In this interview with Dr. Chafic Safi Dr. Nasseh explores the modern intentional replantation technique. If you are a Pro-Member, you can watch this video on the RWE Website for 1CE Credit here: bit.ly/2a0L6TT
You really have amazing videos! I have a 9yrs old patient with an avulsed upper left central incisor, that has unfortunately became symtomatic after two months from reimplantiom and splinting(3 weeks), the apex is wide open, i would also like to avoid TAP and instead do one week intracanal medication with Ledermix and then 4 weeks of Calcium hydroxide, in an an attempt to do revascularisation, what is your view on this sequence of intracanal medication? Thank you!
Great information here. You mentioned apexification procedures aren't really carried out anymore. Can you shed some light on why that might be? I had the understanding that it's a good treatment to close the apex of a young, non-vital tooth...
Regenerative procedures are replacing apexification as a better method of getting root width instead of simply filling the roots with a root canal filling material without strengething and maturing the root. That's the reason why apexification is not as good as regeneration.
Please do a search in the literature to see whether others have used this technique with Biodentine or not. We do not use BioDentine clinically and are unable to give you constructive feedback on it.
Can you please provide us with the literature that states CaOH action against bacterial is limited .. because im doing a presentation on a similar case. Thank you very kuch
That would be apexogenesis, not revitalization. No need to do any apical instrumentation in such case. Just coronal pulpotomy and application of bioceramic on the pulpal floor after pulpal disinfection and hemostasis.
Very nice video. Thanks for sharing. This technique of revascularization shown is for immature teeth. Do you think for a mature teeth with necrotic pulp would revascularization be successful or RCT should be a preferred treatment option?
Getting revasc for mature pulps is not predictable as total sterilization/disinfeciton is unreliable and also the shortage of stem sells in the area and a closed apex make revascularizaiton more difficutl. Endodontic therapy is reocmmended for necrotic adult teeth.
Regenerative endodontic treatment can be done on mature permanent root canal treated teeth. If yes then in your known reference can suggest a endodontics clinic or hospital name for doing this treatment please reply me as soon as possible ....
can regenerative endodontics used only in immature or young teeth. it can not be used in mature teeth as the norm or apex being at least 1.5 mm was mentioned.
Doesn't have to be only young teeth. Can work in mature teeth too as long as they are easy to sterilize. Unfortunately there's no way to effectively sterilize teeth that have any complex anatomy, including isthmus, fins, and other anomalies. That's why people are using this procedure primarily in younger teeth in order to obtain additional root strength through dentin deposition.
RWE Much respect. After this great talk, I'm a little bit confused about your takes on apixification; Dr. Shafic is proapixification, while Dr. Ali is against it! Would you clarify, please! Many thanks.
Dr. Safi talked about an apexification technique while Dr. Nasseh mentioned that many apexification cases can now have regenerative procedures as an alternative to apexification. However, there are still indications for apexification technique, when regenerative procedures are not predictable due to complex anatomy such as in multi-rooted teeth. For most single rooted teeth with blunderbuss apex, a regenerative procedure is likely a better first option if the patient is willing to have the multiple appointments required to do them. Otherwise, a one step apexificaiton is likely a better option.
How can we check pulp vitality status on follow up of regenerative cases where there is no coronal pulp remaining & MTA is nonconducting barrier . Pls reply my querry. Thank you Doctor .
In some cases, EPT or even Cold Testing can induce a response if the regeneration is complete with nerve regrowth. In others, you simply have to follow up and combine the radiographic findings with patient’s clinical report of any existing symptoms. Cheers!
Nice case. I would not use TAP btw cause there are enough case reports which have been successful without using TAP. Besides you will nit have the side effects such as discoloration and allergy. And want of reasons BC instead of Proroot or Angulus MTA is prevention of discoloration ;)!
I know. That it what I also said but my point is not MTA but using TAP (triple antibiotic paste) which also can cause discoloration and I don't think medication with TAP is not necessary.
