Conservative management of lateral canal biofilm-related persistent intraoral sinus and other complications in traumatized, immature incisors: A case report with 30 months’ follow-up

Abstract

Conservative or regenerative endodontic treatments are the preferred approaches for managing traumatized (vital or necrotic) immature permanent teeth in growing patients. Diagnosing pulp vitality preoperatively using sensitivity tests can be challenging, especially if multiple teeth are traumatized, potentially leading to the failure of the chosen endodontic treatment. Unexpected complications, such as persistent intraoral sinus related to the lateral canal (often not visible on conventional radiographs) and delayed periradicular bone healing, may also arise. This case report presents the successful conservative management of three traumatized incisors with such complications. A novel intracanal dressing method was used to treat a persistent intraoral sinus related to the lateral canal in the permanent maxillary left central incisor, which was unresponsive to traditional dressing materials and methods, thereby avoiding surgery or extraction. Additionally, delayed bone healing in response to revascularization treatment in the permanent maxillary right central incisor, and the initially involved vital permanent maxillary right lateral incisor, was addressed with re-revascularization and root canal treatment, respectively. This article discusses tailored management strategies and possible reasons for associated complications in traumatized teeth. It emphasizes the importance of high-quality radiographic images, pulp vitality tests based on blood oxygenation, understanding the presence of biofilm in lateral canals, modified dressing methods, appropriate dressing vehicles, and the necessity of patience in treating traumatic dental injuries. Keywords: Biofilm; Conservative Management; Pediatric Dentistry; Root Canal Medicaments; Teeth Injuries