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Title: Interventions for managing necrotic immature permanent teeth following traumatic dental injury
Author: Gartshore, Laura Margaret
ISNI:       0000 0004 7656 3598
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2017
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Background: There is debate in the literature as to whether an optimal intervention exists for the management of necrotic, immature, permanent teeth following traumatic dental injury. There are currently three recognised intervention strategies, including apexification with calcium hydroxide (CaOH), apexification with mineral trioxide aggregate (MTA), and regenerative endodontic procedures (REP). Affected children face unexplored outcomes. Adherence to evidence-based best practice is impeded. Aim: To address the research question: Is there an optimal intervention for the management of necrotic, immature, permanent teeth? Methods: A survey was designed to determine the clinical decision-making practices of specialists in paediatric dentistry and endodontics. A systematic review was carried out to produce a thorough, explicit and objective description of the relevant literature. A randomised controlled trial was conducted, of participants aged 7-21 years, with a history of traumatic dental injury, and a diagnosis of a non-vital, permanent maxillary central incisor, to compare outcomes of endodontic success for immature teeth, following REP or MTA. Results: Some 89% of specialists agree that young people have difficulty accessing good quality management of necrotic, immature teeth. Paediatric dentists are significantly more likely than endodontists to manage this clinical problem (p < .001). Some 57% of specialists would choose to carry out MTA as a first line intervention. Some 16% of endodontists and 1% paediatric dentists would plan REP. No randomised controlled trials have been reported that adequately address the research question in full. Clinical and radiographic healing was favourable for both intervention groups. Mean increases in root length were 0.5mm for REP (SD 0.44, range 0.10 to 1.50mm), and 0.25mm for MTA (SD 0.36, range -0.10 to 1mm). There was no significant effect of intervention in relation to root length (p < 0.093). Mean increases in radiographic root area were 9.03% for REP (SD 5.55, range 2.2 to 21.6), and 0.85% for MTA (SD 2.92%, range -4.6 to 6.8). There was a significant effect of intervention in relation to radiographic root area (p= < 0.0001). Effect size and feasibility have been established to facilitate development of the interventions, and the design of future experimental studies. Conclusions: There is variation in practice between, and within, the specialities, and there are disparities in access to specialist management. There is a lack of quality controlled, comparative randomised controlled trials to support the decisionmaking practices of clinicians in relation to the optimal management of necrotic, immature teeth. The first randomised controlled trial of its kind has generated reliable evidence to support the clinical and radiographic effectiveness of the interventions, and the occurrence of statistically significant tooth development in regenerative endodontic procedures. Regenerative endodontic procedures may be associated with clinically significant advantages in relation to tooth development.
Supervisor: Fox, K. ; Albadri, S. ; Jarad, F. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral