The Outcome of Endodontic Regeneration in a Delayed Replanted Immature Permanent Incisor: A TurboReg Analysis of a Case.

OBJECTIVES: The aim of this case report is to address a delayed replantation and successful regenerative endodontic procedure of an avulsed immature permanent incisor which was confirmed by TurboReg analysis. STUDY DESIGN: In this case, regenerative endodontic procedure was performed on an avulsed tooth with a delayed replantation in a 7 year old boy. In the emergency visit after the avulsion accident in February 2017, the tooth was replanted and one week later regenerative endodontic procedure began. After 17 months follow up, in July 2018, root wall thickness and length increase was confirmed by TurboReg analysis. CONCLUSION: The outcome of this treatment was evaluated by TurboReg analysis which was a remarkable increase in root length and dentinal wall thickness, despite of the delayed replantation. CLINICAL SIGNIFICANCE: This case report helps to add to the literature for treatment plan in avulsion traumatic injuries.

Revascularization outcomes: a prospective analysis of 16 consecutive cases.

INTRODUCTION: Recent reviews lament the lack of evidence on the efficacy of regenerative procedures to induce further root maturation despite claims of a paradigm shift in the way infected, necrotic immature teeth with arrested root development can be endodontically treated. The majority of reports are either case series or successful case reports where nonstandardized images may make interpretation uncertain. METHODS: This prospective clinical study reports on preliminary outcomes of regenerative endodontic procedures carried out on 16 teeth, 3 mandibular premolars and 13 traumatized central incisors, after 18-month reviews. Qualitative analysis of resolution of periapical radiolucencies and apical closure was undertaken. Quantitative analysis compared preoperative and recall radiographs by using a geometrical imaging program that calculated percentage changes in root length and dentin wall thickness. RESULTS: Qualitative assessment showed 90.3% resolution of the periapical radiolucency. Apical closure was assessed as incomplete in 47.2% and complete apical closure in 19.4% of cases. Quantitative assessment showed change in root length varying from -2.7% to 25.3% and change for root dentin thickness of -1.9% to 72.6%. CONCLUSIONS: Patterns of continued root maturogenesis were variable at 18-month review. Reviews at 36 months showed continued root maturogenesis for 2 cases. Quantitative analysis can control for changes in angulation but may introduce other measurement errors. However, not all anterior teeth were suitable for TurboReg assessment because overlapping of the cementoenamel junctions and/or further eruption of teeth often precluded stable landmark positioning. Discoloration of the crown was a common consequence, with unaesthetic results in 10 of the 16 cases.

Correlation of the same fields imaged in the TEM, confocal, LM, and microCT by image registration: from specimen preparation to displaying a final composite image.

Correlated imaging is the process of imaging a specimen with two complementary modalities and then registering and overlaying the fields obtained in each modality to create a composite view. One of the images is made somewhat transparent, allowing detail in the underlying image to be visible and assisting in the registration of the two images. As an example, an image localizing a specific tissue component by fluorescence may be overlaid atop a TEM image of the same field. The resulting composite image would demonstrate specific ultrastructural features in the high-resolution TEM field, which are colorized in the overlay. Other examples include composites from MicroCT or soft X-ray images overlaid atop light microscopy or TEM images. Automated image registration may be facilitated by a variety of sophisticated computer programs utilized by high-throughput laboratories. This chapter is meant for the more occasional user wishing to align images manually. ImageJ is a public domain, image processing program developed at the National Institutes of Health and is available to anyone as a free download. ImageJ performs marvelously well for the purpose of image registration; therefore, step-by-step instructions are included here. Specimen handling, including fixation and choice of embedding media, is not straightforward for correlative imaging. A step-by-step description of the protocols which work in our laboratory is included for simultaneous localization in LM, EM and micro-CT, as well as maintaining GFP emission in tissue embedded for TEM.