Pulp revascularization for the management of avulsed incisors with immature roots and pulp necrosis

Abstract

The aim of the study was to assess the efficacy of pulp revascularization (PR) in children with pulp necrosis in immature roots incisors with the history of avulsion. The study group comprised 11 children (4 girls and 7 boys aged 86-133 months) with 13 traumatized incisors with pulp necrosis. Mean age at the time of injury was 98.0 months. In 5 children pulp necrosis was associated with extensive periapical lesion (PL, 5-26 mm diameter), 4 children with the history of inadequate or ineffective endodontic treatment had radiological signs of external root resorption. PR was performed according to standard protocol and the results were assessed 3, 6, 12, 18 and 24 months after the procedure. All 13 teeth were clinically asymptomatic 24 months after PR, but continuous root growth and/or apexification was seen in 9 teeth only. PL resolved in all cases, root apexification correlated positively with the absence of PL and external root resorption, continuous root growth and dentinal walls thickening were less evident in patients with pulp necrosis at earlier stages of root development. No progression of external root resorption was observed. PR is a useful tool for the treatment of immature root incisors with pulp necrosis after teeth avulsion but extensive PL and external root resorption prevent adequate apexification probably because of the apical papilla necrosis.