%0 Journal Article
%T Platelet-Rich Plasma Supplemented Revascularization of an Immature Tooth Associated with a Periapical Lesion in a 40-Year-Old Man
%A Ganesh Ranganath Jadhav
%A Naseem Shah
%A Ajay Logani
%J Case Reports in Dentistry
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/479584
%X The present case report is the first of its kind that documents the successful outcome of ˇ°revascularization,ˇ± a regeneration-based treatment protocol in a mature adult patient. It belies the myth that ˇ°revascularizationˇ± should only be done in children and young, adolescent patients. The misconception that stem cells number as well as viability in older age group patients will not allow revascularization to be successful is also contradicted by this case. The paper highlights all the mechanisms that come into play and the enhancing of regenerative response by supplementation with platelet-rich plasma (PRP). 1. Introduction Revascularization as a treatment option for the management of nonvital, immature teeth is an established ADA procedure code [1]. Numerous case reports/case series have documented its efficacy and success. Till date, its application has been limited to the patients between the age group of 8 and 16 years [2] and in teeth with minimal periapical pathology. However the scope of this procedure stands to change with the growing evidence of persistence of self-maintained mesenchymal stem cells (MSCs) in adults [3] and advent of superior scaffolds like platelet-rich plasma and platelet-rich fibrin that delivers enhanced concoction of growth factors. In addition, the presence of inflamed periapical progenitor cells (iPAPCs) [4], infection survived stem cells from apical papilla (SCAP) [5] in teeth with large periapical pathology, may further widen its horizon. The present case reports the use of platelet-rich plasma as a supplementary scaffold for successful revascularization of a maxillary lateral incisor associated with large periapical lesion in a forty-year-old Asian male. 2. Case Report A 40-year-old healthy Asian male presented with the chief complaint of intermittent pus discharge from the right upper gums. Patient gave a history of trauma sustained thirty years ago while playing. Clinical examination revealed a discolored right maxillary lateral incisor and an associated intraoral draining sinus in the labial vestibular region. On palpation a localized bony hard swelling was discernible. The tooth was nontender to percussion and had a grade I mobility. Vitality tests (cold and electric pulp tests) were negative. Intraoral tracer periapical radiograph with a 30 gutta-percha point was exposed (Figure 1(a)). It revealed a blunderbuss root apex with thin lateral dentinal walls associated with a large periapical pathology measuring (Figure 1(a)). Based on clinical, pulp sensibility and radiographic findings, a diagnosis of pulp necrosis
%U http://www.hindawi.com/journals/crid/2014/479584/