Long-term Outcome of Revascularization Procedure: A Retrospective Case Series

Giyong Cho

Cho, Giyong
Faculty / Advisor: Lee, Sumin
University of Pennsylvania School of Dental Medicine, Department of Endodontics


Revascularization is a regenerative endodontic procedure that may be the treatment of choice over conventional root canal treatment (RCT) for treating apical periodontitis and periapical abscess in immature necrotic teeth. Immature teeth often present with open apices and thin fragile root walls, which increase the risk of inadequate apical seal and root fracture when treated with conventional RCT or traditional apexification. Through revascularization procedure, clinicians can promote the continuation of root development and increase the longevity of immature teeth in young patients. This study aims to evaluate long-term treatment outcomes and demonstrate the pattern of the healing or failure outcomes.


The revascularization protocol of this study strictly follows the methodologies developed by the Department of Endodontics at University of Pennsylvania School of Dental Medicine based on the recommendations from the American Association of Endodontics. Clinical and radiograph records of treatment rendered between June 2010 and June 2015 were reviewed and sorted to include those of necrotic immature permanent teeth treated with revascularization procedure. Their pre-, post-operative, and follow-up conditions were assessed to determine the absence of clinical symptoms and resolution of periapical radiolucency. In addition, root maturation was evaluated both clinically and radiographically. In this study, data were collected from patients who were present to their routine follow-up minimum 3 years after completion of their treatment.


Thirty-three cases treated with revascularization were collected, and 14 subjects with 17 treated teeth were included in this study. The average follow-up period was 5.7 years. Fifteen cases (88%) showed complete resolution of periapical radiolucency: one case had persistent periapical radiolucency and one case was healed for the first six years but the recurrence of apical periodontitis and external root resorption were developed during orthodontic treatment. Twelve cases (70.5%) had an increase in the root dentin thickness and six cases (35.3%) had an increase in the root length. Apical closure and intracanal calcification occurred in 11 cases (64.7%) and 7 cases (41.2%) respectively.


Our data suggest that the long-term outcome of revascularization, wherein healing of periapical periodontitis and maturation of roots occurs, is fairly high, making it a viable treatment option in comparison with traditional apexification. This retrospective case series demonstrate that the long-term outcome of the revascularization procedure is high. Treated teeth should receive follow-ups for a more extensive period as the majority of patients undergoing revascularization are young growing and may require orthodontic treatment.