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Oren Munwes
5th year, group 13
PULP THERAPY IN YOUNG PERMANENT DEN-TITION: A SYSTEMATIC REVIEW
Master’s Thesis
Supervisor: Sandra Petrauskienė
Kaunas, 2019
�1
LITHUANIAN UNIVERSITY OF HEALTH SCIENCES
MEDICAL ACADEMY
FACULTY OF ODONTOLOGY
CLINIC FOR PREVENTIVE AND PEDIATRIC DENTISTRY
Pulp therapy in young permanent dentition: A SYSTEMATIC REVIEW
Master’s Thesis
The thesis was done
by student ................................................ Supervisor ............................................... (signature) (signature)
..................................................... ...................................................................
.......... (name surname, year, group) (degree, name surname)
.............................. 20…. .............................. 20…. (day/month) (day/month)
Kaunas, 2019
�2
EVALUATION TABLE OF THE MASTER’S THESIS
Evaluation: ..................................................................................................................................
Reviewer: ................................................................................................................................... (scientific degree. name and surname)
Reviewing date: ...........................................
�3
No. MT parts MT evaluation aspects
Compliance with MT requirements and
evaluation
Yes Partially
No
1Summary (0.5 point)
Is summary informative and in compliance with the thesis content and requirements?
0.3 0.1 0
2 Are keywords in compliance with the thesis essence?
0.2 0.1 0
3Introduc-tion, aim and tasks (1 point)
Are the novelty, relevance and significance of the work justified in the introduction of the thesis?
0.4 0.2 0
4 Are the problem, hypothesis, aim and tasks formed clearly and properly?
0.4 0.2 0
5 Are the aim and tasks interrelated? 0.2 0.1 0
6
Selection criteria of
the studies, search
methods and
strategy (3.4 points)
Is the protocol of systemic review present? 0.6 0.3 0
7Were the eligibility criteria of articles for the selected protocol determined (e.g., year, language, publication condition, etc.)
0.4 0.2 0
8
Are all the information sources (databases with dates of coverage, contact with study authors to identify additional studies) described and is the last search day indicated?
0.2 0.1 0
9
Is the electronic search strategy described in such a way that it could be repeated (year of search, the last search day; keywords and their combinations; number of found and se lec ted a r t i c l es accord ing to the combinations of keywords)?
0.4 0.1 0
10
Is the selection process of studies (screening, eligibility, included in systemic review or, if applicable, included in the meta-analysis) described?
0.4 0.2 0
11
Is the data extraction method from the articles (types of investigations, participants, interventions, analysed factors, indexes) described?
0.4 0.2 0
12Are all the variables (for which data were s o u g h t a n d a n y a s s u m p t i o n s a n d simplifications made) listed and defined?
0.4 0.2 0
�4
13
Are the methods, which were used to evaluate the risk of bias of individual studies and how this information is to be used in data synthesis, described?
0.2 0.1 0
14 Were the principal summary measures (risk ratio, difference in means) stated?
0.4 0.2 0
15
Systemiza-tion and
analysis of data
(2.2 points)
Is the number of studies screened: included upon assessment for eligibility and excluded upon giving the reasons in each stage of exclusion presented?
0.6 0.3 0
16
Are the characteristics of studies presented in the included articles, according to which the data were extracted (e.g., study size, follow-up period, type of respondents) presented?
0.6 0.3 0
17
Are the evaluations of beneficial or harmful outcomes for each study presented? (a) simple summary data for each intervention group; b) effect estimates and confidence intervals)
0.4 0.2 0
18Are the extracted and systemized data from studies presented in the tables according to individual tasks?
0.6 0.3 0
19
Discussion (1.4 points)
Are the main findings summarized and is their relevance indicated?
0.4 0.2 0
20 Are the limitations of the performed systemic review discussed?
0.4 0.2 0
21 Does author present the interpretation of the results?
0.4 0.2 0
22Conclusion
s (0.5 points)
Do the conclusions reflect the topic, aim and tasks of the Master’s thesis?
0.2 0.1 0
23 Are the conclusions based on the analysed material?
0.2 0.1 0
24 Are the conclusions clear and laconic? 0.1 0.1 0
25
References (1 point)
Is the references list formed according to the requirements?
0.4 0.2 0
26Are the links of the references to the text correct? Are the literature sources cited correctly and precisely?
0.2 0.1 0
27 Is the scientific level of references suitable for Master’s thesis?
0.2 0.1 0
�5
28Do the cited sources not older than 10 years old form at least 70% of sources, and the not older than 5 years – at least 40%?
0.2 0.1 0
Additional sections, which may increase the collected number of points
29 Annexes Do the presented annexes help to understand the analysed topic?
+0.2 +0.1 0
30Practical
recommen-dations
Are the practical recommendations suggested and are they related to the received results?
+0.4 +0.2 0
31Were additional methods of data analysis and their results used and described (sensitivity analyses, meta-regression)?
+1 +0.5 0
32Was meta-analysis applied? Are the selected statistical methods indicated? Are the results of each meta-analysis presented?
+2 +1 0
General requirements, non-compliance with which reduce the number of points
33
General require-ments
Is the thesis volume sufficient (excluding annexes)?
15-20 pages (-2 points)
<15 pages (-5 points)
34 Is the thesis volume increased artificially?
-2 points
-1 point
35 Does the thesis structure satisfy the requirements of Master’s thesis?
-1 point -2 points
36Is the thesis written in correct language, scientifically, logically and laconically?
-0.5 point -1 points
37 Are there any grammatical, style or computer literacy-related mistakes?
-2 points
-1 points
38Is text consistent, integral, and are the volumes of its structural parts balanced?
-0.2 point-0.5
points
39 Amount of plagiarism in the thesis. >20% (not evaluated)
40
Is the content (names of sections and sub-sections and enumeration of pages) in compliance with the thesis structure and aims?
-0.2 point -0.5 points
�6
*Remark: the amount of collected points may exceed 10 points. Reviewer’s comments:
Reviewer’s name and surname Reviewer’s signature
41
Are the names of the thesis parts in compliance with the text? Are the titles of sections and sub-sections distinguished logically and correctly?
-0.2 point-0.5
points
42 Are there explanations of the key terms and abbreviations (if needed)?
-0.2 point -0.5 points
43Is the quality of the thesis typography (quality of printing, visual aids, binding) good?
-0.2 point-0.5
points
*In total (maximum 10 points):
�7
TABLE OF CONTENTS
SUMMARY ………………………………………………………….……….…10.
INTRODUCTION ………………………………………………………………11.
SELECTION CRITERIA OF THE STUDIES. SEARCH METHODS AND STRATE-
GY……………………………………………………………..…….…………..13.
SYSTEMIZATION AND ANALYSIS OF DATA ……….………….………….15.
DISCUSSION …………………………………….………………….…………20.
CONCLUSIONS ………………………….……………………………………21.
REFERENCES …………………………………………………………………22.
ANNEXES …………………………..………………………………………….27.
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ABBREVIATIONS
RPL- resolution of periapical lesions
TCW- thickening of canal walls
CRD- continued root development
AC- apical closure
PRF- plateled rich fibrin
CR- case report
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Pulp therapy in young permanent dentition
SUMMARY
Objective: to evaluate the most proper dental materials and treatment method that are used
in pulp treatment of young permanent dentition.
Material and methods. According to the PRISMA guidelines, publications of this sys-
tematic review were selected through PUBMED. The comprehensive search was restricted
to English language articles, published from 2008 to 2018. In the results it was shown 97
publications (abstracts). Later, 54 articles related to the topic were revised, of which 18
consistent with the subject of this review were qualified regarding to PICOS criteria.
Results. In total 64 patients were included. The age of patients was from 6 to 16 years old.
Overall 80 teeth were treated, mainly due to reversible or irreversible pulpitis, apical
chronic periodontitis and necrotic pulp. During treatment process sodium hypochlorite so-
lution, saline, 17% EDTA, chlorhexidine were used as irrigators; Ca(OH)2 paste, and
pastes of various antibiotics were used as intermediate material; MTA and Biodentine was
used for obturation, respectively. Mostly in all cases resolution of periapical lesion,
thichkeninf of canal walls and continued root development was recorded.
Conclusion. This systematic review relealed that partial pulpotomy is proper method in
reversible or irreversible pulpitis cases and apexofication and regenerative endodontics
was widely used in necrotic pulp or apical chronic periodontitis cases when roots are not
fully developed. While many variations of irrigation agents, intermediate agents and obtu-
ration material were applied in used treatment protocols.
Key words: Immature tooth, open apex, pulpotomy, apexofication, apexogenesis, root canal
treatment.
�10
INTRODUCTION
Root development of permanent teeth continues from 1 to 4 years after their eruption in the
mouth [1]. During this period, teeth are considered to be immature [2, 3]. Especially in young
permanent teeth with immature roots, the pulp is integral to continue apexogenesis [4]. Thus,
pulp preservation is a primary goal for restorative treatment in the young permanent dentition
[5].
When pulp of immature tooth is irreversibly damaged due to various reasons such as caries or
trauma, later root development will be arrested, apices of root will remain open and thin
dentinal walls will be observed [2, 3].Therefore, root canal treatment of immature tooth with
pulp necrosis is a unique challenge to the dentist, because conventional endodontic treatment
has traditionally been difficult to achieve in tooth with open due to the absence of apical
constriction and a potential danger of root fracture during lateral condensation [6, 2, 7].
Root canal therapy is usually done for teeth with irreversible pulpitis, even the radicular pulp
is often free of infection in order to prevent further infection development of the root canal
system [8]. Subsequently, pulpotomy is kind of a vital pulp therapy methods when the coronal
portion of the inflamed pulp is removed and the radicular pulp is preserved to ensure the pulp
vitality [9].
Pulpotomy is performed with various materials based on their biocompatibility, sealing ability
and antimicrobial efficacy on contact with pulp tissues. Various materials, like Mineral
Trioxide Aggregate (MTA), Biodentine, Calcium-Enriched Mixture (CEM) have a high
biocompatibility, sealing abilities and inducing proliferation of the pulpal cells [10].
Biodentine has shown an equal efficacy to MTA and can be considered as an alternative pulp
capping material and formation of complete dentinal bridge [11]. Biodentine has shorter
setting time better compressive strength and sealing ability than MTA [12].
Apexofication is a proper method for immature permanent teeth with non-vital pulp [13].The
main drawbacks of apexification are remained thin canal walls,weakened dentine structure
due to degradation of the proteins and arrested root development, furthermore these teeth are
susceptable to root fracture, especially when a long-term treatment of non-setting calcium hy-
droxide in non-vital immature incisors was performed [14,15,16]. Meanwhile, apexofication
�11
with mineral trioxide aggregate (MTA) requires fewer visits,but dentinal walls remains thin
and probability for a failure of further root development is present [17,18].
Revascularization procedures are defined as a better treatment option than traditional
apexification procedures due to elongation of root and thickening of lateral canal walls due to
deposition of new dentine, root maturation due to generating vital tissue [19, 20, 21].
Meanwhile, there is no standardized protocol for regenerative endodontics procedures yet
[22]. Satisfactory results are reached due to a proper disinfection of the canal, a suitable
matrix for new tissue ingrowth and an effective seal material [15]. Although the
revascularization treatment is minimally invasive, but technically is challenging for dentists
[23].
The overall success of vital pulp therapy mainly depends on which technique is performed,
the inflammatory status of the teeth, the type of the agent which is used, the success criteria,
and the period of follow-up [24].
Aim- to assess the most suitable treatment methods and used dental materials for pulp therapy
when roots of teeth are not fully developed.
Objectives:
1. To search and select the publications for analysis according to the conclusion and exclu-
sion criteria.
2. To identify the most proper treatment methods and dental materials used in cases of pulp
therapy.
3. To evaluate the efficacy of special dental materials which are used in such procedures.
�12
SELECTION CRITERIA OF THE STUDIES. SEARCH METHODS AND STRATEGY
Literature search strategy.
According to the PRISMA guidelines, publications of this systematic review were selected
through PUBMED. The flowing key words and their combinations immature tooth, open
apex, pulpotomy, apexofication, apexogenesis, root canal treatment. The comprehensive
search was restricted to English language articles, published from 2008 to 2018. One in-
vestigator carried out the selection and evaluation of articles. In the results it was shown 97
publications (abstracts). If full-content publications were not accessible without purchasing
and duplicated articles were excluded. Later, 54 articles related to the topic were revised,
of which 18 consistent with the subject of this review were qualified regarding to PICOS
criteria.
After all information’s having collected and exclusions that have been made, the gathering
information was sufficient and efficient for the research project.
Selection criteria.
Inclusion criteria for the selection were the following children needed pulp therapy for
immature permanent tooth, studies performed on humans, studies in vivo, article written in
English language, articles published in last 10 years and follow up period >1 year.
Exclusion criteria were the following pulp treatment for primary tooth, endodontic treatment
permanent tooth with fully developed roots, follow up period < 1 year, abstract, conference
proceedings, commentaries, practice guidelines, studies performed on animals.
PICOS (eligibility criteria).
Participants were included if age was under 18 years old and gender did not play any role.
Pemanent eeth were included with not fully developed roots.
Clinical examinations (palpation, percussion) and radiographic examinations as evaluation
method were used in all publications.
Intervention: pulpotomy, pulp apexofication, regenerative endodontics treatment methods.
�13
Successful outcomes- resolution of periapical lesions, thickening of root walls, apical closure
of roots, continued root formation.
Risk of bias was high in majority of articles due to a low number of participants in majority of
selected articles (Case repots). Usually, authors did not focus on comparison between differ-
ent treatment methods, success rate was based on control radiographic and clinical examina-
tion findings.
Figure 1. illustrates by a flow chart the process of filtering (PRISMA flow diagram)
�14
Identification
Eligibility
Screening
Included
Records identified through database searching in Pubmed (n-97)
Full-text articles assessed for eligibility (n-49)
Records excluded as clearly irrelevant (n-48)
Studies included in qualitative synthesis (n-18)
Records screened (n=97)
Full-text articles excluded, (n=31)
SYSTEMISATION AND ANALYSIS OF DATA
The main findings of this systematic review are presented in Table 1.
A total 18 articles were analyzed, while 16 of them were case reports and 2 clinical
studies.
Al studies were performed in vivo.
The sample of subjects (patients) ranged from 1 to 20. Age of patient varied from 6 to
16 years old.
The number of treated teeth ranged from1 to 20; and overall 80 teeth were treated.
Premolars were the most prevalent treated teeth, while pulp therapy of incisors and
molars were less common with the following diagnosis apical chronic periodontitis or
necrotic pulp. Subsequently, follow-up period ranged from 1 to 5 years.
Outcome was assessed according to healing process in control x-ray, which was de-
scribed as a continued root development, healing of periodical lesion, apical closure,
thickening of canal walls.
Considering the type of treatment, partial pulpotomy (with Ca(OH)2- 2 articles; with
MTA- 1 article), apexofication (with MTA- 2 articles; with Ca(OH)2- 2 articles) and
regenerative endodontics (11 articles). In these studies various irrigation agents were
used like saline, 1.25-5.25% NaOHCl, 0.2% or 2% chlorhexidine, and 17% EDTA
(Table 2).
Partial pulpotomy did not required any intermediate agents and teeth were restored
with Ca(OH)2 paste or MTA and crown restoration with depend on esthetics need
(amalgam or composite filling) (Table 2).
Intermediate agents were used in apexofication and regenerative endodontics methods.
Furthermore, not only Ca(OH)2 based paste was used in apexofication methods, but
antibiotics pastes(containing of ciprofloxacin, metronidazoleand minocycline)as well.
Later MTA or/and guttapercha were used as obturation materials. The most proper
crown restoration material were composite restorations (Table 2).
Articles presented cases of regenerative endodontics showed the highest range of in-
termediate agents and obturation techniques. Various compositions of antibiotics were
used as an intermediate agents and paste of ciprofloxacin, metronidazoleand minocy-
cline was the most common choice of authors. Moreover, the main principle of obtura-
�15
tion technique could be defined as blood clot formation or PRF (plateled rich fibrin)
inserting into apical part of canal and applying MTA or Biodentine above the clot. In
addition, in some cases gutta-percha was used after setting of MTA. Finally, restora-
tion material did not differ from other treatment methods and composite (with GIC or
without GIC lining), metal crowns (Table 2).
Table 1. The main descriptions of articles included into systamatic review.
Author, year
Type of study
Sample size
Age Tooth Reason Treatment method
Follow up (years)
Outcomes
Soares et al., 2012
CR 1 9 Incisor Trauma (subluxation)
Apexoficationwith Ca(OH)2
5 RPL TCW CRD
Chen et al., 2011
Clinical study
20 8-13 Premolar incisors
Apical chronic periodontitis
Regenerative endodontics
1-2.2 RPL (100%) TCW (100%) CRD (75%)
Sharma et al., 2016
CR 1 16 Incisor Apical chronic periodontitis (Trauma)
Apexoficationwith MTA
1 RPL
Kottoor et al., 2013
CR 1 11 Incisor Apical chronic periodontitis (Trauma)
Regenerative endodontics
5 TCW CRD AC
Bacaksiz et al., 2013
CR 1 11 Premolar Reversible pulpitis
Partial pulpotomy with Ca(OH)2
1 CRD AC
Kim et al., 2012
CR 3 10-12 Premolars
Apical chronic periodontitis
Regenerative endodontics
2-4 TRW (100%) CRD (33%)
Li et al., 2016
Clinical study
20 8-12 Premolars
Necrotic pulp Regenerative endodontics
1 Regained responsiveness to the pulp (25%) RPL (90%) AC (60%)
López et al., 2017
CR 5 6.5-8 Molars; Incisor
Trauma (subluxation); Symptomatic pulpitis; Apical chronic periodontitis
Regenerative endodontics
1-1.5 RPL (100%); TDW (100%); AC; Canal obliteration (40% of teeth)
�16
Raju et al., 2014
CR 1 12 Premolar Apical chronic periodontitis
Regenerative endodontics
1 TDW; AC: A mineralized bridge developed beneath the MTA
Mishra et al., 2013
CR 1 11 Incisor Apical chronic periodontitis (Trauma)
Regenerative endodontics
1 HPL; CRD; AC
Aldakaket al., 2016
CR 1 11 Premolar Pulp necrosis Regenerative endodontics
2 Complete root maturation.
Forghani et al., 2013
CR. 2 9 Incisors Apical chronic periodontitis* Irreversible pulpitis** (Trauma*,**)
Regenerative endodontics*
Pulpotomy**
1.5 RPL*; CRD*,**; AC*,**;
Sachdeva et al., 2015
CR 1 16 Incisor Necrotic pulp Regerative endodontics
3 TRW; CRD; AC
Keswaniet al., 2013
CR 1 7 Incisor Necrotic pulp (Trauma)
Regenerative endodontics
1.25 CRD; AC
Jung et al, 2008
CR 9 9-14 Premolars
Necrotic pulp; Apical chronic periodontitis
Apexofication Regenerative endodontics
1-5 RPL; TCW; CRD; AC
Tsukiboshiet al., 2017
CR 3 12 Premolars
Apical chronic periodontitis
Partial pulpotomy with Ca(OH)2p
1.3-5 RPL; TCW; AC
Topcuoglu,et al, 2016
CR 3 8-9 Molars Necrotic pulp Regerative endodontics
1.5 TCW; AC
Petrino et al., 2010
CR 6 6-13 Incisors, Premolars
Apical chronic periodontitis (trauma, in incisors)
Regenerative endodontics
1 RPL (100%). TRW (83%)
�17
Table 2. Dental materials used in different methods of pulp therapy
Treatment method
Irigation materials Intermediate agent (between visits)
Canal obturation material
Tooth restoration material
Partial pulpotomy
Partial pulpotomy with Ca(OH)2p [28, 37]
Saline [28] 2% NaOHCl [37]
Ca(OH)2paste [28] GIC and amalgam [28] Composite [37]
Pulpotomy with MTA [34]
5% NaOHCl [34] MTA [34] Composite [34]
Apexofication
Apexofication with MTA [21, 27]
NaOHCl 1.25% [27]; 5.25% [21]; 17% EDTA
Ca(OH)2 paste [21, 27]
Paste of ciprofloxacin, metronidazole, and minocycline [21]
MTA apical plug with PRF as an internal matrix and obturation with Gutta-percha using lateral obturation [21].
MTA was placed in to root canal over apical tissue [27]
Composite [21, 27]
Apexofication with Ca(OH)2 [21, 25]
2% chlorhexidine gel, saline, 17% EDTA [25]
5.25% NaOHCl [21]
Past mixture of calcium hydroxide and 2% chlorhexidine gel and zinc oxide in a 2:1:2 proportion [25]
1v- Paste of ciprofloxacin, metronidazole, and minocycline; 2v- erythromycin and Ca(OH)2, 3, 4v- Ca(OH)2p [21]
Gutta-percha [21, 25] Modeled fiber glass post and composite [25] Composite [21]
Regenerative endodontics
�18
Regenerative endodontics [3, 6, 22, 23, 26, 29, 30, 31, 32, 33, 35]
NaOHCL- 2.5% [3, 21, 22, 30, 32] 3% [29] 5% [31] 5.25% [6, 23, 26, 33, 34, 35, 36]
17% EDTA [33, 22]
0.12%chlorhexidine [23] 2% chlorhexidine [33] Saline [33, 22, 23]
Calcium hydroxide paste [26, 30]
Ciprofloxacin, metronidazole, and minocycline [6, 21, 23, 31, 32, 34, 35, 36]
Metronidazole ciprofloxacin and cefaclor [29]
Triple antibiotics paste [3]
Bleeding was induced into the canal space by K-file, coronal canal space was sealed with MTA (6, 21, 23, 26, 30, 32, 34]
Bleeding was induced into the canal space by K-file, coronal canal MTA was sealed over the blood clot, remained space of canal was obturated with Obtura II [29]
Bleeding was induced into the canal space by K-file, coronal canal space was sealed with Biodentine [33, 22]
PRF (Plateled rich fibrin) clot in the apical region and MTA in the cervical region [3, 35, 36]
Composite [22, 23, 26, 29, 32, 34, 36]
GIC and composite [6, 30, 31, 33, 35]
GIC, composite and metal crown [31]
�19
DISCUSSION
This systematic review showed that authors presented many variations of pulp
therapy in young permanent dentition. Subsequently, a partial pulpotomy as a
treatment method had the least variations in choice of materials, while apexofication
and regenerative endodontics revealed a wide range in concentration of irrigation
materials, especially sodium hypochlorite, intermadiate agents (mainly combinations
of antibiotics) and variations in obturation (with mainly MTA or Biodentine)
technique. Positive outcome was mainly defined by control rentgenography and
clinical examination.
Various endodontists‘ associations have different protocols of regenerative endodontics for
non-vital teeth pulp treatment with immature roots. For instance, American association of
endodontists (AAE) recommends at least two appointments‘ protocol, where 1.5% NaOCl is
used for irrigarion, calcium hydroxide paste or low concentration of triple antibiotic paste
(ciprofloxacin, metronidazole, minocycline) as intermediate agents and canal is obturated
with MTA above PRP or PRF or autologous fibrin matrix (AFM) and sealed with glass
ionomer cements. Sometimes bioceramics or tricalcium silicate cements are recommended
to substitute MTA for an esthetic concern [38].
Meanwhile, the European Society of Endodontology (ESE) advise several irrigators such as
1.5–3% sodium hypochlorite, later sterile physiological saline to minimize the cytotoxic
effects and 17% EDTA. Another difference than in AAE protocol is that only calcium
hydroxide is used between visits. Subsequently, during obturation procedure ESE recommend
to induce bleeding by mechanical irritation of periapical tissue, to wait for blood clot
formation for 15 min, to cover with a collagen matrix for avoiding formation of a hollow
space and ,finally, to place a hydraulic silicate cement (e.g. MTA or tricalcium silicate
cement) on top of the collagen matrix. Tooth should be restored with a glass–ionomer or
calcium hydroxide cement and adhesive restoration [39].
In this systematic review majority of authors used antibiotics pastes as an intermediate
agents, like AAE recommends.
In this systematic review any study compared results between two or more obturation
materials was not included, therefore it was impossible to compare the higher effectiveness of
�20
different materials. Some studies compared MTA effectiveness over Biodentine and found
that although MTA and biodentine as bioactive dental materials are successfully used for root
end closure of open apices, biodentine showed better initial healing while MTA had better
long-term effect [40]. Moreover, Kaur et al. concluded that MTA had same drawbacks such
as difficult manipulation, slow setting time and high cost and Biodentine has some advantages
like easier manipulation, low cost and faster setting is the major advantages of this material
when compared to MTA. Due to lack of long term observational studies, it is complicated to
distinguish which material MTA or Bio dentine is superior, however Biodentine is more
recommended for open apices then MTA [41].
The main limitations of this systematic review and that mainly only case reports were
included. Consequently, usually only susscesfull and favourable cases are published by
authors. No any study compared two different treatment methods was analysed in this
systematic review. Thus, it is not possible to state which treatment method or metarials used
for endodontics treatment for teeth with immature roots is the most proper.
CONCLUSION The most suitable treatment methods for Necrotic pulp or Apical chronic periodontitis when
the roots are not fully developed is apexofication or the newest methods- Regenerative
endodontics, the dental materials ware Ca(OH)2p, MTA or Biodentine . No differences were
found in the efficacy of the treatment. The success rate of all the materials is very high, and
even in some of the articles, 100% success rate.
�21
REFERENCES 1. Boj JR, Catalá M, García‐Ballesta C, Mendoza A, Planells P. Odontopediatría:
La evolución del niño al adulto joven [in Spanish], 1st edn. Madrid: Ripano
Editorial Médica; 2012. P. 69–84.
2. Neha K, Kansal R, Garg P, Joshi R, Garg D, Grover HS. Management of
immature teeth by dentin‐pulp regeneration: a recent approach. Med Oral Patol
Oral Cir Bucal 2011;16:e997–1004.
3. Mishra N, Narang I, Mittal N. Platelet‐rich fibrin‐mediated revitalization of
immature necrotic tooth. Contemp Clin Dent 2013;4:412–5.
4. Soni KH. Biodentine pulpotomy in mature permanent molar: A case report. J
Clin Diagn Res. 2016;10(7): ZD09-ZD11.
5. Fuks AB. Pulp therapy for the primary dentition. In:Pinkham JR, Casamassimo
PS, Fields HW Jr., McTigueDJ, Nowak A, eds. Pediatric Dentistry: Infancy
through adolescence. 5th ed. St. Louis, Mo.: Elsevier Saunders Co.; 2013:331-51.
6. Kottoor J, Velmurugan N. Revascularization for a necrotic immature permanent
lateralincisor: a case report and literature review.Int J Paediatr Dent. 2013;23(4):
310-6. doi: 10.1111/ipd.12000.
7.Andreasen JO, Farik B, Munksgaard EC. Long-term calcium hydroxide as a
root canal dressing mayincrease risk of root fracture. Dent Traumatol.
2002;18:134–7.
8. Spanberg LS. Endodontic treatment of teeth with apical periodontitis. In:
Orstavik D, Pittford T, editors. Essential Endodontology. Oxford: Blackwell
Science Ltd;1998:211-14.
9. Eghbal MJ, Asgary S, Ali Baglue R, Parirokh M, Ghoddusi J. MTA pulpotomy
of human permanent molars with irreversible pulpitis. Aust Endod J. 2009;35:4-8.
10. Sanz JL, Rodríguez-Lozano FJ, Llena C, Sauro S, Forner L. Bioactivity of
Bioceramic Materials Used in the Dentin-Pulp Complex Therapy: A Systematic
Review. Materials (Basel). 2019; 27;12(7).
11. Nowicka A, Lipski M, Parafiniuk M, Sporniak-Tutak K, Lichota D,
Kosierkiewicz A, Kaczmarek W, Buczkowska-Radlińska J. Response of human
dental pulp capped with biodentine and mineral trioxide aggregate. J Endod.
2013;39(6):743-7.
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12. Rajasekharan S, Martens L, Cauwels R, Verbeeck R. Biodentine™ material
characteristics and clinical applications: a review of the literature. Eur Arch
Paediatr Dent. 2014;15(3):147-58.
13. Rafter M. Apexification: a review. Dent Traumatol. 2005; 21, 1–8.
14. Bonte E, Beslot A, Boukpessi T, Lasfargues JJ.MTA versus Ca(OH)2 in
apexification of non-vital immature permanent teeth: a randomized clinical trial
comparison. Clin Oral Investig. 2015;19(6):1381-8.
15. Banchs F, Trope M. Revascularization of immature permanent teeth with
apical periodontitis: new treatment protocol? J Endod 2004;30:196–200.
doi: 10.1097/00004770-200404000-00003.
16. Cvek M. Prognosis of luxated non-vital maxillary incisors treated with
calciumhydroxide and filled with gutta-percha: a retrospective clinical study.
Endodontics and Dental Traumatology 1992;8, 45–55.
17. Murray PE, Garcia-Godoy F, Hargreaves K. Regenerative endodontics: a
review of current status and a call for action. J Endod 2007;33:337–90.
18. Torabinejad M, Parirokh M. Mineral trioxide aggregate: a comprehensive
literature review—Part II: Leakage and biocompatibility investigations. J Endod.
2010;36 2:190–202.
19. Yamauchi N, Yamauchi S, Nagaoka H, Duggan D, Zhong S, Lee SM, Teixeira
FB, Yamauchi M.Tissue engineering strategies for immature teeth with apical
periodontitis. J Endod. 2011;37:390–397.
20. Hargreaves K, Geisler T, Henry M, Wang Y. Regeneration potential of the
young permanent tooth: what does the future hold? J Endod 2008; 34: S51–S56.
21. Jung IY, Lee SJ, Hargreaves KM. Biologically based treatment of immature
permanent teeth with pulpal necrosis: a case series. J Endod. 2008;34(7):876-87.
doi: 10.1016/j.joen.2008.03.023.
URL: https://www.ncbi.nlm.nih.gov/pubmed/18571000
22. Topçuoğlu G, Topçuoğlu HS. Regenerative endodontic therapy in a single visit
using platelet-rich plasma and Biodentine in necrotic and asymptomatic immature
molar teeth: a report of 3 cases. J Endod. 2016;42(9):1344-6.
doi: 10.1016/j.joen.2016.06.005.
URL: https://www.ncbi.nlm.nih.gov/pubmed/27427186.
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23. Petrino JA, Boda KK, Shambarger S, Bowles WR, McClanahan SB. Challen-
ges in regenerative endodontics: a case series. J Endod. 2010;36(3):536-41. doi:
10.1016/j.joen.2009.10.006.
URL: https://www.ncbi.nlm.nih.gov/pubmed/20171379
24.Waterhouse PJ, Nunn JH, Whitworth JM, and Soames JV. Primary molar pulp
therapy - Histological evaluation of failure. Int J of Paediatric Dent ,vol. 10, no. 4,
pp. 313–321, 2000.
25. de Jesus Soares A, Yuri Nagata J, Casarin RC, Flávio Affonso de Almeida J,
Gomes BP, Augusto Zaia A, Randi Ferraz CC, José de Souza-Filho F.
Apexification with a new intra-canal medicament: A Multidisciplinary Case
Report Iran Endod J. 2012; 7(3): 165–170. URL: https://www.ncbi.nlm.nih.gov/
pmc/articles/PMC3467138/
26. Chen MY, Chen KL, Chen CA, Tayebaty F, Rosenberg PA, Lin LM.Responses
of immature permanent teeth with infected necrotic pulp tissue and apical
periodontitis/abscess to revascularization procedures. Int Endod J. 2012;45(3):
294-305. doi: 10.1111/j.1365-2591.2011.01978.x.
URL: https://www.ncbi.nlm.nih.gov/pubmed/22077958
27. Sharma V, Sharma S, Dudeja P, Grover S. Endodontic management of nonvital
permanent teeth having immature roots with one step apexification, using mineral
trioxide aggregate apical plug and autogenous platelet-rich fibrin membrane as an
internal matrix: case series. Contemp clin dent. 2016; 7(1): 67–70. doi:
10.4103/0976-237X.177107.
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4792059/
28. Bacaksiz A, Alaçam A. Induction of maturogenesis by partial pulpotomy: 1
year follow-up. Case Rep Dent. 2013; 2013:975834.
URL: http://dx.doi.org/10.1155/2013/975834
29. Kim DS, Park HJ, Yeom JH, Seo JS, Ryu GJ, Park KH, Shin SI, Kim SY.
Long-term follow-ups of revascularized immature necrotic teeth: three case
reports. Int J Oral Sci. 2012;4(2):109-13. dio:10.1038/ijos.2012.23.
URL: https://www.ncbi.nlm.nih.gov/pubmed/22627612
30. Li L, Pan Y, Mei L, Li J. Clinical and radiographic outcomes in immature
permanent necrotic evaginated teeth treated with regenerative endodontic
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procedures. J Endod. 2017;43(2):246-251. doi: 10.1016/j.joen.2016.10.015.
URL: https://www.ncbi.nlm.nih.gov/pubmed/27955921
31.López C, Mendoza A, Solano B, Yáñez-Vico R. Revascularization in immature
permanent teeth with necrotic pulp and apical pathology: case series. Case Rep
Dent. 2017;2017:3540159. doi: 10.1155/2017/3540159.
32. Raju SM, Yadav SS, Kumar M SR. Revascularization of immature mandibular
premolar with pulpal necrosis - a case report. J Clin Diagn Res.
2014;8(9):ZD29-31. doi: 10.7860/JCDR/2014/8963.4858.
URL: https://www.ncbi.nlm.nih.gov/pubmed/25386542
33. Aldakak MM, Capar ID, Rekab MS, Abboud S. Single-visit pulp
revascularization of a nonvital immature permanent tooth using Biodentine. Iran
Endod J. 2016;11(3):246-9. doi: 10.7508/iej.2016.03.020.
34. Forghani M, Parisay I, Maghsoudlou A. Apexogenesis and revascularization
treatment procedures for two traumatized immature permanent maxillary incisors:
a case report. Restor Dent Endod. 2013;38(3):178-81. doi: 10.5395/rde.
2013.38.3.178.
URL: https://www.ncbi.nlm.nih.gov/pubmed/24010086
35. Sachdeva GS, Sachdeva LT, Goel M, Bala S. Regenerative endodontic
treatment of an immature tooth with a necrotic pulp and apical periodontitis using
platlet-rich plasma (PRP) and mineral trioxide aggregate (MTA): a case report Int
Endod J. 2015;48(9):902-10. doi: 10.1111/iej.12407.
URL: https://www.ncbi.nlm.nih.gov/pubmed/25369448
36.Keswani D, Pandey RK. Revascularization of an immature tooth with a
necrotic pulp using platelet-rich fibrin: a case report. Int Endod J. 2013;46(11):
1096-104. doi: 10.1111/iej.12107.
URL: https://www.ncbi.nlm.nih.gov/pubmed/23581794
37. Tsukiboshi M, Ricucci D, Siqueira JF Jr. Mandibular premolars with immature
roots and apical periodontitis lesions treated with pulpotomy: report of 3 cases. J
Endod. 2017;43(9S):S65-S74. doi: 10.1016/j.joen.2017.06.013.
URL: https://www.ncbi.nlm.nih.gov/pubmed/28778508
38. AAE Clinical Considerations for a Regenerative Procedure Revised 4/1/2018.
39. Galler KM, Krastl G, Simon S, Van Gorp G, Meschi N, Vahedi B, Lambrechts
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P. European Society of Endodontology position statement: Revitalization
procedures. Int Endod J. 2016;49(8):717-23. doi: 10.1111/iej.12629.
40. Elumalai D, Kapoor B, Tewrai RK, Mishra SK. Comparison of mineral
trioxide aggregate and biodentine for management of open apices. J Interdiscip
Dentistry 2015;5:131-541.
41. Kaur M, Singh H, Dhillon JS, Batra M, Saini M. MTA versus Biodentine:
Review of literature with a comparative analysis. J Clin Diagn Res. 2017 Aug;
11(8): ZG01–ZG05. doi: 10.7860/JCDR/2017/25840.10374.
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5620936/
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EVALUATION FORM OF THE MASTER’S THESIS FOR THE MEMBER OF DEFENCE COMMITTEE
Graduate student
___________________________________________________________________,
of the year ______, and the group _____ of the integrated study programme of Odontology
Master’s Thesis title: …………………............................………………….……………….....
…………
…………………………………………..................................….………………….....……......
No. MT evaluation aspects
Evaluation
YesPartiall
y No
1Has the student’s presentation lasted for more than 10 minutes?
2Has the student presented the main problem of the Master’s thesis, its aim and tasks?
3Has the student provided information on research methodology and main research instruments?
4Has the student presented the received results comprehensively?
5Have the visual aids been informative and easy to understand?
6 Has the logical sequence of report been observed?
7Have the conclusions been presented? Are they resulting from the results?
8 Have the practical recommendations been presented?
9 Have the questions of the reviewer and commission’s members been answered correctly and thoroughly?
10Is the Master’s thesis in compliance with the essence of the selected study programme?
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Remarks of the member of evaluation committee of Master’s Thesis ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
Evaluation of the Master’s Thesis
_____________________________________________________________________________
Member of the MT evaluation committee:
________________ ___________________________ _____________________ (scientific degree) (name and surname) (signature)
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Protocol of systematic review
TITLE Permanent tooth pulp therapy in young permanent dentition (roots were not fully developed)in pediatrics as treatment option: a systematic review.
INTRODUCTIN
Rationale
Objectives/aim
Aim: To assess the most suitable treatment methods and used dental materials for pulp therapy when roots of teeth are not fully developed.
Objectives: - Analyzing recent clinical data and discussing different clinical key
factors that might alter or enhance success and survival rates of this treatment.
- To search and select the publications for analysis according to the conclusion and exclusion criteria.
- To identify the most proper treatment methods and dental materials used in cases of pulptherapy.
- To evaluate the efficacy of special dental materials which are used in such procedures.
METHODS
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Eligibilitycriteria
Information sources
Studyselection
Outcomes and prioritization
. PICOS: o P- Participants: Children needed pulptherapy for immature
permanent tooth o I- Intervention: partial pulpotomy, apexofication, regenerative
endodontics o C- Group of examined subjects: - immature permanent teeth
with deep caries lesions whit pulp involvement; o O- Success / Survival rate outcomes; o S- Study design selection: clinical trials and case reports
.
. Inclusion criteria: o Follow-up period >1 year. o Report characteristics: if was published over the last 10 years; o English language; o Full texts. o Study design: case report; clinical trials; o Studies performed on humans (in vivo)
.
. Exclusion criteria: o Non-full articles or inaccessible full articles unless purchased o Study design: systematic reviews o Studies mixing both children and adults, including only adults. o Lack of important data: follow-up period. o Studies in vitro, on animals, non-english, follow-up period less
than1years. o Studies in which traumatic teeth were pulp involvment.
. Electronic databases: Pubmed, ReasearchGate, Wiley Online Library.
. Keywords: dental/tooth, immature tooth, pulpotomy,apexogenesis, apexofication, regenerative endodontics, pediatric/child.
. Timeframe: June 2018 – December 2018.
. Identification phase by entering the keywords in different combinations and according inclusion criteria.
. Screening excluding duplicates;
. Eligibility according exclusion criteria: non-full texts, other study designs, articles about adult and pediatric patients, lack of relevant details.
. Double-checking articles that were included in systematic review by supervisor (Sandra Petrauskienė).
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