Abstract
The regenerative endodontic procedure (REP) is considered a viable treatment option for immature teeth with necrotic pulp and periapical radiolucency which can facilitate continued root formation. In this report, an immature necrotic mandibular molar received REP in three appointments wherein chemomechanical debridement was performed with a sequential application of nonsetting calcium hydroxide (in the whole canal) and triple antibiotics paste (in the root's middle third) dressings in the first and second appointments, respectively. In the third appointment, blood clots were created in the root canals. MTA was placed over the blood clots and the tooth was restored with a composite filling and stainless-steel crown. Recall appointments were performed for two years where the tooth was deemed asymptomatic clinically and a complete root formation with significant periapical healing was evident radiographically. More cases are required to warrant the feasibility of this disinfection protocol.
Highlights
Pulp necrosis in immature teeth usually results in incomplete root development with open apices and thin walls that make endodontic management challenging [1]
Case Reports in Dentistry in 13% of the included case reports while the triple antibiotics paste (TAP) accounts for 86% of the reports [10]
Published case reports have differences in the management protocol which were mainly limited to the disinfection protocol of the root canal system
Summary
Pulp necrosis in immature teeth usually results in incomplete root development with open apices and thin walls that make endodontic management challenging [1]. The apexification procedure with calcium hydroxide (CaOH) was adopted This procedure requires intracanal placement of CaOH for the long term which leads to weakening and brittleness of the dentinal wall [2]. Several published cases with immature roots [5,6,7,8,9] indicate that the REP has the potential to encourage the continued formation of the root width and length. This procedure involves proper infection control, a suitable matrix for fresh tissue ingrowth, and adequate coronal seal [7]. This case report describes the REP for management of an immature permanent molar tooth with necrotic pulp, wherein both CaOH and TAP were sequentially used
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