lnnovative techniques for immature permanent teeth treatment – Pulp revascularization





Endodontics; Regenerative endodontics; Pulp necrosis.


The treatment of incomplete rizogenesis and pulp necrosis presents a great challenge for endodontic therapy, mainly due to the fragility of the root walls of these teeth. The main therapy chosen is pulp revascularization with the aim of replacing damaged structures, including dentin and root structures, as well as cells of the dentin-pulp complex with a tissue that allows the root formation to continue in thickness and size. These procedures have been shown to be capable of promoting continuous root development, thus increasing the thickness and strength of previously thin fracture-prone roots.  The objective of this study is to carry out a review of the literature on pulpal revascularization and the clinical importance in the treatment of teeth affected by pulpal necrosis and whose apical formation has not yet been completed. A survey was performed on the PubMed platform and included articles published between 2004 and 2020. Pulp revascularization may be considered a promising alternative as the treatment for teeth with incomplete rizogenesis and pulp necrosis, the blinds struggle with the traditional apicification process.


Al Ansary, M. A. D., Day, P. F., Duggal, M. S., & Brunton, P. A. (2009). Interventions for treating traumatized necrotic immature permanent anterior teeth: inducing a calcific barrier & root strengthening. Dental Traumatology. 25, 367-379.

American Association of Endodontists (AAE). (2016). Clinical Considerations for a Regenerative Procedure [acesso em outubro, 2017]. Disponível em http://www.aae.org/uploadedfiles/publications_and_research/research/currentregener ativeendodonticconsiderations.pdf.

Aldakak, M. M. N., Capar, I. D., Rekab, M. S., & Abboud, S. (2016). Single-Visit Pulp Revascularization of Nonvital Immature Permanent Tooth Using Biodentine. Iranian Endodontic Journal. 11 (3), 246-249.

Banchs, F., & Trope, M. (2004). Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol? Journal of Endodontics. 30(4), 196-200.

Botero, T. M., Tang, X., Gardner, R., Hu, J. C. C., Boynton, J. R., & Holland, G. R. (2017). Clinical Evidence for Regenerative Endodontic Procedures: Immediate versus Delayed Induction?. Journal of Endodontics. 43, 75-81.

Cehreli, Z. C., Isbitiren, B., Sara, S., & Erbas, G. (2011). Regenerative Endodontic Treatment (Revascularization) of Immature Necrotic Molars Medicated with Calcium Hydroxide: A Case Series. Journal of Endodontics. 37(9), 1327-1330.

Conde, M. C. M., Chisini, L.A., Sarkis-Onofre, R., Schuch, H. S., Nör, J. E., & Demarco, F. F. (2016) A Scoping review of Root Canal Revascularization: Relevant Aspects for Clinical Success and Tissue Formation. International Endodontic Journal. 50(9), 860-874.

Chen, Y., Jovani-Sancho, M. D. M., & Sheth, C. C. (2015). Is revascularization of immature permanent teeth an effective and reproducible technique?. Dental Traumatology. 31, 429-436.

Ding, R. Y., Cheung, S., Chen, J., Yin, X. Y., Wang, Q. Q., & Zhang, C. F. (2009). Pulp Revascularization of Immature Teeth With Apical Periodontitis: A Clinical Study. Journal of Endodontics. 35(5), 745-749.

Eramo, S., Natali, A., Pinna, R., & Milia, E. (2018). Dental pulp regeneration via cell homing. International Journal Endodontic. 51(4), 405-419.

Galler, K. M., D’Souza, R. N., Federlin, M., Cavender, A. C., Hartgenrink, J. D., Hecker, S., & Schmalz, G. (2011). Dentin conditioning codetermines cell fate in regenerative endodontics. J Endod . 37, 1536-41.

Galler, K. M. (2016). Clinical Procedures for Revitalization: Current Knowledge and Considerations. International Endodontic Journal. 49, 926-936.

He, L., Kim, S. G., Gong, Q., Zhong, J., Wang, S., Zhou, X., Ye, L., Ling, J., & Mao, J. J. (2017). Regenerative endodontics for adults patients. Journal of Endodontics. 43 (9S), 57-64.

Jadhav, G., Shah, N., & Logani, A. (2012). Revascularization with and without Platelet-rich Plasma in Nonvital, Immature, Anterior Teeth: A Pilot Clinical Study. Journal of Endodontics. 38(12), 1581-1587

Jeeruphan, T., Jantarat, J., Yanpiset, K., Suwannapan, L., Khewsawai, P., Hargreaves, K. M. (2012). Mahidol study 1: comparison of radiographic and survival outcomes of immature teeth treated with either regenerative endodontic or apexification methods: a retrospective study. Journal of Endodontics. 38(10), 1330-6.

JO, Farik, B., & Munksgaard, E. C. (2002). Long-term calcium hydroxide as a root canal dressing may increase risk of root fracture. Dental Traumatology. 18, 134-137.

Jung, I. Y., Lee, S. J., & Hargreaves, K. M. (2008). Biologically Based Treatment of Immature Permanent Teeth with Pulpal Necrosis: A Case Series. J Endod. 34(7), 876-887.

Koç, S., & Del Fabbro, M. (2020). Does the Etiology of Pulp Necrosis Affect Regenerative Endodontic Treatment Outcomes? A Systematic Review and Meta-analyses. J Evid Based Dent Pract. 20(1),101-400.

Lin, L. M., Shimizu, E., Gibbs, J. L., Loghin, S., & Ricucci, D. (2014). Histologic and histobacteriologic observations of failed revascularization/revitalization therapy: a case report. Journal of Endodontics. 40(2), 291-5.

Martin, D. E., De Almeida, J. F. A, Henry, M. A., Teixeira, F. B., & Diogenes, A. (2014). Concentrationdependent effect of sodium hypochlorite on stem cells of apical papilla survival and differentiation. J Endod. 40, 51-5.

Montero-Miralles, P., Martín-González, J., Alonso-Ezpeleta, O., Jiménez-Sánchez, M. C., Velasco-Ortega, E., & Segura-Egea, J. J. (2018). Effectiveness and clinical implications of the use of topical antibiotics in regenerative endodontic procedures: a review. International Journal Endodontic. 51(9), 981-988.

Moradi, S., Talati, A., Forghani, M., Jafarian, A. H., Naseri, M., & Shojaeian, S. H. (2016). Immunohistological evaluation of revascularized immature permanent necrotic teeth treated by platelet-rich plasma: an animal investigation. Cell Journal. 18(3), 389-396.

Nosrat, A., Kolahdouzan, A., Khatibi, A. H., Verma, P., Jamshidi, D., Nevins, A. J., & Torabinejad, M. (2019). Clinical, radiographic and histologic outcome of regenerartive treatment in human teeth using a novel collagen-hydroxyapatite scaffolds. Journal of Endodontics. 45:13-143.

Saoud, T. M. A, Zaazou, A., Nabil, A., Moussa, S., Lin, L. M., & Gibbs, J. L. (2014). Clinical and Radiographic Outcomes of Traumatized Immature Permanent Necrotic Teeth after Revascularization/Revitalization Therapy. Journal of Endodontics. 40(12), 1946-1952.

Soares, A. J., Lins, F. F., Nagata, J. Y., Gomes, B. P. F. A., Zaia, A. A., Ferraz, C. C. R., et al. (2013). Pulp Revascularization after Root Canal Decontamination with Calcium Hydroxide and 2% Chlorhexidine Gel. Journal of Endodontics. 39(3), 417-420.

Seghi, R. R., Nasrin, S., Draney, J., & Katsube, N. (2013) Root Fortification. Journal of Endodontics. 39(3S), S57-S62.

Silujjai, J., & Linswanont, P. (2017). Treatment Outcomes of Apexification or Revascularization in Nonvital Immature Permanent Teeth: A Retrospective Study. Journal of Endodontics. 43(2), 238-245.

Shah, N., Logani, A., Bhaskar, U., & Aggarwal, V. (2008). Efficacy of Revascularization to Induce Apexification/Apexogensis in Infected, Nonvital, Immature Teeth: A Pilot Clinical Study. Journal of Endodontics. 34(8), 919-925.

Shin, S.Y., Albert, J. S., & Mortman, R. E. (2009). One step pulp revascularization treatment of an immature permanent tooth with chronic apical abscess: a case report. International Endodontic Journal. 42, 1118–1126.

Timmerman, A., & Parashos, P. (2018). Bleaching of a Discolored Tooth with Retrieval of Remnants after Successful Regenerative Endodontics. Journal of Endodontics. 44(1), 93- 97.

Torabinejad, M., Faras, H., Corr, R., Wright, K. R., & Shabahang, S. (2014). Histologic Examinations of Teeth Treated with 2 Scaffolds: A Pilot Animal Investigation. Journal of Endodontics. 40(4), 515-520.

Verma, P., Nosrat, A., Kim, J. R., Price, J. B., Wang, P., Bair, E., et al. (2016). Effect of Residual Bacteria on the Outcome of Pulp Regeneration In Vivo. Journal of Dental Research. 96(1), 100-106.

Wigler, R., Kaufman, A. Y., Lin, S., Steinbock, N., Molina-Hazan, H., & Torneck, C. D. (2013). Revascularization: A Treatment for Permanent Teeth with Necrotic Pulp and Incomplete Root Development. Journal of Endodontics. 39(3), 319-326.

Wikström, A., Brundin, M., Lopes, M. F., El Sayed, M., & Tsilingaridis, G (2021). What is the best long-term treatment modality for immature permanent teeth with pulp necrosis and apical periodontitis? Eur Arch Paediatr Dent. 22(3), 311-340.



How to Cite

SILVA, N. A. da .; LIMA, A. A. .; PEREIRA, P. L. R. .; BUENO, C. S. P. .; OLIVEIRA, D. P. de .; SILVA, L. C. .; ESPÍNDOLA, L. C. P. .; NEVES, W. K. F. .; FAGUNDES, D. dos S. . lnnovative techniques for immature permanent teeth treatment – Pulp revascularization . Research, Society and Development, [S. l.], v. 11, n. 2, p. e14111225546, 2022. DOI: 10.33448/rsd-v11i2.25546. Disponível em: https://www.rsdjournal.org/index.php/rsd/article/view/25546. Acesso em: 24 feb. 2024.



Health Sciences