Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_113_библиотеки_им_акад_М_И_Перельмана

percha in the coronal two- thirds (18). He observed partial or complete replacement of the blood clot, mainly by fibrous connective tissue. These findings were forgotten, and attempts to regenerate the pulp were abandoned for several decades before Iwaya etal. made an interesting observation in 2001(19). In a case report, the authors described the treatment of a lower premolar with incomplete root formation, chronic apical periodontitis and a sinus tract. After disinfection and intracanal medication, the authors still demonstrated vital tissue inside the root canal and applied calcium hydroxide only to the area of the canal entrance. Thirty months after treatment, the completion of root formation was radiographically evident and the tooth responded again to electrical pulp testing(19). A landmark clinical report was finally published in 2004 by Banchs and Trope, translating this observation into a potential treatment approach(20). Similar to the case of Iwaya etal., the tooth involved was a lower premolar with an apical radiolu­cency and a sinus tract. The root canal was disinfected and treated with an intracanal medication. After the signs of inflammation had subsided, bleeding into the canal was induced by mechanical irritation of the vital apical tissue (Figure9.4). The resulting blood clot was covered with mineral trioxide aggregate (MTA) at the level of the enamel- cementum junction. After 24months, the osseous lesion had healed, root lengthening and thickening as well as apical closure were clearly visible radiographically(20).