Influence of The Use of Scaffold on The Regeneration Potential of Necrotic Immature Human Permanent Anterior Teeth: Clinical Study

Abstract

Necrotic immature permanent teeth present a problem in dentistry as no further root completion occurs, leaving open apecies that make cleaning and shaping of wide blunderbuss roots and creating an apical stop or having an apical seal in endodontic treatment difficult. Having incomplete dentin deposition, the root is more prone to fracture during mechanical filing or lateral condensation due to thin dentinal walls. Also increased tooth mobility is expected with the periodontal breakdown resulting from the poor crown-to-root ratio. Endodontic surgery and retrograde filling were used for treating such cases, but this approach is invasive and has its disadvantages as surgical complications and the already fragile root. Apexification is a technique that was firstly introduced by Kaiser, 1964 using calcium hydroxide (Ca (OH)2) and later by Torabinejad and Chivian, 1999 using mineral trioxide aggregate (MTA). It entails creating an apical stop or stimulating its formation using one of the mentioned materials. Regeneration is a technique that is more superior to apexification as it results into normal maturation of the root entirely achieving increase in root length preventing tooth mobility and increase in radicular dentinal wall thickness leading to increased root resistance to fracture (Cehreli et al., 2012). The current idea of pulp tissue regeneration incorporates two potential methodologies. The first is revascularization, where another pulp tissue is required to develop into the root canals from the excess tissues that exist apically in the root canal. The second incorporates the replacement of the infected pulp with a healthy tissue that can revive the tooth and reestablish dentin formation. Stem cell therapy, gene therapy, three-dimensional (3D) cell printing, scaffold implantation, and pulp implantation are suggested for this methodology.