Three Dimensional Analysis of Root Development and Bone Formation in an Immature Non Vital Permanent Molar Using Regenerative Endodontic Procedure: A Case Report

Abstract

The Regenerative Endodontic Procedure (REP) is one of the latest biological procedures for successfully treating immature non vital teeth. Treating non vital immature teeth in children with associated bone resorption poses a challenge. In the present case, a 10- year-old male patient presented with an immature pulpally involved right permanent first molar, exhibiting a periapical radiolucency measuring 2×3.2×10.5 mm (distal root) and 4.4×5.2×10.5 mm (mesial root). The molar was non-surgically treated using a minimally invasive REP approach, aiming for anatomical healing and root completion. Mineral Trioxide Aggregate (MTA) was applied over a blood clot used as a scaffold. The radiolucency decreased significantly to a size of 0.9×1.3×0.2 mm (distal root) and 1×0.4×0.2 mm (mesial root). Continuous root formation was also observed, resulting in complete resolution of the Apical Bone Defect (ABD). The mesial and distal roots progressed from Nolla stage 8 (2/3rd of root formation) to Nolla stage 9 (root formation complete) over a twelve-month period. Three-dimensional (3D) analysis was employed to explain pathosis and the healing of lesions from every aspect. The present case demonstrates that REP may be the treatment of choice for managing non vital immature permanent posterior teeth with severe ABD in a paediatric patients, particularly when the surgical approach is contraindicated due to the presence of other developing structures. Furthermore, long-term follow-up is required, and the type of healing and root completion may vary depending on the stage of root formation, disinfection, and coronal seal achieved.