Regenerative endodontic procedure (REP) is a progressive treatment modality for immature permanent teeth with necrotic pulp. The ambiguousness about the predictability of REP outcome in relation to complete disinfection of the root canal system and the occurrence of discoloration still exists. The aim of this retrospective study was to analyze two treatment protocols on clinical success rate, radiographic root development and the occurrence of discoloration. Eighteen patients were treated by a single operator by either treatment protocol according to the American Association of Endodontists (AAEP, n = 9) or a modified protocol (MP, n = 9) with the use of 5% sodium hypochlorite and sandblasting. Patients were followed up after 3, 6, 9, 12, 18 and 24 months and clinical success, radiographic root development and the occurrence of discoloration were assessed. The clinical success of MP was significantly higher in two years follow-up (p = 0.015), but the change in radiographic root area was higher for AAEP (p = 0.017) and the occurrence of discoloration was higher in AAEP (p = 0.029). The use of 5% sodium hypochlorite for a longer period of time leads to a higher success rate. The sandblasting of the access cavity reduces the occurrence of discoloration.

Czech Educational and Dental Research Innovative Group Vídeňská 6 639 00 Brno Czech Republic

Department of Mathematical Analysis and Applications of Mathematics Faculty of Science Palacký University Olomouc Tř 17 Listopadu 12 772 00 Olomouc Czech Republic

Institute of Dentistry and Oral Sciences Medical Faculty Palacký University Olomouc 772 00 Olomouc Czech Republic

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Tong H.J., Rajan S., Bhujel N., Kang J., Duggal M., Nazzal H. Regenerative Endodontic Therapy in the Management of Nonvital Immature Permanent Teeth: A Systematic Review-Outcome Evaluation and Meta-Analysis. J. Endod. 2017;43:1453–1464. doi: 10.1016/j.joen.2017.04.018. PubMed DOI

Torabinejad M., Nosrat A., Verma P., Udochukwu O. Regenerative Endodontic Treatment or Mineral Trioxide Aggregate Apical Plug in Teeth with Necrotic Pulps and Open Apices: A Systematic Review and Meta-Analysis. J. Endod. 2017;43:1806–1820. doi: 10.1016/j.joen.2017.06.029. PubMed DOI

Kakehashi S., Stanley H.R., Fitzgerald R.J. The Effects of Surgical Exposures of Dental Pulps in Germ-Free and Conventional Laboratory Rats. Oral. Surg. Oral. Med. Oral. Pathol. 1965;20:340–349. doi: 10.1016/0030-4220(65)90166-0. PubMed DOI

Yanpiset K., Trope M. Pulp Revascularization of Replanted Immature Dog Teeth after Different Treatment Methods. Endod. Dent. Traumatol. 2000;16:211–217. doi: 10.1034/j.1600-9657.2000.016005211.x. PubMed DOI

Verma P., Nosrat A., Kim J.R., Price J.B., Wang P., Bair E., Xu H.H., Fouad A.F. Effect of Residual Bacteria on the Outcome of Pulp Regeneration In Vivo. J. Dent. Res. 2017;96:100–106. doi: 10.1177/0022034516671499. PubMed DOI

Diogenes A., Henry M.A., Teixeira F.B., Hargreaves K.M. An Update on Clinical Regenerative Endodontics. Endod. Top. 2013;28:2–23. doi: 10.1111/etp.12040. DOI

American Association of Endodontists Considerations for a Regenerative Endodontics Procedure. [(accessed on 24 December 2020)];2013 Available online: http://www.aae.org/specialty/wp-content/uploads/sites/2/2017/07/considerationsregendo.pdf.

Galler K.M., Krastl G., Simon S., Van Gorp G., Meschi N., Vahedi B., Lambrechts P. European Society of Endodontology Position Statement: Revitalization Procedures. Int. Endod. J. 2016;49:717–723. doi: 10.1111/iej.12629. PubMed DOI

Ruparel N.B., Teixeira F.B., Ferraz C.C.R., Diogenes A. Direct Effect of Intracanal Medicaments on Survival of Stem Cells of the Apical Papilla. J. Endod. 2012;38:1372–1375. doi: 10.1016/j.joen.2012.06.018. PubMed DOI

Martin D.E., De Almeida J.F.A., Henry M.A., Khaing Z.Z., Schmidt C.E., Teixeira F.B., Diogenes A. Concentration-Dependent Effect of Sodium Hypochlorite on Stem Cells of Apical Papilla Survival and Differentiation. J. Endod. 2014;40:51–55. doi: 10.1016/j.joen.2013.07.026. PubMed DOI

Kontakiotis E.G., Filippatos C.G., Tzanetakis G.N., Agrafioti A. Regenerative Endodontic Therapy: A Data Analysis of Clinical Protocols. J. Endod. 2015;41:146–154. doi: 10.1016/j.joen.2014.08.003. PubMed DOI

Lee J.Y., Kersten D.D., Mines P., Beltran T.A. Regenerative Endodontic Procedures among Endodontists: A Web-Based Survey. J. Endod. 2018;44:250–255. doi: 10.1016/j.joen.2017.09.010. PubMed DOI

Žižka R., Šedý J., Gregor L., Voborná I. Discoloration after Regenerative Endodontic Procedures: A Critical Review. Iran. Endod. J. 2018;13:278–284. doi: 10.22037/iej.v13i3.21271. PubMed DOI PMC

Kahler B., Rossi-Fedele G. A Review of Tooth Discoloration after Regenerative Endodontic Therapy. J. Endod. 2016;42:563–569. doi: 10.1016/j.joen.2015.12.022. PubMed DOI

Chrepa V., Joon R., Austah O., Diogenes A., Hargreaves K.M., Ezeldeen M., Ruparel N.B. Clinical Outcomes of Immature Teeth Treated with Regenerative Endodontic Procedures-A San Antonio Study. J. Endod. 2020;46:1074–1084. doi: 10.1016/j.joen.2020.04.008. PubMed DOI

Schwartz R.S., Fransman R. Adhesive dentistry and endodontics: Materials, clinical strategies and procedures for restoration of access cavities: A review. J. Endod. 2005;31:151–165. doi: 10.1097/01.don.0000155222.49442.a1. PubMed DOI

Cvek M. Prognosis of Luxated Non-Vital Maxillary Incisors Treated with Calcium Hydroxide and Filled with Gutta-Percha. A Retrospective Clinical Study. Endod. Dent. Traimatol. 1992;8:45–55. doi: 10.1111/j.1600-9657.1992.tb00228.x. PubMed DOI

Orstavik D., Kerekes K., Eriksen H.M. The Periapical Index: A Scoring System for Radiographic Assessment of Apical Periodontitis. Endod. Dent. Traumatol. 1986;2:20–34. doi: 10.1111/j.1600-9657.1986.tb00119.x. PubMed DOI

Bose R., Nummikoski P., Hargreaves K. A Retrospective Evaluation of Radiographic Outcomes in Immature Teeth with Necrotic Root Canal Systems Treated with Regenerative Endodontic Procedures. J. Endod. 2009;35:1343–1349. doi: 10.1016/j.joen.2009.06.021. PubMed DOI

Flake N.M., Gibbs J.L., Diogenes A., Hargreaves K.M., Khan A.A. A Standardized Novel Method to Measure Radiographic Root Changes after Endodontic Therapy in Immature Teeth. J. Endod. 2014;40:46–50. doi: 10.1016/j.joen.2013.09.025. PubMed DOI PMC

Agresti A. Foundations of Linear and Generalized Linear Models. 1st ed. John Wiley & Sons; London, UK: 2015.

Shrout P.E., Fleiss J.L. Intraclass Correlations: Uses in Assessing Rater Reliability. Psychol. Bull. 1979;86:420–428. doi: 10.1037/0033-2909.86.2.420. PubMed DOI

Bates D., Mächler M., Bolker B., Walker S. Fitting Linear Mixed-Effects Models using lme4. J. Stat. Soft. 2015;67:1–48. doi: 10.18637/jss.v067.i01. DOI

R Core Team . R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing; Vienna, Austria: 2019. [(accessed on 24 December 2020)]. Available online: https://www.R-project.org.

Kuznetsova A., Brockhoff P.B., Christensen R.H.B. lmerTest Package: Tests in Linear Mixed Effects Models. J. Stat. Soft. 2017;82:1–26. doi: 10.18637/jss.v082.i13. DOI

Revelle W. Psych: Procedures for Psychological, Psychometric and Personality Research. Northwestern University; Evanston, IL, USA: 2020. [(accessed on 24 December 2020)]. R package version 2.0.12. Available online: https://CRAN.R-project.org/package=psych.

Koç S., Del Fabbro M. Does the Etiology of Pulp Necrosis Affect Regenerative Endodontic Treatment Outcomes? A Systematic Review and Meta-Analyses. J. Evid. Based Dent. Pr. 2020;20:101400. doi: 10.1016/j.jebdp.2020.101400. PubMed DOI

Ong T.K., Lim G.S., Singh M., Fial A. V Quantitative Assessment of Root Development after Regenerative Endodontic Therapy: A Systematic Review and Meta-Analysis. J. Endod. 2020;46:1856–1866. doi: 10.1016/j.joen.2020.08.016. PubMed DOI

Li L., Pan Y., Mei L., Li J. Clinical and Radiographic Outcomes in Immature Permanent Necrotic Evaginated Teeth Treated with Regenerative Endodontic Procedures. J. Endod. 2017;43:246–251. doi: 10.1016/j.joen.2016.10.015. PubMed DOI

Fang Y., Wang X., Zhu J., Su C., Yang Y., Meng L. Influence of Apical Diameter on the Outcome of Regenerative Endodontic Treatment in Teeth with Pulp Necrosis: A Review. J. Endod. 2018;44:414–431. doi: 10.1016/j.joen.2017.10.007. PubMed DOI

Nazzal H., Duggal M.S. Regenerative Endodontics: A True Paradigm Shift or a Bandwagon about to Be Derailed? Eur. Arch. Paeditr. Dent. 2017;18:3–15. doi: 10.1007/s40368-016-0265-5. PubMed DOI PMC

Žižka R., Šedý J. Paradigm Shift from Stem Cells to Cell-Free Regenerative Endodontic Procedures: A Critical Review. Stem Cells Dev. 2017;26:147–153. doi: 10.1089/scd.2016.0264. PubMed DOI

Tagelsir A., Yassen G.H., Gomez G.F., Gregory R.L. Effect of Antimicrobials used in Regenerative Endodontic Procedures on 3-Week-Old Enterococcus Faecalis Biofilm. J. Endod. 2016;42:258–262. doi: 10.1016/j.joen.2015.09.023. PubMed DOI

Latham J., Fong H., Jewett A., Johnson J.D., Paranjpe A. Disinfection Efficacy of Current Regenerative Endodontic Protocols in Simulated Necrotic Immature Permanent Teeth. J. Endod. 2016;42:1218–1225. doi: 10.1016/j.joen.2016.05.004. PubMed DOI

Sabrah A.H.A., Yassen G.H., Spolnik K.J., Hara A.T., Platt J.A., Gregory R.L. Evaluation of Residual Antibacterial Effect of Human Radicular Dentin Treated with Triple and Double Antibiotic Pastes. J. Endod. 2015;41:1081–1084. doi: 10.1016/j.joen.2015.03.001. PubMed DOI

Almutairi W., Yassen G.H., Aminoshariae A., Williams K.A., Mickel A. Regenerative Endodontics: A Systematic Analysis of the Failed Cases. J. Endod. 2019;45:567–577. doi: 10.1016/j.joen.2019.02.004. PubMed DOI

Chan E.K.M., Desmeules M., Cielecki M., Dabbagh B., Ferraz Dos Santos B. Longitudinal Cohort Study of Regenerative Endodontic Treatment for Immature Necrotic Permanent Teeth. J. Endod. 2017;43:395–400. doi: 10.1016/j.joen.2016.10.035. PubMed DOI

Andreasen J.O., Paulsen H.U., Yu Z., Bayer T., Schwartz O. A Long-Term Study of 370 Autotransplanted Premolars. Part II Tooth Survival and Pulp Healing Subsequent to Transplantation. Eur. J. Orthod. 1990;12:14–24. doi: 10.1093/ejo/12.1.14. PubMed DOI

Estefan B.S., El Batouty K.M., Nagy M.M., Diogenes A. Influence of Age and Apical Diameter on the Success of Endodontic Regeneration Procedures. J. Endod. 2016;42:1620–1625. doi: 10.1016/j.joen.2016.06.020. PubMed DOI

Lin J., Zeng Q., Wei X., Zhao W., Cui M., Gu J., Lu J., Yang M., Ling J. Regenerative Endodontics Versus Apexification in Immature Permanent Teeth with Apical Periodontitis: A Prospective Randomized Controlled Study. J. Endod. 2017;43:1821–1827. doi: 10.1016/j.joen.2017.06.023. PubMed DOI

Tsukiboshi M., Ricucci D., Siqueira J.F.J. Mandibular Premolars with Immature Roots and Apical Periodontitis Lesions Treated with Pulpotomy: Report of 3 Cases. J. Endod. 2017;43:S65–S74. doi: 10.1016/j.joen.2017.06.013. PubMed DOI

Shetty H., Shetty S., Kakade A., Desai R., Zhang C.F., Neelakantan P. Cone-Beam Computed Tomographic and Histological Investigation of Regenerative Endodontic Procedure in an Immature Mandibular Second Premolar with Chronic Apical Abscess. J. Investig. Clin. Dent. 2018;9:e12352. doi: 10.1111/jicd.12352. PubMed DOI

Nair P.N.R. Endodontic Biofilm, Technology and Pulpal Regenerative Therapy: Where Do We Go from Here? Int. Endod. J. 2014;47:1003–1011. doi: 10.1111/iej.12287. PubMed DOI

Linsuwanont P., Sinpitaksakul P., Lertsakchai T. Evaluation of Root Maturation after Revitalization in Immature Permanent Teeth with Nonvital Pulps by Cone Beam Computed Tomography and Conventional Radiographs. Int. Endod. J. 2017;50:836–846. doi: 10.1111/iej.12705. PubMed DOI

Shetty H., Shetty S., Kakade A., Mali S., Shetty A., Neelakantan P. Three-Dimensional Qualitative and Quantitative Analyses of the Effect of Periradicular Lesions on the Outcome of Regenerative Endodontic Procedures: A Prospective Clinical Study. Clin. Oral. Investig. 2020 doi: 10.1007/s00784-020-03583-z. PubMed DOI

Możyńska J., Metlerski M., Lipski M., Nowicka A. Tooth Discoloration Induced by Different Calcium Silicate-Based Cements: A Systematic Review of In Vitro Studies. J. Endod. 2017;43:1593–1601. doi: 10.1016/j.joen.2017.04.002. PubMed DOI

Camilleri J. Color Stability of White Mineral Trioxide Aggregate in Contact with Hypochlorite Solution. J. Endod. 2014;40:436–440. doi: 10.1016/j.joen.2013.09.040. PubMed DOI

Marciano M.A., Duarte M.A.H., Camilleri J. Dental Discoloration Caused by Bismuth Oxide in MTA in the Presence of Sodium Hypochlorite. Clin. Oral. Investig. 2015;19:2201–2209. doi: 10.1007/s00784-015-1466-8. PubMed DOI

Chen S.J., Karabucak B., Steffen J.J., Yu Y.-H., Kohli M.R. Spectrophotometric Analysis of Coronal Tooth Discoloration Induced by Tricalcium Silicate Cements in the Presence of Blood. J. Endod. 2020;46:1913–1919. doi: 10.1016/j.joen.2020.09.009. PubMed DOI

Jeeruphan T., Jantarat J., Yanpiset K., Suwannapan L., Khewsawai P., Hargreaves K.M. Mahidol Study 1: Comparison of Radiographic and Survival Outcomes of Immature Teeth Treated with Either Regenerative Endodontic or Apexification Methods: A Retrospective Study. J. Endod. 2012;38:1330–1336. doi: 10.1016/j.joen.2012.06.028. PubMed DOI

Saoud T.M.A., Zaazou A., Nabil A., Moussa S., Lin L.M., Gibbs J.L. Clinical and Radiographic Outcomes of Traumatized Immature Permanent Necrotic Teeth after Revascularization/Revitalization Therapy. J. Endod. 2014;40:1946–1952. doi: 10.1016/j.joen.2014.08.023. PubMed DOI PMC

Alobaid A.S., Cortes L.M., Lo J., Nguyen T.T., Albert J., Abu-Melha A.S., Lin L.M., Gibbs J.L. Radiographic and Clinical Outcomes of the Treatment of Immature Permanent Teeth by Revascularization or Apexification: A Pilot Retrospective Cohort Study. J. Endod. 2014;40:1063–1070. doi: 10.1016/j.joen.2014.02.016. PubMed DOI PMC

Bezgin T., Yilmaz A.D., Celik B.N., Kolsuz M.E., Sonmez H. Efficacy of Platelet-Rich Plasma as a Scaffold in Regenerative Endodontic Treatment. J. Endod. 2015;41:36–44. doi: 10.1016/j.joen.2014.10.004. PubMed DOI

Bukhari S., Kohli M.R., Setzer F., Karabucak B. Outcome of Revascularization Procedure: A Retrospective Case Series. J. Endod. 2016;42:1752–1759. doi: 10.1016/j.joen.2016.06.021. PubMed DOI

Song M., Cao Y., Shin S.-J., Shon W.-J., Chugal N., Kim R.H., Kim E., Kang M.K. Revascularization-Associated Intracanal Calcification: Assessment of Prevalence and Contributing Factors. J. Endod. 2017;43:2025–2033. doi: 10.1016/j.joen.2017.06.018. PubMed DOI

Nagy M.M., Tawfik H.E., Hashem A.A.R., Abu-Seida A.M. Regenerative Potential of Immature Permanent Teeth with Necrotic Pulps after Different Regenerative Protocols. J. Endod. 2014;40:192–198. doi: 10.1016/j.joen.2013.10.027. PubMed DOI

Nevins A.J., Cymerman J.J. Revitalization of Open Apex Teeth with Apical Periodontitis using a Collagen-Hydroxyapatite Scaffold. J. Endod. 2015;41:966–973. doi: 10.1016/j.joen.2014.12.010. PubMed DOI

Silujjai J., Linsuwanont P. Treatment Outcomes of Apexification or Revascularization in Nonvital Immature Permanent Teeth: A Retrospective Study. J. Endod. 2017;43:238–245. doi: 10.1016/j.joen.2016.10.030. PubMed DOI