Visser LC, Arnoczky SP, Caballero O, Egerbacher M. Platelet-rich fibrin constructs elute higher concentrations of transforming growth factor-β1 and increase tendon cell proliferation over time when compared to blood clots: A comparative in vitro analysis. Vet Surg 2010;39:811-7.  Back to cited text no. 36
[PUBMED]    
37.Haupt JL, Donnelly BP, Nixon AJ. Effects of platelet-derived growth factor-BB on the metabolic function and morphologic features of equine tendon in explant culture. Am J Vet Res 2006;67:1595-600.  Back to cited text no. 37
[PUBMED]    
38.Abrahamsson SO. Similar effects of recombinant human insulin-like growth factor-I and II on cellular activities in flexor tendons of young rabbits: Experimental studies in vitro. J Orthop Res 1997;15:256-62.  Back to cited text no. 38
[PUBMED]    
39.Marx RE. Platelet-rich plasma: Evidence to support its use. J Oral Maxillofac Surg 2004;62:489-96.  Back to cited text no. 39
[PUBMED]    
40.Dohan D, Rasmusson L, Albrektsson T. Classification of platelet concentrates: From pure platelet-rich plasma [PRP] to leucocyte- and platelet- rich fibrin (L-PRF). Trends Biotechnol 2009;27:158-67.  Back to cited text no. 40
    
41.Dohan D, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, et al. Platelet-rich fibrin [PRF]: A second- generation platelet concentrate. Part II: Platelet-related biologic features. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:e45-50.  Back to cited text no. 41
    
42.Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, et al. Platelet-rich fibrin (PRF): A second- generation platelet concentrate. Part III: Leucocyte activation: A new feature for platelet concentrates? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:e51-5.  Back to cited text no. 42
[PUBMED]    
43.Choukroun J, Adda F, Schoeffler C, Vervelle A. an opportunity in paro-implantology: The PRF. Implantodontie 2001;42:55-62.  Back to cited text no. 43
    
44.Lucarelli E, Beretta R, Dozza B, Tazzari PL, O'Connel SM, Ricci F, et al. A recently developed bifacial platelet rich fibrin matrix. Eur Cell Mater 2010;20:13-23.  Back to cited text no. 44
[PUBMED]    
45.Tsay R, Vo J, Burke A, Eisig S, Lu H, Landesberg R. Differential growth factor retention by platelet-rich plasma composites. J Oral Maxil Surg 2005;63:521-8.  Back to cited text no. 45
    
46.Seale NS, Glickman GN. Contemporary perspectives on vital pulp therapy: Views from the endodontists and pediatric dentists. Pediatr Dent 2008;30:261-7.  Back to cited text no. 46
[PUBMED]    
47.Thibodeau B, Trope M. Pulp revascularization of necrotic infected immature permanent tooth: A case report and review of literature. Pediatr Dent 2007;29:47-50.  Back to cited text no. 47
[PUBMED]    
48.Myers WC, Fountain SB. Dental pulp regeneration aided by blood and blood substitutes after experimentally induced periapical infection. Oral Surg Oral Med Oral Pathol 1974;37:441-50.  Back to cited text no. 48
[PUBMED]    


    Figures

  [Figure 1], [Figure 2]


This article has been cited by
1 Second-generation Platelet Concentrate (Platelet-rich Fibrin) as a Scaffold in Regenerative Endodontics: A Case Series
Hengameh Bakhtiar,Shahram Esmaeili,Setareh Fakhr Tabatabayi,Mohammad Reza Ellini,Mohammad Hossein Nekoofar,Paul M.H. Dummer
Journal of Endodontics. 2017;
[Pubmed] | [DOI]
2 Regenerative Endodontics
Kristina Feigin,Bonnie Shope
Journal of Veterinary Dentistry. 2017; 34(3): 161
[Pubmed] | [DOI]
3 Regenerative Endodontic Treatment or Mineral Trioxide Aggregate Apical Plug in Teeth with Necrotic Pulps and Open Apices: A Systematic Review and Meta-analysis
Mahmoud Torabinejad,Ali Nosrat,Prashant Verma,Oyoyo Udochukwu
Journal of Endodontics. 2017;
[Pubmed] | [DOI]
4 Influence of Apical Diameter on the Outcome of Regenerative Endodontic Treatment in Teeth with Pulp Necrosis: A Review
Yanjun Fang,Xinhuan Wang,Jingjing Zhu,Chaonan Su,Ying Yang,Liuyan Meng
Journal of Endodontics. 2017;
[Pubmed] | [DOI]
5 An Innovative Regenerative Endodontic Procedure Using Leukocyte and Platelet-rich Fibrin Associated with Apical Surgery: A Case Report
Nelson Pinto,Alexandra Harnish,Carolina Cabrera,Catherine Andrade,Tony Druttman,Claudia Brizuela
Journal of Endodontics. 2017;
[Pubmed] | [DOI]
6 Pulp and Periodontal Regeneration of an Avulsed Permanent Mature Incisor Using Platelet-rich Plasma after Delayed Replantation: A 12-month Clinical Case Study
Harini Priya M,Pavan B. Tambakad,Jaya Naidu
Journal of Endodontics. 2016; 42(1): 66
[Pubmed] | [DOI]
7 A Review of Tooth Discoloration after Regenerative Endodontic Therapy
Bill Kahler,Giampiero Rossi-Fedele
Journal of Endodontics. 2016;
[Pubmed] | [DOI]
8 A scoping review of root canal revascularization: relevant aspects for clinical success and tissue formation
M. C. M. Conde,L. A. Chisini,R. Sarkis-Onofre,H. S. Schuch,J. E. Nör,F. F. Demarco
International Endodontic Journal. 2016;
[Pubmed] | [DOI]
9 Is revascularization of immature permanent teeth an effective and reproducible technique?
Yu-Po Chen,Maria del Mar Jovani-Sancho,Chirag C. Sheth
Dental Traumatology. 2015; 31(6): 429
[Pubmed] | [DOI]
10 Evaluation of Antimicrobial Effects of Different Concentrations of Triple Antibiotic Paste on Mature Biofilm of Enterococcus faecalis
Mohammad Frough Reyhani,Saeed Rahimi,Zahra Fathi,Sahar Shakouie,Amin Salem Milani,Mohammad Hossein Soroush Barhaghi,Javad Shokri
Journal of Dental Research, Dental Clinics, Dental Prospects. 2015; 9(3): 138
[Pubmed] | [DOI]
11 Coronal Pulpotomy Technique Analysis as an Alternative to Pulpectomy for Preserving the Tooth Vitality, in the Context of Tissue Regeneration: A Correlated Clinical Study across 4 Adult Permanent Molars
Raji Viola Solomon,Umrana Faizuddin,Parupalli Karunakar,Grandhala Deepthi Sarvani,Sevvana Sree Soumya
Case Reports in Dentistry. 2015; 2015: 1
[Pubmed] | [DOI]
12 Novel use of platelet-rich fibrin matrix and MTA as an apical barrier in the management of a failed revascularization case
Pankaj Yadav,Preeti Jain Pruthi,Ruchika Roongta Naval,Sangeeta Talwar,Mahesh Verma
Dental Traumatology. 2015; : n/a
[Pubmed] | [DOI]
13 Platelet preparations in dentistry: How? Why? Where? When?
Luigi Fabrizio Rodella
World Journal of Stomatology. 2015; 4(2): 39
[Pubmed] | [DOI]
14 Regenerative Endodontic Therapy: A Data Analysis of Clinical Protocols
Evangelos G. Kontakiotis,Christos G. Filippatos,Giorgos N. Tzanetakis,Anastasia Agrafioti
Journal of Endodontics. 2014;
[Pubmed] | [DOI]
15 Levels of Evidence for the Outcome of Regenerative Endodontic Therapy
Evangelos G. Kontakiotis,Christos G. Filippatos,Anastasia Agrafioti
Journal of Endodontics. 2014;
[Pubmed] | [DOI]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Case Report
   Discussion
   Conclusions
    References
    Article Figures

 Article Access Statistics
    Viewed4536    
    Printed70    
    Emailed2    
    PDF Downloaded640    
    Comments [Add]    
    Cited by others 15    

Recommend this journal