Endodontic Specialists of Colorado, PC
Endodontic Specialists of Colorado, PC has realized some success in the new field of regenerative endodontics, also known as “regendo” whereby pulp and dentin tissues damaged by trauma, disease or infection are being regenerated through revascularization of necrotic root canal systems. What follows is a case from our own files.
9 y.o. male arrived with father to our office complaining of mild cold sensitivity on tooth #8. Father reported trauma 3 weeks previous. Pt slipped and fell and chipping tooth #8 and bumping #9. Both #8 and #9 were incompletely developed with open apices. Tooth #8 was repaired with composite and tooth #9 did not respond to initial cold testing at his general dentist’s office. The child had also started palatal expansion with later orthodontic treatment planned. The child was referred for endodontic evaluation of tooth #9.
At the initial evaluation in our office, tooth #8 responded normally to cold, percussion and palpation. Tooth #9 did not respond to cold or EPT. Because recent trauma can sometimes alter responses to sensitivity testing for a period of time we asked the pt to return in 3 weeks to retest.
At the second visit, tooth #9 was still non-responsive to vitality testing. Because #9 was immature with an open apex, the decision was made to access #9 and attempt a revascularization or regenerative procedure. We advised the parent and also consulted with the orthodontist that palatal expansion could continue but complete development of the root-end would ideally need to be evident prior to placing brackets for orthodontic treatment.
Local infiltration anesthesia was administered, rubber dam placed and #9 was accessed. Copious but gentle irrigation of the canal was applied with NaOCl. Next, the canal was irrigated with sterile saline followed by 0.12% CHX (Peridex). The canal was dried and then a triple antibiotic paste (mixture of 1:1:1 Ciprofloxacin, Metronidazole, Minocycline) was delivered into the canal with a Centrix syringe (CaOH has also been used in some case reports). The access was restored with Cavit. The patient was scheduled to return in 3-4 weeks.
At the second appointment, local anesthetic was administered this time with 3% Carbocaine with NO EPI. The canal was irrigated with 17% EDTA. The canal was dried with paper points and then a file was placed beyond the apex to induce bleeding into the canal. The bleeding was stopped 3mm short of canal orifice and allowed to clot. A piece of Collaplug was placed over the clot to form a barrier over the canal. 3-4mm of White MTA was placed over the Collaplug barrier and the access was restored with a bonded composite restoration.
Pt returned for a 2 week post operative follow up. Pt presented asymptomatic. Tooth #9 responded normally to cold, percussion and palpation. There was no evidence of intra/extra oral swelling or a sinus tract. Pt was scheduled for a 6 month recall appointment.
Pt returned for a 6 month recall. Pt presented asymptomatic. Tooth #9 responded normally to cold, percussion and palpation. Again there was no evident intra/extra oral swelling nor was there a sinus tract. Tooth #9 showed some root development since the last appointment. The walls of the root also showed thickening with additional length. However, complete development was not evident. We recommended waiting to place orthodontic brackets and placed pt on another 6 month recall.