minocycline and Dental-Fistula

Histologic studies of teeth from animal models of revascularization/revitalization are available; however, specimens from human studies are lacking. The nature of tissues formed in the canal of human revascularized/revitalized teeth was not well established.. An immature mandibular premolar with infected necrotic pulp and a chronic apical abscess was treated with revascularization/revitalization procedures. At both the 18-month and 2-year follow-up visits, radiographic examination showed complete resolution of the periapical lesion, narrowing of the root apex without root lengthening, and minimal thickening of the canal walls. The revascularized/revitalized tooth was removed because of orthodontic treatment and processed for histologic examination.. The large canal space of revascularized/revitalized tooth was not empty and filled with fibrous connective tissue. The apical closure was caused by cementum deposition without dentin. Some cementum-like tissue was formed on the canal dentin walls. Inflammatory cells were observed in the coronal and middle third of revascularized/revitalized tissue.. In the present case, the tissue formed in the canal of a human revascularized/revitalized tooth was soft connective tissue similar to that in the periodontal ligament and cementum-like or bone-like hard tissue, which is comparable with the histology observed in the canals of teeth from animal models of revascularization/revitalization.

Topics: Aluminum Compounds; Anti-Bacterial Agents; Apexification; Bicuspid; Blood Coagulation; Calcification, Physiologic; Calcium Compounds; Cementogenesis; Child; Ciprofloxacin; Connective Tissue; Dental Fistula; Dental Pulp Cavity; Dental Pulp Necrosis; Dentin; Drug Combinations; Female; Follow-Up Studies; Humans; Methylmethacrylates; Metronidazole; Minocycline; Oxides; Periapical Abscess; Root Canal Filling Materials; Root Canal Preparation; Silicates; Tooth Apex; Zinc Oxide-Eugenol Cement

To present a case report in which the pulp of two bilateral mandibular premolars with dens evaginatus were revascularized using a modified novel technique to avoid undesired crown discolouration.. Recently, regeneration of necrotic pulps has become an alternative conservative treatment option for young permanent teeth with immature roots and is a subject of great interest in the field of endodontics. This novel procedure exploits the full potential of the pulp for dentine deposition and produces a stronger mature root that is better able to withstand the forces than can result in fracture. However, the current protocol has potential clinical and biological complications. Amongst them, crown discolouration, development of resistant bacterial strains and allergic reaction to the intracanal medication. In the case presented, a modified technique to avoid undesired crown discolouration was applied sealing the dentinal tubules of the chamber, thus avoiding any contact between the tri-antibiotic paste and the dentinal walls.. * Sealing the dentinal tubules of the chamber prevents the undesirable crown discolouration produced by tri-antibiotic medication whilst maintaining the revascularization potential of the pulp. * Further research is warranted to seek an alternative infection control protocol capable of preventing possible allergic reactions and development of resistant strains of bacteria, as well as a biological material capable of inducing angiogenesis and allow a more predictable scaffold and tissue regeneration.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Bicuspid; Child; Ciprofloxacin; Dental Fistula; Dental Pulp; Dental Pulp Necrosis; Drug Combinations; Female; Follow-Up Studies; Humans; Metronidazole; Minocycline; Neovascularization, Physiologic; Periapical Periodontitis; Root Canal Irrigants; Root Canal Preparation; Root Canal Therapy; Tooth Discoloration