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Publication
Procedimentos de endodontia regenerativa em dentes anteriores permanentes necrosados com ápice aberto: revisão narrativa
| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| Projeto de pós-graduação_39509 | 2.04 MB | Adobe PDF |
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Abstract(s)
A necrose pulpar pode resultar de cárie ou traumatismo, afetando especialmente os dentes anteriores permanentes imaturos, dada a sua localização e vulnerabilidade. Tradicionalmente tratados por apexificação ou Plug Apical, estes casos apresentam desafios clínicos como fragilidade das paredes radiculares e ápice aberto. A endodontia regenerativa surge como alternativa inovadora, visando não apenas preservar a estrutura dentária, mas também restaurar a vitalidade pulpar. Esta revisão narrativa, com base em literatura entre 2015 e 2024, analisa os resultados clínicos dos protocolos de regeneração aplicados em dentes necrosados com ápice aberto, comparando técnicas como Blood Clot e PRF, bem como o uso de TAP, MTA branco e CEM®. A análise dos estudos de caso evidencia que tratamentos regenerativos proporcionam desenvolvimento radicular mais completo (em comprimento e espessura), maior resistência à fratura e possível recuperação da resposta à sensibilidade pulpar. O protocolo ideal inclui: TAP com doxiciclina ou amoxicilina, MTA branco ou CEM® como selamento canalar, e PRF como vetor de regeneração. Apesar dos avanços, ainda não é possível recriar um tecido pulpar idêntico, mas sim um tecido “pulp-like” funcional.
Pulp necrosis may result from caries or trauma, particularly affecting immature permanent anterior teeth due to their position and vulnerability. Traditionally managed through apexification or apical plug techniques, these cases pose clinical challenges such as thin dentinal walls and open apices. Regenerative endodontics offers an innovative alternative aimed not only at preserving dental structure but also at restoring pulp vitality. This narrative review, based on literature from 2015 to 2024, analyzes the clinical outcomes of regenerative protocols applied to necrotic anterior teeth with open apices, comparing techniques such as Blood Clot and PRF, as well as the use of TAP, white MTA, and CEM®. Case analyses show that regenerative treatments allow for more complete root development (length and thickness), increased fracture resistance, and potential recovery of pulp sensitivity. The ideal protocol includes TAP with doxycycline or amoxicillin, white MTA or CEM® as canal sealers, and PRF as the regenerative scaffold. Despite progress, it is not yet possible to recreate true pulp tissue, but rather a functional “pulp-like” substitute.
Pulp necrosis may result from caries or trauma, particularly affecting immature permanent anterior teeth due to their position and vulnerability. Traditionally managed through apexification or apical plug techniques, these cases pose clinical challenges such as thin dentinal walls and open apices. Regenerative endodontics offers an innovative alternative aimed not only at preserving dental structure but also at restoring pulp vitality. This narrative review, based on literature from 2015 to 2024, analyzes the clinical outcomes of regenerative protocols applied to necrotic anterior teeth with open apices, comparing techniques such as Blood Clot and PRF, as well as the use of TAP, white MTA, and CEM®. Case analyses show that regenerative treatments allow for more complete root development (length and thickness), increased fracture resistance, and potential recovery of pulp sensitivity. The ideal protocol includes TAP with doxycycline or amoxicillin, white MTA or CEM® as canal sealers, and PRF as the regenerative scaffold. Despite progress, it is not yet possible to recreate true pulp tissue, but rather a functional “pulp-like” substitute.
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Keywords
Endodontia regenerativa Necrose pulpar Dente imaturo Ápice aberto MTA PRF TAP Revascularização Regenerative endodontics Pulp necrosis Immature teeth Open apex Revascularization