From: Fred Barnett
To: ROOTS
Sent: Sunday, November 08, 2009 7:12 AM
Subject: [roots] [EinsteinResidents] #8 retreat and revasc

from a 2nd yr resident....cool case.....fingers crossed!! - Fred

Pt presented with a history of trauma 4 years ago
The 2 pink sticks and a golden screw were stuck in by a dentist soon after.
He presented with a chronic periapical abscess w/ sinus tract.
Easy retreat with braided hedstrom technique...or a variant of it.
Apex was severely resorbed and using light speed files was gauged to be >#120.
A quick glance over to Dr B, and next thing I know I was being handed over bimix paste by Lorie!
Pt returned 4 weeks later with the sinus tract resolved.
Getting a heme scaffold all the way up the canal was real easy.
MTA cervical seal+Triage and a Luxacore build-up were used to restore the tooth.
Lets see if this works. Herodontics, anyone? - Bilal






can you explain me what is revascularization? as far as i understood  you allow fresh blood to clot
in the canal and initiate new blood vessels to grow in the tooth  and completing the apexogenesis
process naturally. but in this case since its a periapical abscess don't you expect some bacteria
inside the canal? how do you manage it? kindly explain me  - Dr.kishore nallapati.

Hi Pavan, Revascularization is where you create a blood clot in the canal.The clot then acts as a
scaffold or fibrin matrix on which cells get trapped and can lead to regeneration. Well wht type of
cells are there, nobody knows...some authors/researchers feel that the cells are from the periodontoum..
.so that is a big question.

Prior to attempting the revasc procedure, you need to disinfect the canal space. This is done with
the use of copious amounts of Hypo and the Triple Antibiotic paste (Ciprofloxacin+Metranidazole+Minocycline).
But during the entire prep, you do not mechnically instrument the canal. Hope this a a little helpful

For more papers on revascularization check out Dr. Robert Kaufmann's site...there is a gold mine of
literature on revascularization & regenerative endodontics - Trishul

how does this compare/contrast to apexigenesis....can CaOH or MTA be used instead -	Joseph A Belsito

Giving it my best shot, but correct me if i am wrong .......Apexogenesis is the physiologic process of
root formation where apexification is when root formation has been induced.
Well when you use CaOH or MTA its just apexification. Its where a hard tissue barrier is formed
which offers you an apical stop/barrier against which you can backfill with guttapercha. Some of the
disadvantages seen when this is done is
1) Time factor - With CaOH u need to wait atleast 4 to 6 months for the apical barrier to form
2) Long term use of CaOH results in the weaking of the dentin (Andreasen Study,2002), and hence
   suceptibilty to root fractures    increases even after filling with guttapercha
3) MTA does not result in apxification, it just provides u with an apical barrier against which you can
   backfill.This still leaves you with the basic problem, where you are left with thin dentinal walls,
   which are again suceptible to fracture.

In revascularization you just create a disinfected space using a triple paste,which is then filled with a
blood clot. This provides a matrix which allows cellular growth and results in normal/healthy root development.
MTA IS used when revascularization is carried out, it is used as a coronal seal upon which a suitable
access restoration can be placed. Well it can be seen in the photo's posted Dr.Barnett in the previous mail.
- Trishul

Hi , Similar to apexogenesis,But use 3mix paste intead of CaOH2 as dressing.1st visit -irrigation with
hypochlorite,3mix paste.3 weeks later initiate bleeding and MTA plug at CEJ level.Calcium hydroxide use is
avoided because of possible damage to Hertzwig's epithelial root sheath,irregular barrier formation and seal
is inferior to MTA. a good seal coronally is important to prevent reinfection of the canal space.
(what i've understood so far from the literature in a nutshell) - Impran

hi trishul, thank you for your explanation. where do you get this tripple antibiotic paste? can you send me
an article regarding this procedure.i will get back to you incase of any doubts - Dr.kishore nallapati.