Regenerative Endodontic Procedures: A Pathway to Induce Natural Tissue Growth

Objectives: To present a case report of an immature central incisor treated with regenerative endodontics procedures (REPs) and to measure its tomographic evolution in a two-year follow-up, performed at the Department of Endodontics, Dentistry School, University of Buenos Aires.
Methods: After diagnosis, REP was chosen for a patient with open apex, necrotic pulp and chronic apical abscess in tooth #2.1.
Local anesthesia, rubber dam isolation and access were performed. Canal was explored by a size 15 K-file. It was irrigated with 20 mL of 2.5% sodium hypochlorite, 20 mL of 17% EDTA, dried with paper points and medicated with calcium hydroxide with physiological saline. It was temporary restored. After 15 days, sinus tract had healed. Anesthesia without vasoconstrictor was used. Isolation, access, and irrigation with 20 mL of 17% EDTA and 20 mL of physiological saline, were performed. Bleeding of apical papilla was stimulated by size 30 K-file. Biodentine^TM was placed coronal to blood clot. It was temporary restored. A week later, permanent restoration was placed. Cone-beam computed tomography (CBCT) images were solicited at preoperative, 6, 12, 18 and 24 months. Comparisons between sagittal planes were made by measuring tools of 3D imaging software. Root length, apical canal width, and visualization of periapical lesion were compared.
Results: Root length was 13.3 mm at preoperative, 14.5 mm at 12 months, and 14.8 mm at 24 months. Apical canal width was 1.4 mm at preoperative, 0.8 mm at 12 months and 0.5 mm at 24 months. Periapical lesion remitted at 6 months and did not reappeared. Visualization of the external dental anatomy and surrounding bone resembles to the rest of the healthy teeth.
Conclusions: Natural growth of the dental structures due to REPs correlates to a paradigm shift in endodontics. CBCTs should be always considered as an effective tool for diagnosis and follow-up in such cases.