SP-25 - Management of Challenges and Mishaps Associated with Regenerative Endodontics: From Diagnosis to Prognosis

Teeth with mature apexes, necrotic pulps, and periapical lesions are routinely treated with conventional endodontic procedures with a high and long-term survival rate. Traumatic injuries associated with severance of the blood supply result in pulpal ischemia and often a secondary infection with bacteria. The consequence of pulpal necrosis in teeth with immature apexes, however, is the cessation of root development, making endodontic treatment with conventional techniques and materials difficult and sometimes impossible. Currently, treatment options for these teeth include MTA apexification, regenerative endodontics or a new tooth. MTA Apexification induces an artificial apical stop that allows for condensation of obturation materials. However, this procedure does not promote continuation of root development, nor does it increase fracture resistance of the root walls. An ideal treatment for a tooth with necrotic pulp and immature apex is the regeneration of pulp tissue into a root canal and promotion of a normal root development. The advantages of regenerative endodontic procedures (REPs) lie in the potential for reinforcement of dentinal walls by deposition of hard tissue and the potential for the development of an apical morphology more appropriate for conventional endodontic therapy if future treatment becomes necessary. The American Association of Endodontists has developed Clinical Considerations for REPs, which outlines detailed information regarding the steps involved in REPs. However, there are challenges, and mishaps that can occur during pre- treatment, mid treatment or following treatment. The presenter will discuss how to prevent and manage these challenges and Mishaps.