Regenerative potential of immature permanent teeth with necrotic pulps after different regenerative protocols

J Endod. 2014 Feb;40(2):192-8. doi: 10.1016/j.joen.2013.10.027. Epub 2013 Dec 15.


Introduction: Regenerative endodontics is a promising alternative treatment for immature teeth with necrotic pulps. The present study was performed to assess the regenerative potential of young permanent immature teeth with necrotic pulp after the following treatment protocols: (1) a mineral trioxide aggregate (MTA) apical plug, (2) the regenerative endodontic protocol (blood clot scaffold), and (3) the regenerative endodontic protocol with a blood clot and an injectable scaffold impregnated with basic fibroblast growth factor.

Methods: Immature necrotic permanent maxillary central incisors (n = 36) of patients 9-13 years old were divided into 3 groups according to the treatment protocol: the MTA group (MTA apical plug), the REG group (regenerative endodontic protocol [blood clot]), and the FGF group (regenerative endodontic protocol [blood clot + injectable scaffold]). Follow-up was done up to 18 months. Standardized radiographs were digitally evaluated for an increase in root length and thickness, a decrease in the apical diameter, and a change in periapical bone density.

Results: After a follow-up period of 18 months, most of the cases showed radiographic evidence of periapical healing. Groups 2 and 3 showed a progressive increase in root length and width and a decrease in apical diameter.

Conclusions: The regenerative endodontic procedure allowed the continued development of roots in teeth with necrotic pulps. The use of artificial hydrogel scaffold and basic fibroblast growth factor was not essential for repair.

Keywords: Basic fibroblast growth factor; hydrogel scaffold; mineral trioxide aggregate; regeneration; revascularization.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Aluminum Compounds / therapeutic use*
  • Anti-Bacterial Agents / administration & dosage
  • Apexification / methods*
  • Blood Coagulation / physiology
  • Bone Density / physiology
  • Calcium Compounds / therapeutic use*
  • Child
  • Ciprofloxacin / administration & dosage
  • Dental Pulp Necrosis / therapy*
  • Doxycycline / administration & dosage
  • Drug Combinations
  • Female
  • Fibroblast Growth Factor 2 / therapeutic use
  • Follow-Up Studies
  • Humans
  • Male
  • Metronidazole / administration & dosage
  • Oxides / therapeutic use*
  • Periapical Tissue / physiopathology
  • Radiography, Bitewing / methods
  • Radiography, Dental, Digital / methods
  • Regeneration / physiology*
  • Root Canal Filling Materials / therapeutic use*
  • Silicates / therapeutic use*
  • Tissue Engineering / methods*
  • Tissue Scaffolds
  • Tooth Apex / physiopathology
  • Tooth Root / physiopathology


  • Aluminum Compounds
  • Anti-Bacterial Agents
  • Calcium Compounds
  • Drug Combinations
  • Oxides
  • Root Canal Filling Materials
  • Silicates
  • mineral trioxide aggregate
  • Fibroblast Growth Factor 2
  • Metronidazole
  • Ciprofloxacin
  • Doxycycline