REVASCULARIZACIÓN PULPAR POR LA TÉCNICA LIBRE EN CÉLULAS EN DIENTES ANTERIORES PERMANENTES INMADUROS – REVISIÓN INTEGRATIVA DE REPORTES DE CASOS CLÍNICOS
DOI:
https://doi.org/10.47820/recima21.v6i1.6817Palabras clave:
Revascularización pulpar; dientes inmaduros; dientes anteriores; necrosis pulpar; terapia libre de células; caso clínico.Resumen
Los dientes inmaduros con necrosis pulpar representan un desafío significativo para los cirujanos dentistas debido a la fragilidad de sus paredes. En este contexto, la revascularización pulpar se presenta como una alternativa prometedora para la preservación de estos dientes a largo plazo. Sin embargo, la diversidad de técnicas, materiales y protocolos de medicación, junto con el desconocimiento de muchos profesionales, contribuye a su limitada aplicación clínica. El objetivo de este estudio fue analizar, mediante una revisión integrativa de la literatura, casos clínicos de revascularización pulpar con terapia libre de células en dientes anteriores inmaduros necróticos, identificando las prácticas clínicas asociadas con los mayores índices de éxito. La búsqueda se realizó en enero de 2025, en las bases de datos PubMed y BVS, con un recorte temporal de cinco años, utilizando la estrategia: ("Regenerative endodontic treatment" OR "revital" OR "endodontic regeneration" OR "regenerative endodontics" OR "pulp revascularization") AND ("immature" OR "open apex") AND "Case Report". Los 14 estudios seleccionados evidenciaron una tasa de éxito clínico-radiográfico del 94,4%, presentando resultados como aumento de la longitud radicular, engrosamiento de las paredes dentinarias, cierre apical y regresión de las lesiones periapicales. Se concluye que la revascularización pulpar con terapia libre de células es un enfoque eficaz, conservador y viable en la práctica clínica, incluso ante la variación de protocolos.
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Referencias
1. Grossman L. Endodontic practice. 8th ed. Lea & Febiger US, editor. Philadelphia: 1974; 1974. 435 p.
2. Lopes HP, Siqueira JF. ENDODONTIA BIOLOGIA E TÉCNICA. 4a. Elsevier; 2015. 1455–1478 p.
3. ALBUQUERQUE MTP, NAGATA JY, SOARES A de J, ZAIA AA. Pulp revascularization: an alternative treatment to the apexification of immature teeth. RGO - Revista Gaúcha de Odontologia. 2014 Dec;62(4):401–10. DOI: https://doi.org/10.1590/1981-8637201400040000082673
4. American Association of Endodontists. Guide to Clinical Endodontics [Internet]. 2013 [cited 2024 Nov 30]. Available from: https://www.aae.org/specialty/clinical-resources/guide-clinical-endodontics/
5. Murray PE. Review of guidance for the selection of regenerative endodontics, apexogenesis, apexification, pulpotomy, and other endodontic treatments for immature permanent teeth. Vol. 56, International Endodontic Journal. John Wiley and Sons Inc; 2023. p. 188–99. DOI: https://doi.org/10.1111/iej.13809
6. Silva MR da, Pereira LB. Revascularização pulpar: uma revisão narrativa da literatura. Research, Society and Development [Internet]. 2022 Dec 8;11(16):e280111638164. Available from: https://rsdjournal.org/index.php/rsd/article/view/38164 DOI: https://doi.org/10.33448/rsd-v11i16.38164
7. Friedlander LT, Cullinan MP, Love RM. Dental stem cells and their potential role in apexogenesis and apexification. Int Endod J. 2009 Nov;42(11):955–62. DOI: https://doi.org/10.1111/j.1365-2591.2009.01622.x
8. Stefanidou M, Kostenkova A, Siudikienė J, Lodienė G. Evaluation of Outcomes in Immature Teeth After Revitalization or Apexification Procedures: A Systematic Review and Meta-Analysis. Cureus. 2024 May 15; DOI: https://doi.org/10.7759/cureus.60357
9. Wei X, Yang M, Yue L, Huang D, Zhou X, Wang X, et al. Expert consensus on regenerative endodontic procedures. Vol. 14, International Journal of Oral Science. Springer Nature; 2022. DOI: https://doi.org/10.1038/s41368-022-00206-z
10. Yan H, De Deus G, Kristoffersen IM, Wiig E, Reseland JE, Johnsen GF, et al. Regenerative Endodontics by Cell Homing: A Review of Recent Clinical trials. Vol. 49, Journal of Endodontics. Elsevier Inc.; 2023. p. 4–17. DOI: https://doi.org/10.1016/j.joen.2022.09.008
11. AMERICAN ASSOCIATION OF ENDODONTISTS. AAE Clinical Considerations for Regenerative Procedures. 2021 May 18 [cited 2024 Nov 30]; Available from: https://www.aae.org/specialty/wp-content/uploads/sites/2/2021/08/ClinicalConsiderationsApprovedByREC062921.pdf
12. Lin LM, Huang GTJ, Sigurdsson A, Kahler B. Clinical cell-based versus cell-free regenerative endodontics: clarification of concept and term. Vol. 54, International Endodontic Journal. Blackwell Publishing Ltd; 2021. p. 887–901. DOI: https://doi.org/10.1111/iej.13471
13. Galler KM. European Society of Endodontology position statement: Revitalization procedures. Vol. 49, International endodontic journal. 2016. p. 926–36. DOI: https://doi.org/10.1111/iej.12606
14. Duncan HF, Kirkevang LL, Peters OA, El-Karim I, Krastl G, Del Fabbro M, et al. Treatment of pulpal and apical disease: The European Society of Endodontology (ESE) S3-level clinical practice guideline. Int Endod J. 2023 Oct 1;56(S3):238–95. DOI: https://doi.org/10.1111/iej.13974
15. Iwaya S, Ikawa M, Kubota M. Revascularization of an immature permanent tooth with apical periodontitis and sinus tract. Dental Traumatology [Internet]. 2001 Feb 21;17(4):185–7. Available from: https://onlinelibrary.wiley.com/doi/10.1034/j.1600-9657.2001.017004185.x DOI: https://doi.org/10.1034/j.1600-9657.2001.017004185.x
16. Safi L, Ravanshad S. Continued root formation of a pulpless permanent incisor following root canal treatment: a case report. Int Endod J [Internet]. 2005 Jul 7;38(7):489–93. Available from: https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2591.2005.00966.x DOI: https://doi.org/10.1111/j.1365-2591.2005.00966.x
17. Chen MYH, 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 Mar;45(3):294–305. DOI: https://doi.org/10.1111/j.1365-2591.2011.01978.x
18. Claudia GG, Tania MP, Sara QG, Carolina LF, Paula BE. Clinical, Histological, and Molecular Perspective on Regenerating Nonvital Immature Teeth. Contemp Clin Dent. 2023;14(3):220–6. DOI: https://doi.org/10.4103/ccd.ccd_44_23
19. Austah O, Joon R, Fath WM, Chrepa V, Diogenes A, Ezeldeen M, et al. Comprehensive Characterization of 2 Immature Teeth Treated with Regenerative Endodontic Procedures. J Endod. 2018 Dec 1;44(12):1802–11. DOI: https://doi.org/10.1016/j.joen.2018.09.007
20. Zhou R, Wang Y, Chen Y, Chen S, Lyu H, Cai Z, et al. Radiographic, Histologic, and Biomechanical Evaluation of Combined Application of Platelet-rich Fibrin with Blood Clot in Regenerative Endodontics. J Endod. 2017 Dec 1;43(12):2034–40. DOI: https://doi.org/10.1016/j.joen.2017.07.021
21. Cvek M. Prognosis of luxated non‐vital maxillary incisors treated with calcium hydroxide and filled with gutta‐percha. A retrospective clinical study. Dental Traumatology [Internet]. 1992 Apr 27;8(2):45–55. Available from: https://onlinelibrary.wiley.com/doi/10.1111/j.1600-9657.1992.tb00228.x DOI: https://doi.org/10.1111/j.1600-9657.1992.tb00228.x
22. Swaikat M, Faus-Matoses I, Zubizarreta-Macho Á, Ashkar I, Faus-Matoses V, Bellot-Arcís C, et al. Is Revascularization the Treatment of Choice for Traumatized Necrotic Immature Teeth? A Systematic Review and Meta-Analysis. Vol. 12, Journal of Clinical Medicine. Multidisciplinary Digital Publishing Institute (MDPI); 2023.
23. Gronthos S, Mankani M, Brahim J, Robey PG, Shi S. Postnatal human dental pulp stem cells (DPSCs) in vitro and in vivo. Proceedings of the National Academy of Sciences [Internet]. 2000 Dec 5;97(25):13625–30. Available from: https://pnas.org/doi/full/10.1073/pnas.240309797 DOI: https://doi.org/10.1073/pnas.240309797
24. Albuquerque MTP, Valera MC, Nakashima M, Nör JE, Bottino MC. Tissue-engineering-based strategies for regenerative endodontics. Vol. 93, Journal of Dental Research. SAGE Publications Inc.; 2014. p. 1222–31. DOI: https://doi.org/10.1177/0022034514549809
25. Kahler B, Rossi-Fedele G, Chugal N, Lin LM. An Evidence-based Review of the Efficacy of Treatment Approaches for Immature Permanent Teeth with Pulp Necrosis. Vol. 43, Journal of Endodontics. Elsevier Inc.; 2017. p. 1052–7. DOI: https://doi.org/10.1016/j.joen.2017.03.003
26. Araújo PR de S, Silva LB, Neto AP dos S, Almeida de Arruda JA, Álvares PR, Sobral APV, et al. Pulp Revascularization: A Literature Review. Open Dent J. 2017 Feb 10;10(1):48–56. DOI: https://doi.org/10.2174/1874210601711010048
27. BANCHS F, TROPE M. Revascularization of Immature Permanent Teeth With Apical Periodontitis: New Treatment Protocol? J Endod [Internet]. 2004 Apr;30(4):196–200. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0099239905601203 DOI: https://doi.org/10.1097/00004770-200404000-00003
28. Saad AY. Calcium hydroxide and apexogenesis. Oral Surgery, Oral Medicine, Oral Pathology [Internet]. 1988 Oct;66(4):499–501. Available from: https://linkinghub.elsevier.com/retrieve/pii/0030422088902770 DOI: https://doi.org/10.1016/0030-4220(88)90277-0
29. Galler KM, Buchalla W, Hiller KA, Federlin M, Eidt A, Schiefersteiner M, et al. Influence of root canal disinfectants on growth factor release from dentin. J Endod. 2015 Mar 1;41(3):363–8. DOI: https://doi.org/10.1016/j.joen.2014.11.021
30. Shah N, Logani A, Bhaskar U, Aggarwal V. Efficacy of Revascularization to Induce Apexification/Apexogensis in Infected, Nonvital, Immature Teeth: A Pilot Clinical Study. J Endod. 2008;34(8):919–25. DOI: https://doi.org/10.1016/j.joen.2008.05.001
31. Ramezani M, Sanaei-rad P, Hajihassani N. Revascularization and vital pulp therapy in immature molars with necrotic pulp and irreversible pulpitis: A case report with two-year follow-up. Clin Case Rep. 2020 Jan 1;8(1):206–10. DOI: https://doi.org/10.1002/ccr3.2614
32. Tavares De Souza M, Dias Da Silva M, De Carvalho R. Revisão integrativa: o que é e como fazer Integrative review: what is it? How to do it? Vol. 8. 2010.
33. Alencar MN, Kowaltschuk TC, Kowalczuck A, Carneiro E, da Silva Neto UX, Ditzel Westphalen VP. Regenerative Endodontic Treatment of a Traumatized Immature Necrotic Permanent Incisor: A Case Report. Iran Endod J [Internet]. 2022;17(3):146–50. Available from: http://www.ncbi.nlm.nih.gov/pubmed/36704083
34. S. Sakthivel, V. Gayathri, Subha Anirudhan, R. Jaya Shree Roja. Platelet-rich fibrin and collagen matrix for the regeneration of infected necrotic immature teeth. J Clin Transl Res [Internet]. 2020; Available from: https://www.jctres.com/en/06.202001.001
35. Abu Zeid ST, Edrees HY. Root fracture healing outcome after a revascularization procedure: an 8-year follow-up case report. Journal of Clinical Pediatric Dentistry. 2022 Sep 1;46(5):88–93.
36. Patra A, Gupta S, Shrivastava R, Ayub S, Langthasa M. Cone-beam Computed Tomography Evaluation Timings of Closure of Open Apex by Using Deciduous Tooth Pulp Autotransplantation for the Regenerative Endodontic Treatment of Permanent Teeth with Pulp Necrosis. Contemp Clin Dent. 2024;15(4):279–84. DOI: https://doi.org/10.4103/ccd.ccd_307_23
37. Asgary S, Parhizkar A, Samiei M. Management of an infected immature tooth with a talon cusp using regenerative endodontic treatment: A case report. Journal of Clinical Pediatric Dentistry. 2022 Nov 1;46(6):45–9. DOI: https://doi.org/10.22514/jocpd.2022.025
38. Maniglia-Ferreira C, Filho EDG, Gomes F de A, Reis SA, Pappen FG. 12-year follow-up of regenerative endodontic treatment of immature permanent upper incisors with acute abscess. Braz Dent J. 2020 Nov 1;31(6):680–4. DOI: https://doi.org/10.1590/0103-6440202003663
39. Sheikhnezami M, Azarpazhooh A, Mokhber A, Shamsian K, Bagheri M, Jafarzadeh H. The Outcome of Endodontic Regeneration in a Delayed Replanted Immature Permanent Incisor: A TurboReg Analysis of a Case. Journal of Clinical Pediatric Dentistry. 2022 Jul 13;46(3):183–7. DOI: https://doi.org/10.17796/1053-4625-46.3.2
40. Asgary S. Long-Term Success of Regenerative Endodontic Treatment in Managing Traumatized Teeth: A Case Report With Seven-Year Follow-Up. Cureus. 2024 Mar 27; DOI: https://doi.org/10.7759/cureus.57012
41. Nivedhitha MS, Jacob B, Ranganath A. Concentrated Growth Factor: A Novel Platelet Concentrate for Revascularization of Immature Permanent Teeth - A Report of Two Cases. Case Rep Dent. 2020;2020. DOI: https://doi.org/10.1155/2020/1329145
42. Kolcu M, Yurdakul H, Belli S. Regenerative Endodontic Treatment of an Immature Incisor Tooth with a Novel Platelet-Rich Product: A Five-Year Follow-Up Case Report. Niger J Clin Pract. 2023 Sep 1;26(9):1388–92. DOI: https://doi.org/10.4103/njcp.njcp_747_22
43. Alsofi L, Almarzouki S. Failed Regenerative Endodontic Case Treated by Modified Aspiration-irrigation Technique and Apexification. Journal of Contemporary Dental Practice. 2024;25(1):92–7. DOI: https://doi.org/10.5005/jp-journals-10024-3601
44. Nosrat A, Bolhari B, Saber Tahan S, Dianat O, Dummer PMH. Revitalizing previously treated teeth with open apices: A case report and a literature review. Vol. 54, International Endodontic Journal. John Wiley and Sons Inc; 2021. p. 1782–93. DOI: https://doi.org/10.1111/iej.13570
45. Petel R, Noy A. Regenerative endodontic treatment of an immature permanent canine-A case report of a 13-year follow-up. Journal of Indian Society of Pedodontics and Preventive Dentistry. 2021 Jan 1;39(1):106–9. DOI: https://doi.org/10.4103/jisppd.jisppd_1_20
46. Rivas Escobar P, Torres Ramos G, López Ramos RP. Revascularización en incisivo permanente joven no vital post traumatismo dental: Reporte de caso. Revista de Odontopediatría Latinoamericana. 2021 Jul 1;11(2). DOI: https://doi.org/10.47990/alop.v11i2.254
47. Swaikat M, Faus-Matoses I, Zubizarreta-Macho Á, Ashkar I, Faus-Matoses V, Bellot-Arcís C, et al. Is Revascularization the Treatment of Choice for Traumatized Necrotic Immature Teeth? A Systematic Review and Meta-Analysis. Vol. 12, Journal of Clinical Medicine. Multidisciplinary Digital Publishing Institute (MDPI); 2023. DOI: https://doi.org/10.3390/jcm12072656
48. Estefan BS, El Batouty KM, Nagy MM, Diogenes A. Influence of Age and Apical Diameter on the Success of Endodontic Regeneration Procedures. J Endod. 2016 Nov 1;42(11):1620–5. DOI: https://doi.org/10.1016/j.joen.2016.06.020
49. Cymerman JJ, Nosrat A. Regenerative Endodontic Treatment as a Biologically Based Approach for Non-Surgical Retreatment of Immature Teeth. J Endod. 2020 Jan 1;46(1):44–50. DOI: https://doi.org/10.1016/j.joen.2019.10.010
50. Cornélio AL. Avaliação da citotoxicidade, genotoxicidade e bioatividade de cimentos experimentais a base de silicato de cálcio com diferentes radiopacificadores e dos cimentos biodentine e mta plus. [Internet]. Araraquara; 2015 Mar [cited 2025 May 31]. Available from: https://repositorio.unesp.br/server/api/core/bitstreams/1776c37a-4d30-448e-8d05-63b1a0f5024e/content
51. Feli M, Taheri A, Mehrabani M. Revascularization of a Previously Treated Mandibular First Molar with Open Apices: A Case Report. Iran Endod J. 2024 Mar 1;19(2):120–3.
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