Pulp Revascularization of Immature Permanent Teeth: A Review of the Literature and a Proposal of a New Clinical Protocol
Table 2
Pulp revascularization using a triple antibiotic paste (TAP).
(a)
First step
Local anesthesia
Isolation of the tooth with a rubber dam
Disinfection of the tooth with 10% povidone-iodine (iso-Betadine) before opening ita
Opening of the pulp chamber to canal entrance (pulpotomy)
Irrigation of root canalb with 20 mL sodium hypochlorite (1.25%–5.25%) then with physiological serum and finally with 2% chlorhexidine
No instrumentation in root canal
Drying root canal with paper cones
Insertion of the triple antibiotic pastec into root canal
Place a cotton ball at the root canal entrance
Sealing of the access cavity with a temporary filling
According to the authors, disinfection is done or not.
bAccording to the authors, irrigation may vary.
cMixture of equal proportion of three antibiotics: metronidazole, ciprofloxacin, and minocycline bonded with propylene glycol. Minocycline may be replaced by cefaclor to avoid inducing coloration.
(b)
Second step
(two or three weeks later if asymptomatic tooth and/or absence of fistula)
Local anesthesia without vasoconstrictora
Isolation of the tooth with a rubber dam
Disinfection of the tooth with 10% povidone-iodine (iso-Betadine) before opening itb
Opening the tooth to have a access to root canal
Removal of the triple antibiotic paste using irrigation with sodium hypochlorite (1.25%–5.25%) then with physiological serum and finally with 2% chlorhexidinec
An apical bleeding is caused. Blood level must be at the cement-enamel junction.
Preparation of mineral trioxide aggregate (MTA) and its placement on the clotd in order to form a hermetic sealing
Place a wet a cotton ball on MTA filling
Sealing of the cavity with a temporary filling
In order to not inhibit the future apical bleeding.
bAccording to the authors, disinfection is done or not.
cIrrigation is done in order to make space for the future blood clot.
dIt takes 15 minutes to obtain a blood clot.
