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Sci Rep. 2017 Oct 24;7(1):13941. doi: 10.1038/s41598-017-14412-x.

Treatment of Necrotic Teeth by Apical Revascularization: Meta-analysis.

He L1,2, Zhong J1,3, Gong Q1,2, Kim SG4, Zeichner SJ5, Xiang L1,2, Ye L3, Zhou X3, Zheng J1,2, Liu Y2, Guan C2, Cheng B6, Ling J7, Mao JJ8,9,10,11.

Author information

1
Columbia University Medical Center, Center for Craniofacial Regeneration 630W. 168 St, New York, NY 10032, USA.
2
Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, 510055, China.
3
State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
4
Columbia University College of Dental Medicine, Division of Endodontics, New York, NY, USA.
5
Columbia University College of Dental Medicine, Division of Oral and Maxillofacial Radiology, New York, NY, USA.
6
Columbia University Mailman School of Public Health, Department of Biostatistics, New York, NY, USA. bc2159@cumc.columbia.edu.
7
Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, 510055, China. lingjunqi@163.com.
8
Columbia University Medical Center, Center for Craniofacial Regeneration 630W. 168 St, New York, NY 10032, USA. jmao@columbia.edu.
9
Columbia University College of Dental Medicine, Division of Oral and Maxillofacial Radiology, New York, NY, USA. jmao@columbia.edu.
10
Department of Pathology and Cell Biology, Columbia University Physician and Surgeons, 630West 168th Street 15-402, New York, NY 10032, USA. jmao@columbia.edu.
11
Department of Orthopaedic Surgery, Columbia University Physician and Surgeons, 630 West 168th Street PH10-102, New York, NY 10032, USA. jmao@columbia.edu.

Abstract

Each year ~5.4 million children and adolescents in the United States suffer from dental infections, leading to pulp necrosis, arrested tooth-root development and tooth loss. Apical revascularization, adopted by the American Dental Association for its perceived ability to enable postoperative tooth-root growth, is being accepted worldwide. The objective of the present study is to perform a meta-analysis on apical revascularization. Literature search yielded 22 studies following PRISMA with pre-defined inclusion and exclusion criteria. Intraclass correlation coefficient was calculated to account for inter-examiner variation. Following apical revascularization with 6- to 66-month recalls, root apices remained open in 13.9% cases (types I), whereas apical calcification bridge formed in 47.2% (type II) and apical closure (type III) in 38.9% cases. Tooth-root lengths lacked significant postoperative gain among all subjects (p = 0.3472) or in subgroups. Root-dentin area showed significant increases in type III, but not in types I or II cases. Root apices narrowed significantly in types II and III, but not in type I patients. Thus, apical revascularization facilitates tooth-root development but lacks consistency in promoting root lengthening, widening or apical closure. Post-operative tooth-root development in immature permanent teeth represents a generalized challenge to regenerate diseased pediatric tissues that must grow to avoid organ defects.

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