PMC5559916_01
(a) Initial radiograph of large occlusodistal caries on tooth 36, extending to the pulp chamber and with periapical translucencies. (b) Radiograph showing triple antibiotic paste in the canal. (c) A size 15 K-file is used to irritate the apical tissue to induce bleeding. (d) Periapical radiograph of MTA over the blood clot and the pulp chamber sealed with glass ionomer, composite, and metal crown. (e) Follow-up radiograph taken 6 months after completion of treatment. By comparing this radiograph with those taken previously, the periapical radiotranslucency has decreased and there is further closure of the apical foramen. (f) Follow-up of 12 months after carrying out revascularization treatment. The periapical radiotranslucency has practically disappeared; there is further thickening of the dentinal walls and the apical foramen has almost closed.
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fig1
The patient was prescribed preliminary antibiotic treatment (Amoxicillin 50 mg/kg) (Figure 1(a)). Finally, the triple antibiotic paste (metronidazole, ciprofloxacin, and minocycline) was placed in the canal in equal proportions, mixed with sterile water, and the chamber was temporarily sealed with IRM and glass ionomer cement (Figure 1(b)). Some 2 mm of MTA was placed in the chamber part of the canal and covered by a wet cotton pellet for an hour, before final obturation with glass ionomer cement, composite, and metal crown (Figure 1(c)). At 6 and 12 months, the periapical pathology has noticeably improved, then healed, and increased dentinal wall thickness and an almost closed apical foramen can be observed (Figure 1(d)).
PMC5559916_02
(a) Periapical radiograph image, 6 months after a trauma-induced subluxation of tooth 21, shows open apex of more than 2 mm, with periapical radiotranslucency. (b) Start of revascularization treatment of tooth 21, determination of working length. (c) Chamber sealed with MTA and wet cotton pellets, waiting for it to set hard. (d) Follow-up radiograph at 3 months, the periapical radiotranslucency at tooth 21 has disappeared. (e) Seven months after completion of revascularization therapy, dentinal wall thickening can be observed at 21, with the consequent narrowing of the apical foramen. (f) One year and 7 months after completion of revascularization treatment and compared with the periapical radiograph taken when revascularization treatment ended, there is a noticeable increase in root length, similar to the adjacent central incisor, thickening of the root walls, and a closed apex.
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fig2
The patient received preliminary antibiotic treatment (Amoxicillin 50 mg/kg) (Figure 2(a)). Revascularization treatment was performed following the same protocol as before (Figures 2(b) and 2(c)). At the control visits, 3 and 7 months after completion of revascularization treatment, the radiotranslucency at 21 has disappeared, and thickening of the dentinal walls and the consequent narrowing of the apical foramen can also be observed (Figures 2(d) and 2(e)). One year and 7 months after revascularization, there is an appreciable increase in root length and root wall thickening and the apex has closed (Figure 2(f)).
PMC5559916_03
(a) Initial periapical radiograph: occlusal caries can be observed extending into the pulp chamber and radiotranslucency on the root apices. (b) A size 15 K-file is used to irritate the apical tissue and stimulate bleeding. (c) Completion of revascularization. (d) Follow-up periapical radiograph, 8 months after completion of revascularization. The periapical radiotranslucency has disappeared and the walls of the root canal have thickened; apical closure has still not taken place. This should occur at the following check-up.
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fig3
Preliminary treatment with antibiotics was prescribed (Amoxicillin 50 mg/kg) (Figure 3(a)). Revascularization treatment was carried out, following the same procedure as above (Figures 3(b) and 3(c)).
PMC5559916_04
(a) Periapical radiograph taken at the first visit, showing large occlusal caries on tooth 36 with pulp exposure, open apices, and a radiotranslucency encompassing the furcation and the distal root of the molar. (b) Size 15 K-files are used for apical irritation to induce bleeding. (c) Completion of revascularization treatment after placing the MTA and metal crown. (d) Check-up at 9 months. The radiotranslucency has completely disappeared. Obliteration of the two mesial canals can be observed.
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fig4
Tooth 36 presented occlusal caries extending into the pulp chamber and open apices, with a large radiotranslucency covering the whole of the distal root surface and the molar furcation (Figure 4(a)). The prognosis for this molar was negative, with revascularization treatment being the final option to try and save it, following the same protocol as described above (Figures 4(b) and 4(c)). Obliteration of the mesial canals can also be observed (Figure 4(d)).
(a) First visit showing occlusal caries on tooth 46 extending to the pulp chamber, with open apices. (b) Determination of working length. (c) End of revascularization therapy, having placed MTA and metal crown. (d) Follow-up radiograph. Apical closure of both roots is shown and radiotranslucencies have disappeared. A complication associated with revascularization is obliteration of the root canals that is shown here.
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fig5
In addition, 46 presented occlusal caries extending into the pulp chamber and open apices (Figure 5(a)). Revascularization treatment was performed, following the protocol described (Figures 5(b) and 5(c)). As a complication of revascularization, the obliteration of all its root canals is evident. (Figure 5(d)).