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

Table 3

New protocol.

(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 it
Opening of the pulp chamber to canal entrance (pulpotomy)
Application of Biodentine on dentinal tubules of the pulp chamber^a
Root canal disinfection with 17% EDTA following by 2.5% sodium hypochlorite warming at 37°C
Drying root canal with paper cones
Insertion of the triple antibiotic paste^b into root canal with a Lentulo^c
Place a cotton ball at the root canal entrance
Sealing of the access cavity with a temporary filling

It is important to keep root canal entrance accessible. This action is intended to seal dentin tubules in order to avoid any subsequent medicine staining.
^bMixture of equal proportion of three antibiotics: metronidazole, ciprofloxacin, and minocycline bonded with propylene glycol (concentration of 0.39 g/mL).
^cWithout overflow at the pulp chamber to avoid any future staining.

(b)  

Second step
(two weeks later if asymptomatic tooth and/or absence of fistula)
Local anesthesia without vasoconstrictor^a
Isolation of the tooth with a rubber dam
Disinfection of the tooth with 10% povidone-iodine (iso-Betadine) before opening it^b
Opening the tooth to have a access to root canal
Removal of the triple antibiotic paste using irrigation with 2.5% sodium hypochlorite then with physiological serum
An apical bleeding is caused. Blood level must be at the cement-enamel junction; After filling root canal with blood, previously prepared PRF can be add
Twelve minutes later, application of Biodentine on the clot formed around PRF in order to close access to root canal
Final hermetic filling after hardening of Biodentine

In order to not inhibit the future apical bleeding.