The Regenerative Endodontic Treatment Approach To Traumatized Immature Permanent Teeth

Method:  Case 1: A 9-year-old boy had an avulsed upper right central incisor. Seven days after repositioning and splinting, the tooth showed signs of pulp necrosis. Case 2: A 10-year-old girl referred with a complicated crown fracture of upper right central incisor two weeks after an accidental car crash. The excessive bleeding of the pulp indicated root canal treatment. Case 3:  A  9-year- old boy presented with an uncomplicated crown fracture in his upper right central incisor with signs of apical periodontitis, one month after trauma. The same treatment protocol was carried out in all cases using NaOCl as irrigant, a bi-antibiotic paste consisting of metranidazole and ciprofloxacin, followed by blood clot induction from the periapical tissues and mineral trioxide aggregate as coronal root canal seal.

Result: Clinical and radiological evaluation of the first case after 6 months showed that the tooth was asymptomatic and the maturation of the root canal continued. In the second case, apical closure was seen in a four months period. 1-year of follow up revealed no periapical pathology. The six month follow-up of the third case showed continuing root development without any signs and symptoms of periapical pathology.

Conclusion: Although long term results are not available up to date, it is important to recognize the potential of regenerative endodontics  which reduces the risk of fracture and premature tooth loss by enabling continued root development.