Innovative methods for the treatment of pulpitis in permanent teeth with unformed roots in children

Abstract

When treating pulpitis of permanent teeth with unformed roots in children, the dentist primarily relies on the knowledge of the morphological structure of their root systems. Therefore, currently, when choosing the tactics of endodontic management of such children preference is given to classical techniques, in particular - vital amputation. The latter involves necrectomy of the infected crown part of the pulp, while the root part remains intact and is covered with a therapeutic agent. This condition is necessary for the successful completion of apexification, i.e. the closure of the root apex during its development stage. A wide range of drugs that stimulate apexification is available when performing a vital amputation. The most effective of these are preparations based on calcium hydroxide, mineral trioxide aggregate (MTA) and paraformaldehyde. However, clinical experience shows that these preparations are not without significant drawbacks, the main of which is dehydration of root dentin, which contributes to the fragility of the root and therefore increases the risk of root fracture of the tooth. Furthermore, treatment with calcium-based formulations is lengthy and requires a large number of visits. To address these shortcomings, the American Association of Endodontics has proposed an alternative technique, revascularization (regenerative endodontic treatment), based on irritation of periapical tissues by intensive instrumentation of root canals to stimulate bleeding and form a blood clot containing induced stem cells and growth factors that promote apex closure. In this regard, this literature review describes clinical studies of recent years containing a comparative analysis of the most common drugs used in the treatment of pulpitis in teeth with unformed roots by the method of vital amputation, as well as the latest prospective studies containing the results of clinical application of the revascularization technique.