Abstract
This case report discusses the endodontic treatment of a 7-year-old girl who suffered trauma (intrusion) to the immature upper central incisors secondary to a fall from a bicycle. Thirty days after the accident the patient was brought by her mother for clinical and radiographic assessment with a chief complaint of swelling and tenderness to percussion and palpation. Acute apical abscess associated with immature teeth were diagnosed. A decision was made to perform regenerative endodontic treatment. Access cavities were made and the root canals were disinfected by irrigation with 2.5% sodium hypochlorite. Final irrigation was performed with 17% EDTA. Due to pain and presence of secretions, 2% chlorhexidine gel was applied as an intracanal medicament. Seven days later, at the second visit, the root canals were once again disinfected and the canals of the right and left permanent upper central incisors were filled with double antibiotic paste (metronidazole/ciprofloxacin) and calcium hydroxide paste, respectively. Zinc oxide was mixed in both pastes. At the third visit, after 21 more days, the pastes were removed and the periapical areas were stimulated with a #80 K-file to encourage clot formation within the pulp cavities. A mineral trioxide aggregate (MTA) paste cervical plug was placed and the teeth were restored with glass ionomer cement. Radiographs and CBCT scans demonstrated complete root formations. The patient has been followed for 12 years, with evidence of clinical success throughout.
Highlights
Treatment of immature permanent teeth with pulp necrosis and apical pathosis constitutes a challenge for endodontists [1,2]
Most use sodium hypochlorite as irrigant solution and triple (TAP) [7,9] or double (DAP) [10,11] antibiotic paste as intracanal medicament. Both substances have antimicrobial activity against endodontic pathogens [10,11,12,13], which allows repair of apical tissues, cellular induction and reestablishment of root formation [10]. The objective of this case report was to describe a combination of different protocols used in regenerative endodontic treatment (RET) with a 12-year follow up – 2.5% sodium hypochlorite as an irrigating agent with calcium hydroxide in association with 2% chlorhexidine gel (CHCXP) and double antibiotic paste (DAP) as intracanal medicaments between sessions – in a 7-year-old child who presented acute apical abscess in the immature upper central incisors after dental trauma
Persistent infection is a major negative factor impacting the histologic regeneration of pulpal tissues after RET [6]
Summary
Treatment of immature permanent teeth with pulp necrosis and apical pathosis constitutes a challenge for endodontists [1,2]. Both substances have antimicrobial activity against endodontic pathogens [10,11,12,13], which allows repair of apical tissues, cellular induction and reestablishment of root formation [10] The objective of this case report was to describe a combination of different protocols used in regenerative endodontic treatment (RET) with a 12-year follow up – 2.5% sodium hypochlorite as an irrigating agent with calcium hydroxide in association with 2% chlorhexidine gel (CHCXP) and double antibiotic paste (DAP) as intracanal medicaments between sessions – in a 7-year-old child who presented acute apical abscess in the immature upper central incisors after dental trauma
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