Clinical evidence of pulp Revascularization in necrosed and immature teeth: a literature review / Evidências clínicas da Revascularização pulpar em dentes necrosados e imaturos: uma revisão de literatura


  • Yara Lima Guerra Brazilian Journals Publicações de Periódicos, São José dos Pinhais, Paraná
  • Elane Lima da Silva
  • Nilton Vivacqua Gomes
  • Flavia Darius Vivacqua



apexification, immature teeth, pulp necrosis, Revascularization.


Introduction: Endodontic treatment in teeth with incomplete root formation and necrotic pulp has been constantly studied and new approaches are being carried out, with revascularization being the most recent of them. Objective: This work is a literature review, which sought to elucidate the clinical aspects of pulp revascularization, about its longevity as a treatment modality. Methods: Articles from the last 7 years were used in the PUBMED, Scielo and VHL databases in English and Portuguese. Randomized clinical studies, clinical cases with follow-up, systematic reviews and meta-analysis were considered. Results and Discussion: Among the various recommendations, due to the clinical cases exposed, the importance of disinfection of root canal systems by the use of irrigating solutions with antimicrobial action, the use of intracanal medication, and calcium hydroxide can be used or the tri-antibiotic paste, both with the aim of eliminating bacteria present on dentin surfaces. Apical revascularization facilitates tooth root development, but it is uncertain how much root length and thickness, or apical closure, is achieved. However, regenerative techniques seem to have superior results, in these aspects, when compared to the Apexification technique. Among the clinical studies evaluated, it was observed that the revascularization technique with blood clot associated with the use of PRP and PRF as a scaffold was more effective for the longevity and success of the technique. Conclusion: After the reviewed articles, it can be concluded that the apical root closure technique, through the induction of the blood clot, is effective in enabling root strengthening and development, being safe, traumatic, and low cost and can be performed in any age, covering a significant number of patients with incomplete apex associated with pulp necrosis.


NATIONAL HEALTH SURVEILLANCE AGENCY (ANVISA). Antimicrobials: theoretical bases and clinical use. 2007.

ALBUQUERQUE, M. T. P. Pulp revascularization protocols. Monograph (Specialization in Endodontics) - School of Dentistry of Piracicaba, Unicamp, 2012.

ALLADE, M. P. et al. Pulpal revascularization: technical considerations and clinical implications. Salusvime, v. 33, n. 3, p. 415-432, 2014.

AMERICAN ASSOCIATION OF ENDODONTISTS. Clinical considerations for a regenerative procedure. 2015.

ANTUNES, L.S. et al. The effectiveness of pulp revascularization in root formation of necrotic immature permanent teeth: A systematic review. Acta Odontology Scandinavia, v. 74, n. 3, p. 161-169, 2016.

BUKHARI, S. et al. Outcome of revascularization procedure: a retrospective case series. Journal of endodontics, v. 42, n. 12, p. 1752-1759, 2016.

BANCHS, F.; TROPE, M. Revascularization of Immature Permanent Teeth With Apical Periodontitis: New Treatment Protocol. JOURNAL OF ENDODONTICS, v.30, n. 4, p. 196-200, 2004.

CAO, Y. et al. Pulp-dentin regeneration: current state and future prospects. Journal of dental research, v. 94, n. 11, p. 1544-1551, 2015.

CHAN, E. K.M. et al. Longitudinal cohort study of regenerative endodontic treatment for immature necrotic permanent teeth. Journal of endodontics, v. 43, n. 3, p. 395-400, 2017.

CUI, D. et al. Roles of Dental Mesenchymal Stem Cells in the Management of Immature Necrotic Permanent Teeth. Frontiers in Cell and Developmental Biology, v. 9, 2019.

DHIMAN, M. et al. Retrieval of Extruded Mineral Trioxide Aggregate Using a Novel Suction Device. Contemporary Clinical Dentistry, n.9, p. 663-666, 2019.

ESTEFAN, B. S. et al. Influence of age and apical diameter on the success of endodontic regeneration procedures. Journal of endodontics, v. 42, n. 11, p. 1620-1625, 2016.

GALLER, K.M. Clinical procedures for revitalization: current knowledge and considerations. International endodontic journal, v. 49, n. 10, p. 926-936, 2016.

GUERRERO, F. et al. Apexification: A systematic review. Journal of Conservative Dentistry, v. 21, n. 5, p.462-465, 2018.

LAW, A. S. Considerations for regeneration procedures. Pediatric dentistry, v. 35, n. 2, p. 141-152, 2013. LEE, Bin-Na et al. A review of the regenerative endodontic treatment procedure. Restorative dentistry & endodontics, v. 40, n. 3, p. 179-187, 2015.

HAMEED, M. H. et al. Management of immature necrotic permanent teeth with regenerative endodontic procedures — a review of literature. Literature review, v. 69, n. 10, 2019.

HE, L. et al. Treatment of Necrotic Teeth by Apical Revascularization: Meta-analysis. Scientific Reports, no. 7, 2017.

MITTMANN, C. W. et al. Outcome of revascularization therapy in traumatized immature incisors. BMC Oral Health, v. 20, p. 207, 2020.

NAMOUR, M.; THEYS, S. Pulp revascularization of immature permanent teeth: a review of the literature and a proposal of a new clinical protocol. The Scientific World Journal, v. 2014, 2014.

PARYANI, K.; KIM, S. G. Regenerative endodontic treatment of permanent teeth after completion of root development: a report of 2 cases. Journal of Endodontics, v. 39, n. 7, p. 929-934, 2013.

PRAMILA, R.; MUTHU, M. S. Regeneration potential of pulp-dentin complex: Systematic review. Journal of conservative dentistry: JCD, v. 15, n. 2, p. 97, 2012. SATO, I. et al. Sterilization of infected root‐canal dentine by topical application of a mixture of ciprofloxacin, metronidazole and minocycline in situ. International endodontic journal, v. 29, n. 2, p. 118-124, 1996.

SHIVASHANKAR, V. Y. et al. Comparison of the effect of PRP, PRF and induced bleeding in the revascularization of teeth with necrotic pulp and open apex: a triple blind randomized clinical trial. Journal of clinical and diagnostic research: JCDR, v. 11, n. 6, p. ZC34, 2017.

SILUJJAI, J.; LINSUWANONT, P. Treatment outcomes of apexification or revascularization in nonvital immature permanent teeth: a retrospective study. Journal of endodontics, v. 43, n. 2, p. 238-245, 2017.

SOARES, A. J. et al. Pulp revascularization after root canal decontamination with calcium hydroxide and 2% chlorhexidine gel. Journal of endodontics, v. 39, n. 3, p. 417-420, 2013.

WANG, Y.; ZHU, X.; ZHANG, C. Pulp revascularization on permanent teeth with open apices in a middle-aged patient. Journal of endodontics, v. 41, n. 9, p. 1571-1575, 2015.

WIKSTROM, A. et al. What is the best long-term treatment modality for immature permanent teeth with pulp necrosis and apical periodontitis?. European Archives of Pediatric Dentistry, v. 22, p. 311–340, 2021.

XIE, Y. et al. Revascularization versus Apexification for treatment of immature teeth based on periapical healing and root development: A systematic review and meta-analysis. European Journal of Pediatric Dentistry, v. 22, n. 3, 2021.

ZHUJIANG, A.; KIM, S. G. Regenerative endodontic treatment of an immature necrotic molar with arrested root development by using recombinant human platelet-derived growth factor: a case report. Journal of endodontics, v. 42, n. 1, p. 72-75, 2016.






Original Papers