Success and Complication Rates of Revascularization Procedures for Immature Necrotic Teeth: A Systematic Review

Lalitha Priya B; Neha Singh; Keshav Kumar Mangalam; Rohan Sachdev; Aishwarrya P; Harshvardhan N Jain; Puneet Kamal Nagi

doi:10.7759/cureus.51364

Success and Complication Rates of Revascularization Procedures for Immature Necrotic Teeth: A Systematic Review

Cureus. 2023 Dec 30;15(12):e51364. doi: 10.7759/cureus.51364. eCollection 2023 Dec.

Authors

Lalitha Priya B¹, Neha Singh², Keshav Kumar Mangalam², Rohan Sachdev³, Aishwarrya P⁴, Harshvardhan N Jain⁵, Puneet Kamal Nagi⁶

Affiliations

¹ Conservative Dentistry and Endodontics, Sri Ramakrishna Dental College and Hospital, Coimbatore, IND.
² Conservative Dentistry and Endodontics, Maharana Pratap Dental College and Hospital, Kanpur, IND.
³ Public Health, The University of Western Australia Dental School, Crawley, AUS.
⁴ Orthodontics and Dentofacial Orthopaedics, Sri Ramakrishna Dental College and Hospital, Coimbatore, IND.
⁵ Dentistry, Terna Dental College and Hospital, Navi Mumbai, IND.
⁶ Periodontics, Punjab Government Dental College and Hospital, Amritsar, IND.

Abstract

Frequently, adolescents exhibit instances of immature necrotic teeth, which are identifiable by their slender root walls and unclosed root tips. The lack of a natural narrowing near the root's end creates difficulty when using standard endodontic procedures, making the effective sealing of the immature root canal difficult or impractical. Revascularization therapy surfaces as a prospective strategy for addressing the management of undeveloped, non-vital, immature, necrotic teeth. Notwithstanding this, apexification continues to hold prominence in the preferences of clinicians owing to its perceived predictability in treatment outcomes. A systematic investigation was conducted involving various search engines and databases, covering the period from 2001 to 2023. The main aim of this investigation was to find randomized clinical trials that compared the efficacy of revascularization therapy to apexification for treating immature necrotic teeth. The evaluation included a thorough examination of both clinical and radiographic outcomes assessing the success rates and complications. Out of the 850 identified articles, 15 studies were chosen for comprehensive analysis. Notable dissimilarities were not identified between the revascularization therapy and apexification groups concerning parameters such as rates of periapical healing, overall effectiveness/invalidation, and apical closure. However, concentrating on measurable factors, it became clear that the revascularization treatment group displayed a notable rise in root length compared to the apexification group. Both revascularization endodontic therapy and apexification demonstrated effectiveness in addressing periapical periodontitis healing and open apex closure. Pulp revascularization stood out for its notable efficacy in enhancing root elongation and thickening, all while having a reduced likelihood of treatment being deemed ineffective overall.

Keywords: apexification; immature necrotic teeth; immature tooth; platelet-rich fibrin (prf); platelet-rich plasma (prp); regenerative endodontic treatment.

Publication types

Review