Pulp Revascularization of Immature Permanent Teeth: A Review of the Literature and a Proposal of a New Clinical Protocol

Table 1

Pulp revascularization using calcium hydroxide.

(a)  

First step
Local anesthesia
Isolation of the tooth with a rubber dam
Opening of the pulp chamber to canal entrance (pulpotomy)
Irrigation of root canal (often with 10 mL sodium hypochlorite at 2.5%)^a
No instrumentation in root canal
Preparation of calcium hydroxide paste^b
Insertion of the paste in the pulp chamber and in the coronary part (third or half) of root canal (with a cotton ball)
Sealing of the access cavity with a temporary filling

According to authors, nature and concentration of the irrigator can vary.
^bCa(OH)₂-sterile water in a 3 : 1 ratio.

(b)  

Second step
(two or three weeks later if asymptomatic tooth and/or absence of fistula)
Local anesthesia without vasoconstrictor^a
Isolation of the tooth with a rubber dam
Opening the tooth to have a access to root canal
Removal of the calcium hydroxide paste
Copious irrigation of root canal with sodium hypochlorite
Rinsing root canal with sterile water
Drying root canal with paper cones
An apical bleeding is caused by irritation of the apical region with a 15 K-file lime^b
Preparation of mineral trioxide aggregate (MTA) and its placement on the clot 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.
^bIt takes 15 minutes to obtain a blood clot. If a root canal is not bleeding, it is possible to transfer blood from one root canal to another. Blood level must be at least 2-3 mm below the cement-enamel junction.