Thesis (M.Sc.) - Cairo University - Faculty of Oral and Dental Medicine - Department of Pedodontics

Pulp vitality is particularly critical for young permanent teeth. If during the period of root development the pulp was irreversibly damaged, by caries or trauma, further root development will not take place. This will result in teeth with open-apices, thin dentinal walls and an inappropriate crown-root ratio. Consequently, teeth will be sensitive to external forces and prone to fracture. Traditionally, in mature teeth, the therapeutic consequence is to sacrifice the pulp tissue and initiate root canal treatment to prevent further bacterial spreading. Such a technique cannot be exercised in young permanent teeth, due to lack of an apical constriction, which creates a clinical challenge. This dilemma is frequently encountered in the first permanent molar. Its early eruption makes it more prone to caries and often jeopardized when compared to other permanent teeth. As it operates an essential key role in occlusion, all efforts should be made to save this tooth. Conventional apexification technique using either Ca(OH)2 or MTA has been the recommended endodontic procedure in these cases. However, this does not promote root development; thus, treated teeth continue to be prone to fracture. Recently, revascularization has been proposed as an improved alternative treatment for irreversibly damaged pulp of immature teeth as it has been shown to preserve the potential for continued root growth in treated teeth. Accordingly, management of these cases has changed over time with a paradigm shift in the current treatment from apexification towards revascularization technique

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