Histologic study of a human immature permanent premolar with chronic apical abscess after revascularization/revitalization

J Endod. 2014 Jan;40(1):133-9. doi: 10.1016/j.joen.2013.07.017. Epub 2013 Aug 31.

Abstract

Introduction: Histologic studies of teeth from animal models of revascularization/revitalization are available; however, specimens from human studies are lacking. The nature of tissues formed in the canal of human revascularized/revitalized teeth was not well established.

Methods: An immature mandibular premolar with infected necrotic pulp and a chronic apical abscess was treated with revascularization/revitalization procedures. At both the 18-month and 2-year follow-up visits, radiographic examination showed complete resolution of the periapical lesion, narrowing of the root apex without root lengthening, and minimal thickening of the canal walls. The revascularized/revitalized tooth was removed because of orthodontic treatment and processed for histologic examination.

Results: The large canal space of revascularized/revitalized tooth was not empty and filled with fibrous connective tissue. The apical closure was caused by cementum deposition without dentin. Some cementum-like tissue was formed on the canal dentin walls. Inflammatory cells were observed in the coronal and middle third of revascularized/revitalized tissue.

Conclusions: In the present case, the tissue formed in the canal of a human revascularized/revitalized tooth was soft connective tissue similar to that in the periodontal ligament and cementum-like or bone-like hard tissue, which is comparable with the histology observed in the canals of teeth from animal models of revascularization/revitalization.

Keywords: Bone-like tissue; cementum-like tissue; chronic apical abscess; human immature permanent tooth; revascularization/revitalization.

Publication types

  • Case Reports

MeSH terms

  • Aluminum Compounds / therapeutic use
  • Anti-Bacterial Agents / administration & dosage
  • Apexification / methods*
  • Bicuspid / pathology*
  • Blood Coagulation / physiology
  • Calcification, Physiologic / physiology
  • Calcium Compounds / therapeutic use
  • Cementogenesis / physiology
  • Child
  • Ciprofloxacin / administration & dosage
  • Connective Tissue / pathology
  • Dental Fistula / therapy
  • Dental Pulp Cavity / pathology
  • Dental Pulp Necrosis / therapy
  • Dentin / pathology
  • Drug Combinations
  • Female
  • Follow-Up Studies
  • Humans
  • Methylmethacrylates / therapeutic use
  • Metronidazole / administration & dosage
  • Minocycline / administration & dosage
  • Oxides / therapeutic use
  • Periapical Abscess / therapy*
  • Root Canal Filling Materials / therapeutic use
  • Root Canal Preparation / methods
  • Silicates / therapeutic use
  • Tooth Apex / pathology
  • Zinc Oxide-Eugenol Cement / therapeutic use

Substances

  • Aluminum Compounds
  • Anti-Bacterial Agents
  • Calcium Compounds
  • Drug Combinations
  • Methylmethacrylates
  • Oxides
  • Root Canal Filling Materials
  • Silicates
  • Zinc Oxide-Eugenol Cement
  • mineral trioxide aggregate
  • Metronidazole
  • Ciprofloxacin
  • IRM cement
  • Minocycline