Management of tooth with failed regeneration procedure

Abstract

Teeth with immature root development, necrotic pulps, and apical periodontitis present multiple challenges for successful endodontic treatment. Regenerative endodontics is a contemporary approach to managing these problems. Successful regeneration depends on a race between the new tissue and bacteria populating the pulp space and on the ability of the patient to heal the dental pulp tissues. Importance of prevention of bacterial entry into the root canal and maintaining proper coronal seal should not be overemphasized. Evidence suggests that mineral trioxide aggregate (MTA) apexification may be more beneficial for severely injured teeth than a regenerative endodontic procedure. Fiber posts, in combination with composite resin or with accessory fiber posts, can be recommended alternative to cast post and core in flared roots, due to the lower risk of catastrophic failures and better stress distribution. It is the tactic of choice for reinforcing structurally weakened roots as the function, and the prognosis of the restored root is improved, compared with the use of one single, inadequately fitting post. This report is about a case with failed regeneration procedure and managed with MTA apexification and multiple fiber posts to enhance its fracture resistance of maxillary central incisor. Clinical Relevance To Interdisciplinary Dentistry Mineral trioxide aggregate apexification may be more beneficial for severely injured teeth than a regenerative endodontic procedure Large diameter posts contribute more favorably to the fracture resistance of the root postcore-crown system than small diameter posts Fiber posts, in combination with composite resin or with accessory fiber posts, can be recommended alternative to cast post and core in flared roots, because of the lower risk of catastrophic failures and better stress distribution.