endodontic procedures (REPs) are usually used to treat human immature
permanent teeth with necrotic pulps and/or apical periodontitis.
Successful REPs result in the elimination of clinical signs/symptoms,
the resolution of apical periodontitis, and, in some cases, thickening
of the canal walls and/or continued root development with or without
apical closure. REPs can restore the vitality of tissue in the canals of
immature permanent teeth previously destroyed by infection or trauma.
Vital tissue is inherited with immune defense mechanisms to protect
itself from foreign invaders. Recently, REPs have also been used to
successfully treat human mature permanent teeth with necrotic pulps and
apical periodontitis. The purpose of this case series was to present the
potential of using REPs for mature permanent teeth with necrotic pulps
and apical periodontitis.
case series consisted of 6 patients, 4 females and 2 males. The
patients' ages ranged from 8–21 years old. Seven permanent teeth, 4
anterior and 3 molar teeth, with necrotic pulps and apical periodontitis
were treated using REP. Radiographically, the root development of all
teeth was almost completed except the apices of 2 molars, which showed
slightly open. Complete chemomechanical debridement of the canals of the
teeth was performed, and the canals were dressed with Metapaste (Meta
Biomed Co, Ltd, Chungbuk, Korea) during treatment visits. Periapical
bleeding into the canals was induced at the last treatment visit by
placing a hand #20 or #25 K-file with the tip slightly bent through the
apical foramina into the periapical tissues. A 3-mm thickness of
mineral trioxide aggregate was placed into the coronal canals over
semicoagulated blood. The access cavities were restored with either
composite resin or amalgam.
of the 7 teeth ranged from 8 to 26 months. The periapical lesions of 2
teeth were considered healed, and 5 teeth revealed healing. Clinical
signs/symptoms were absent in all teeth at follow-up visits at different
time points. None of the treated teeth responded to cold and electric
This case series shows the potential of using REPs for mature teeth with necrotic pulp and apical periodontitis.