Dentaltown August 2019 - 81
O
ne of the recurring hot topics during residency was success: How do
you define treatment success? While most dentists would agree that
endodontic treatment success results in the prevention or reversal
of apical periodontitis/bone loss and symptoms, with trauma and
children's development "the definition of success must change," as
esteemed endodontist and trauma expert Dr. Martin Trope often says.
Historically, in cases of caries, trauma or congenital anomalies, pulp necrosis
of an immature tooth has required an apexification procedure, which involves
placement of an apical barrier and then subsequent obturation.1-3 In these cases,
the level of development at the time of pulp necrosis often results in short, thin,
weak dentinal-root walls, which can be prone to fracture later.1-3 Further, in
terms of endodontic treatment, apexification has less predictability and control
of disinfecting an "open" environment and is more challenging, compared with
the closed root system and conventional endodontics.1-3
While traditional endodontic therapy involves disinfection, debridement and
subsequent obturation of the root canal system with biologically inert material,
the goal of regeneration is for the body to replace functional, live tissue within
the diseased system.1-3 Regenerative endodontics or "regeneration" (previous
terminology has also included "revascularization") implements biologically
based procedures to form new tooth structure and replace that which has
become necrotic.2 Additional benefits of achieving this goal are continued root
development and/or apical closure (root end development) and, ultimately,
avoiding "traditional" root canal therapy.
Hence, the regenerative procedure is the ultimate "endodontic" procedure
when successful: regeneration of the pulp with root end closure, as well as
healing/absence of any periapical pathology and symptoms requiring no further
treatment. However, if signs or symptoms of disease or necrosis of the new
pulp/pulplike tissue occurs, any additional apical closure from the regenerative
endodontic procedure can promote a more predictable outcome, should root
canal therapy later be required. Therefore, even "unsuccessful" regeneration
can still be beneficial as any progress from the initial immature apex state must
be acknowledged as a victory.
dentaltown.com \\ AUGUST 2019
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Dentaltown August 2019
Table of Contents for the Digital Edition of Dentaltown August 2019
Dentaltown August 2019 - Intro
Dentaltown August 2019 - Cover1
Dentaltown August 2019 - Cover2
Dentaltown August 2019 - 1
Dentaltown August 2019 - 2
Dentaltown August 2019 - 3
Dentaltown August 2019 - 4
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Dentaltown August 2019 - Cover3
Dentaltown August 2019 - Cover4
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