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Saving New Permanent Teeth After Injury

Can Root Canal Treatment Help Save An Injured Tooth That's Still Growing?

By Dr. Stephen Cohen

This article is endorsed by the
American Association of Endodontics.


Bio-Materials That Promote Successful Healing

Mineral Trioxide Aggregate (MTA) is a newer material that was developed specifically as a root canal sealer in the 1990s. It is biocompatible (“bio” – life; “compatible” – non-injurious, encourages healing) with the pulpal and periapical tissues (“peri” – around; “apex” – root end), the living structures, bone and periodontal membrane surrounding and attaching to the root. It is stable and not degraded by the body and will not leak, therefore providing a stable seal, which prevents ingress and penetration of bacteria. Importantly it is very alkaline when first mixed with water, so that it acts to disinfect and neutralize areas of infection that are by nature acidic.

Calcium hydroxide, developed in the 1920s and still in use today, is an important root canal filler; it stimulates the periapical tissues to heal and has antimicrobial properties. It is antibacterial and has a very high alkalinity that encourages repair and active calcification — the process by which calcium minerals form the skeleton and teeth.

Today, even when the pulp is damaged its vitality can be maintained. In immature permanent teeth a healthy blood supply and the presence of stem cells can enable stimulation of continued root growth. Treatment using stem cells will promote the complete replacement of dead pulp tissue with new tissue. The latest stem cell technologies enable the body to completely replace a “dead” pulp with a regenerated new pulp.

Life After Pulp Death

Until recently, there were few options for permanent immature teeth in which the pulp tissue had died. But recent research has opened a new pathway. Immature teeth with clear evidence of dead pulp tissues, abscess formation or even infection spreading out of the root canal have been encouraged to grow new pulps to complete root formation. Success is dependent on the activity of a newly identified population of stem cells, which are the building blocks for many different types of cells and tissues in the body. The stem cells in pulp are hidden treasure with enormous potential for tissue regeneration and “bio-root” engineering.

Based on what is known today, all immature teeth with open root ends in children or teenagers may be considered candidates for regenerative treatment. The procedure involves very thoroughly disinfecting the cleaned-out root canal system and then encouraging a bit of bleeding from surrounding healthy tissues into the canal. The blood clot that forms in the canal serves as a building block for pulp regeneration, allowing for root formation to continue. Stem cell regeneration will allow blunderbuss procedures to fade into history.

The Continuing Story

The state of the art and science of endodontic treatment continues to improve the outcomes for injured and infected pulps of immature permanent teeth. Today's successfully treated teeth can go on to form complete roots and last a lifetime — or at least until growth of the face and jaws is complete and state-of-the-art dental implants can be used to replace them. But then again, and not too far off, scientists working with stem cells may even be able to grow you a whole new tooth!

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