Continued Root Development Research Articles

A comparison of MTA and Biodentine as medicaments for pulpotomy in traumatized anterior immature permanent teeth: A randomized clinical trial.

The placement of a biocompatible material after performing pulp therapy in traumatically exposed permanent incisors is one of the important factors that determine pulp healing. The aim of this study was to assess the clinical and radiographic outcomes when using mineral trioxide aggregate (MTA) and Biodentine as pulpotomy materials to maintain the vitality of traumatized immature anterior permanent teeth with pulp exposure. Fifty traumatized immature anterior permanent teeth with exposed pulps were included in the study. Teeth were equally divided and randomly assigned to two groups MTA or Biodentine. After pulpotomy, pulp stumps were covered with MTA or Biodentine followed by a permanent restoration. Blinded clinical and radiographic evaluations were performed at baseline, immediate post-operative and after 6, 12 and 18 months according to pre-determined clinical and radiographic criteria. No statistically significant differences were observed between MTA and Biodentine for any of the clinical parameters, except for discoloration, which was significantly more prevalent in the MTA group (P < .001). No significant statistical difference was observed in the radiographic outcomes between MTA and Biodentine, as evidenced by continued root development and by an increased prevalence of root formation stage H in both groups. Both MTA and Biodentine showed similar clinical and radiographic outcomes when used as pulpotomy materials in the treatment of traumatized immature anterior permanent teeth. However, discoloration was significantly more prevalent in the MTA group.

Survival of Autotransplanted Teeth With Open Apices: A Retrospective Cohort Study

Autotransplantation of teeth is an alternative treatment method in growing patients with hypodontia or impacted teeth. The purpose of the present study was to investigate the occurrence of, and predictors for, the loss of transplanted teeth in children and young adults. All patients who had undergone tooth transplantation at the Department of Oral and Maxillofacial Surgery, Turku University Hospital, from October 1, 2009 to January 5, 2017, were identified from the hospital's database. The outcome variable was survival of the transplanted tooth. The predictor variables were the transplantation type, donor tooth, maturity of the donor tooth, number of roots of the donor tooth, recipient's jaw, the need for extraoral storage of the donor tooth during surgery, continuation of root development during follow-up, and institution experience. One tooth was randomly selected from each subject. The Kaplan-Meier method for survival analysis, and the Cox proportional hazards regression analysis results were used to assess the association between survival and the risk factors. The sample included 36 subjects with a mean age of 14.3years; 33.3% were male, 45 teeth were transplanted, and the median follow-up time was 1.3years. The 1-year survival rate was 87% (95% confidence interval [CI], 75 to 99%). A significant predictor for tooth survival was the continuation of root development (hazard ratio, 21.3; 95% CI, 2.1 to 215.0; P=.009). Although not statistically significantly, more favorable prognoses were found for distant than for transalveolar transplantations, 1-rooted than multirooted teeth, premolars than molars, teeth not stored in an extraoral media, and teeth that had been transplanted later during the study period. The experience of the professional team, use of open apex premolars, and postoperative continuation of root development of the transplant were the factors associated with favorable outcomes. Transplants could benefit from the use of 3-dimensional models during surgery.

Revaskularisasi gigi : Prosedur Perawatan Potensial untuk Regenerasi Gigi Nekrosis Pulpa Apeks Terbuka (Tinjauan Pustaka)

Background: Endodontic treatment of young permanent (immature) necrosis teeth is often challenging because the condition of thin and short roots increases the risk of fracture during treatment. Review: The optimum healing condition for teeth with open apex necrotic pulp is to regrow functional pulp tissue and continued root development. A novel concept of revascularization of immature nonvital, infected teeth was recently introduced. Conclusions: This paper summarizes the literature supporting biological reasons for considering revascularization procedures for immature permanent teeth with pulp necrosis and the future potential of regenerating the pulp tissue as a routine dental procedure

Treatment of peri-invagination lesion and vitality preservation in an immature type III dens invaginatus: a case report

BackgroundTo report a case of type III dens invaginatus associated with peri-invagination periodontitis in an immature permanent mandibular central incisor with open apex, in which only the invagination area was treated and vitality was preserved.Case presentationA 9-year-old boy was referred complaining of pain in the mandibular left central incisor. After radiographic examination, an invagination into the pulp chamber of the tooth associated with periapical radiolucency was detected. Endodontic access was performed and the orifice was identified under a dental operating microscope. The invagination area was chemo-mechanically cleaned. After 1 week, the invagination was obturated with mineral trioxide aggregate. During the 2-year follow up period, the tooth was asymptomatic. Radiographic examination revealed significant progression of periapical healing and root development in the main root canal of the tooth.ConclusionNon-surgical root canal treatment of the invagination may preserve pulp vitality, and continuous root development of the tooth.

Treatment outcomes of pulp revascularization in traumatized immature teeth using calcium hydroxide and 2% chlorhexidine gel as intracanal medication.

Objective Pulp revascularization is an effective treatment for immature necrotic teeth. Calcium hydroxide has been used in pulp revascularization as an intracanal medication due to its antimicrobial action and the non-exhibition of crown discoloration and cytotoxicity for stem cells from the apical papilla. Our study aimed to investigate the clinical success and quantitative radiographic changes of root development in immature traumatized teeth using calcium hydroxide plus 2% chlorhexidine gel as intracanal medication.Methodology In this retrospective study, 16 patients were treated with a standardized pulp revascularization protocol. Calcium hydroxide and 2% chlorhexidine gel were manipulated in a 1:1 (v/v) ratio and inserted into root canals with Lentulo spirals (Dentsply Maillefer, Baillaigues, Switzerland). Patients were followed up for a period from 9 to 36 months for the evaluation of clinical and radiological data. Radiographic measurements of root length, root width, apical diameter, and MTA placement from the apex were quantified using software ImageJ. Wilcoxon test and t-test were used, according to nonparametric or parametric data, respectively, for changes over time in root length, root width, and apical diameter.Results Fifteen teeth survived during the follow-up period (93.75%) and met the criteria for clinical success. Although the changes seem to be very small in many cases, significant increases in the average root length (14.28%, p<0.0001), root width (8.12%, p=0.0196), and decrease in apical diameter (48.37%, p=0.0007) were observed. MTA placement from the apex and age at the time of treatment was not significantly associated with the quantitative radiographic outcomes.Conclusions Pulp revascularization in traumatized immature teeth treated with calcium hydroxide plus 2% chlorhexidine gel as intracanal medication had high success and survival rates, showing periodontal healing and resolution of signs and symptoms. However, concerning the continued root development, the outcomes can still be considered unpredictable.

Regenerative Endodontics: A Paradigm Shift in Clinical Endodontics.

ABSTRACTPreserving the natural dentition in its normal form and function is one of the major goals of endodontic treatment. Re-establishing the lost vitality and development of root maturation in immature permanent teeth with pulp necrosis/apical periodontitis is quiet challenging clinically. The very basis of regenerative endodontics relies on the concept of tissue engineering using stem cells, biomimetic scaffold, and bioactive growth factors to regenerate the pulp tissue damaged by microbial infection, injury, or developmental defects. In clinical endodontics, this approach is referred to as a “paradigm shift.” Even though repair instead of true regeneration is achieved with current protocols, it is hoped that further research in the area of stem-cell-based tissue engineering will allow for true regeneration and improved treatment outcomes. The aim of this review is to discuss about the various aspects of regenerative endodontics, current clinical protocols, and the future of pulp regeneration techniques.

Revitalisation endodontic treatment of traumatised immature teeth: a prospective long-term clinical study

PurposeContinuation of root development following revitalisation endodontics (RET) has been shown to be unpredictable with lower success rates in traumatised teeth. This study reports the outcomes for RET in traumatised teeth over a review period of 4 years.MethodsA prospective uncontrolled study, where RET was performed on traumatised upper immature anterior teeth with necrotic pulps in 15 children (mean age = 8.3 years), was conducted. Patients were reviewed at 3, 9, 12, 24, and 48 months, where clinical and radiographic assessments were performed. At the last review appointment, patients and parents answered questions assessing their perception and acceptance of tooth colour change over time. McNemar’s Exact test and linear mixed model assessment were used to assess changes in pulpal electrical response and radiographic evidence of continuation of root development over time, respectively.ResultsThere was 83.3% healing with no significant changes in EPT responses, and no significant changes in root lengths, while significant changes in root widths (p < 0.05) and root apex widths (p < 0.001) were found over time. Twenty-five percent of patients and 33% of parents felt that there were changes in tooth colour following RET over time.ConclusionWithin the limitations of this study, traumatised teeth treated using RET showed no significant root lengthening, however, acceptable periapical healing, slow thickening of root dentinal walls, and rapid development of apical closure were evident over a period of 43 months. Using Portland cement and omitting minocycline, did not eliminate crown colour change following RET.

Modified Apexification Procedure for Immature Permanent Teeth with a Necrotic Pulp/Apical Periodontitis: A Case Series

The current American Association of Endodontists clinical considerations for a regenerative endodontic procedure state that a regenerative procedure is suitable for immature permanent teeth with necrotic pulp when the pulp space is not needed for a post/core in the final restoration. Therefore, many immature permanent teeth with necrotic pulp that have sustained a substantial loss of coronal tooth structure either from caries or trauma are treated by apexification or mineral trioxide aggregate/Biodentine (Septodent, Lancaster, PA) apical barrier techniques in which no further root maturation would occur. This case series presents 10 immature permanent teeth with necrotic pulp in which a post/core was likely required in the future for adequate coronal restoration because of loss of substantial coronal tooth structure and a modified apexification procedure was used. All 10 cases after the modified apexification procedure showed no clinical symptoms/signs and showed radiographic evidence of healed/healing of periapical lesion after a 2-year review. Eight cases showed increased thickness of the apical root canal walls, increased apical root length, and apical closure. The overall percentage change in root length was 7.52%, in root width at the apical one third it was 18.89%, and in radiographic root area it was 15.04% at the 24- to 72-month follow-up period. This modified apexification procedure allows for the tooth to be restored with a post/core if required for the final restoration in the future as well as continued root development.

Evaluation of Two Pulpotomy Agents in Traumatized Immature Permanent Incisors

Aim: To assess the clinical and radiographic outcomes of mineral trioxide aggregate (MTA) and Biodentine as vital pulpotomy materials to maintain the vitality of traumatized immature anterior permanent teeth with pulpal exposure.Materials and Methods: Fifty vital traumatized immature anterior permanent teeth with exposed pulps were included in the study. Teeth were equally divided and randomly assigned to either a control group (MTA) or the test group (Biodentine). After pulpotomy, pulp stumps were covered with MTA or Biodentine followed by a permanent restoration. Blinded clinical and radiographic evaluations were performed at base line, 6, 12 and 18 months according to pre-determined clinical and radiographic criteria. Results: No statistically significant differences were observed between MTA and Biodentine for any of the clinical parameters, except for discoloration, which was significantly more prevalent in the MTA group (p<0.001). No significant statistical difference was observed in the radiographic success between MTA and Biodentine, as evidenced by continued root development presented by an increased prevalence of root formation stage H in both groups.Conclusions: Both MTA and Biodentine showed similar clinical and radiographic outcomes when used as vital pulpotomy materials in the treatment of traumatized immature anterior permanent teeth. However, discoloration was significantly more prevalent in the MTA group, and given similar clinical and radiographic outcomes in the two groups, Biodentine should be favored over MTA after pulpotomy for anterior traumatized teeth with pulpal exposure where aesthetics would be of concern.

Does Apical Papilla Survive and Develop in Apical Periodontitis Presence after Regenerative Endodontic Procedures?

Regenerative endodontic procedures (REPs) have emerged as a treatment option for immature necrotic teeth to allow the reestablishment of a newly formed vital tissue and enable continued root development. The apical papilla stem cells (SCAPs) play an important role in physiologic root development and may also contribute to further root development during REPs. The goal of these case reports is to show evidence of the apical papilla survival and development, in human teeth with apical periodontitis, after REPs, with 5-year clinical and radiographic follow-up. In the first case, an 11-year-old girl with acute apical abscess of tooth 15 was referred for a REP. Treatment was performed with an intracanal medication followed by induction of a blood clot and a Mineral Trioxide Aggregate (MTA) cervical barrier. The 5-year follow-up showed an appreciable increase in root length as well as root canal thickness. In case 2, a 16-year-old girl was referred for endodontic treatment of tooth 21. The parents of the patient recalled a previous dental trauma (no specified on the patient records) on tooth 21 at age 7. The dental history reports a previous endodontic treatment failure and presence of a long-standing sinus tract. A mineralized tissue beyond the root apical portion could be seen at the preoperative X-ray. Nonsurgical root canal retreatment with an apical barrier was suggested as the treatment plan and accepted by the patient. After 2 weeks, the patient was recalled for a follow-up appointment presenting spontaneous pain, swelling, and sinus tract. Apical surgery was performed. Histopathological assessment of the apical root fragment collected showed the presence of dentin, cementum and pulp tissue, including odontoblasts. The 5-year follow-up depicted complete apical healing. The present case reports support survival and continued potential differentiation of the apical papilla after endodontic infection.

Cervical Level Biological Repair of the Access Opening after Regenerative Endodontic Procedures: Three Cases with the Same Repair Pattern

IntroductionThis article describes the regenerative endodontic procedures applied in 3 cases of maxillary incisor necrosis that resulted in continuous root development, dentinal wall thickening, and cervical level biological repair of the access openings that was verified radiographically in 2 cases and clinically in 1 case. MethodsThree maxillary central incisors in 2 different patients were rendered necrotic after having dentin enamel fracture traumatic dental injuries. All teeth were treated with single- or multiple-visit regenerative endodontic procedures. ResultsThe 5- and 9-year follow-up evaluations revealed similar continuous root development, dentin wall thickening, and hard tissue biological repair of the wide access cavities. In the 9-year follow-up case, the calcium silicate cement was removed because of unacceptable discoloration. The hard tissue biological repair was visualized under the microscope and checked for its continuity with the axial walls, its resistance to displacement, and the presence of possible gaps. The repair tissue seemed to be yellowish in appearance with some brown niches of irregular texture, did not have detectable gaps, was firmly connected with the axial dentinal walls through a demarcated white line, and resisted all displacement forces applied. The tooth was restored with bonded composite resin restoration after internal bleaching. The 10-year follow-up revealed satisfactory esthetics and uneventful soft and hard tissue healing. ConclusionsCervical-level hard tissue repair of the access opening after the application of regenerative endodontic procedures in necrotic immature maxillary incisors might reinforce the weakened tooth structure to a great extent and warrants further investigation.

Management of Immature Necrotic Permanent Teeth with Regenerative Endodontic Procedures - A Review of Literature

Immature necrotic permanent tooth presents a distinctive challenge for the endodontist. Various treatment modalities have been employed to create hard tissue barrier at the apex, which includes non-vital pulp therapy with calcium hydroxide, apexification with mineral trioxide aggregate, pulp revascularisation and regeneration. Regenerative endodontics is a novel modality which involves physiological replacement of the damaged structures of tooth like dentin, root and cells of the pulp-dentin complex. Numerous published case reports have revealed increased dentinal wall thickness, continued root development and apical closure, but there is still lack of sound scientific evidence regarding histological nature of the type of tissue. The current literature review was planned to summarise the evidence regarding the treatment of immature necrotic permanent teeth by regenerative endodontic procedures.

Comparative Study between Revitalization of Necrotic Immature Permanent Anterior Teeth with and without Platelet Rich Fibrin: A Randomized Controlled Trial.

This study was conducted to evaluate the effect of platelet rich fibrin (PRF) during revitalization of necrotic immature permanent anterior teeth after 6 months and 1 year follow up period. The following treatment protocols; Group A: revitalization using blood clot scaffold only, and Group B: revitalization using blood clot and PRF. twenty-two patients (7-12 years old) suffering from immature necrotic permanent maxillary central incisors were randomly selected and randomly allocated into 2 groups. Clinical examinations were performed to detect any pain or swelling during the follow up period. Standardized radiographs were digitally evaluated for changes in root length, periapical radiolucency size, presence of apical or cervical calcific bridges. After a follow-up period of 12 months, most of the cases showed radiographic evidence of periapical healing and showed calcific bridges either cervical and/or apical. No significant differences were shown between both groups. The revitalization procedures succeeded to show continued development of roots in teeth with necrotic pulps. The use of PRF was not essential for repair but it helped during the procedures.

A rare case of an immature incisor with horizontal root fracture traumatized at the time of eruption

Dental trauma resulting in root fracture is a rare condition that affects up to 7% of permanent teeth, and injury to immature teeth is even rarer. This case report aimed to show the prognosis of a horizontal root-fractured immature maxillary incisor traumatized at the time of eruption.&#x0D; Because of an accident, a 6-year-old boy was referred to our clinic with horizontal root fracture of the permanent maxillary left central incisor associated with an extrusive luxation. The coronal segment was repositioned, and a dental splint was applied for 7 weeks. After 48 months, clinical examination revealed a positive response to electrical pulp testing and an absence color change of the tooth. Continuation of root development and calcification of the coronal pulp space was observed radiographically. It was concluded that fixation of teeth is a conservative treatment for immature teeth with horizontal root fractures, resulting in the pulp vitality and spontaneous healing with no other treatment.&#x0D; &#x0D; How to cite this article: Erkmen Almaz M, Şaroğlu Sönmez I, Akbay Oba A. A rare case of an immature incisor with horizontal root fracture traumatized at the time of eruption. Int Dent Res 2018;8(2):94-6.&#x0D; &#x0D; Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

The efficacy of platelet-rich fibrin as a scaffold in regenerative endodontic treatment: a retrospective controlled cohort study

BackgroundBlood Clot (BC) or platelet concentrates have been used as scaffold in regenerative endodontic treatment (RET). The aim of this retrospective study was to compare the performance of platelet-rich fibrin (PRF) with BC in inducing root development and periapical lesion healing after tooth revascularization.MethodsFive patients receiving RET using PRF as a scaffold were matched 1:1 to a previous cohort of 5 patients who underwent tooth revascularization by provoking periapical bleeding. Clinical signs and symptoms were examined at follow-ups. Periapical lesion healing and root development were monitored radiographically. The resolution of clinical signs and symptoms as well as periapical radiolucency was observed in all patients (100%).ResultsRoot elongation, dentinal wall thickening and apex closure were found in most cases (80% in both groups). There was no significant difference between the groups in terms of clinical sign resolution, root development and periapical healing.ConclusionsWithin the limits of this study, PRF achieved comparable outcomes to BC in terms of clinical sign and symptom resolution, periapical lesion healing and continued root development in RET.

Revascularization versus apical barrier technique with mineral trioxide aggregate plug: A systematic review

Aim: To compare the clinical and radiographic outcomes observed in Necrotic Immature Permanent Teeth (NIPT) after revascularization or apexification with MTA-apical plug. Methodology: PubMed/MEDLINE, Web of science and Scopus were the databases used, up to July 30th, 2017, for article research. Independent reviewers read the titles and abstracts of all reports that met inclusion/exclusion criteria: prospective or retrospective clinical studies comparing the revascularization of root canal and apexification. Clinical success of therapies, deposition and thickening of lateral dentinal walls (root width) and the continuation of root development (root length) were investigated. Bias risk of included studies was assessed using the Cochrane risk of bias. Results: From 1642 records, five papers fulfilled all inclusion criteria. Overall, 91 teeth were submitted to revascularization and 64 teeth to apexification with MTA. The mean follow-up was 23.2 months in revascularization and 21.8 in apexification. Clinical success rate was of 87.9% in the revascularization group and 90.6% in the apexification group. An increase on lateral dentinal walls thickening was observed in most revascularization cases (13%) while MTA as apical plug suggest a mild resorption of the root (1.3%). High bias risk was observed on included studies. Conclusions: Apexification with MTA-apical plug provides similar clinical success to revascularization. However, radiographic measurements showed an improvement in thickening of lateral dentinal walls in most of the revascularization cases in addition to a higher dental development. However, these results should be interpreted with caution.

Revascularization versus apical barrier technique with mineral trioxide aggregate plug: A systematic review

AimTo compare the clinical and radiographic outcomes observed in Necrotic Immature Permanent Teeth (NIPT) after revascularization or apexification with MTA-apical plug. MethodologyPubMed/MEDLINE, Web of science and Scopus were the databases used, up to July 30th, 2017, for article research. Independent reviewers read the titles and abstracts of all reports that met inclusion/exclusion criteria: prospective or retrospective clinical studies comparing the revascularization of root canal and apexification. Clinical success of therapies, deposition and thickening of lateral dentinal walls (root width) and the continuation of root development (root length) were investigated. Bias risk of included studies was assessed using the Cochrane risk of bias. ResultsFrom 1642 records, five papers fulfilled all inclusion criteria. Overall, 91 teeth were submitted to revascularization and 64 teeth to apexification with MTA. The mean follow-up was 23.2 months in revascularization and 21.8 in apexification. Clinical success rate was of 87.9% in the revascularization group and 90.6% in the apexification group. An increase on lateral dentinal walls thickening was observed in most revascularization cases (13%) while MTA as apical plug suggest a mild resorption of the root (−1.3%). High bias risk was observed on included studies. ConclusionsApexification with MTA-apical plug provides similar clinical success to revascularization. However, radiographic measurements showed an improvement in thickening of lateral dentinal walls in most of the revascularization cases in addition to a higher dental development. However, these results should be interpreted with caution.

Full Pulpotomy with Biodentine in Symptomatic Young Permanent Teeth with Carious Exposure

IntroductionThis prospective study evaluated the outcome of Biodentine (Septodont, Saint Maur des Fosses, France) pulpotomy in young permanent teeth with carious exposure. MethodsTwenty permanent molar teeth in 14 patients with carious pulp exposure were treated with Biodentine pulpotomy. The age of the patients ranged from 9–17 years (12.3 ± 2.7 years). A preoperative pulpal and periapical diagnosis was established. After informed consent, the tooth was anesthetized, isolated via a dental dam, and disinfected with 5% sodium hypochlorite before caries excavation. Full pulpotomy was performed by amputating the exposed pulp to the level of the canal orifices, hemostasis was achieved via a cotton pellet moistened with 2.5% sodium hypochlorite, a 3-mm layer of Biodentine was placed as the pulpotomy agent, a Vitrebond liner (3M ESPE, St Paul, MN) was applied, and the tooth was subsequently restored. Postoperative periapical radiographs were taken after placement of the permanent restoration. Clinical and radiographic evaluation was completed after 6 months and 1 year postoperatively. Pain levels were scored preoperatively and 2 days after treatment. Statistical analysis was performed using the Fisher exact test. ResultsClinical signs and symptoms suggestive of irreversible pulpitis were established in all teeth and symptomatic apical periodontitis in 14 of 20 (70%). Two days after treatment, all patients reported complete relief of pain. All teeth were clinically successful at 6 months and 1 year postoperatively. Radiographically, immature roots showed continued root development; dentin bridge formation was detected in 5 of 20 teeth. Seven of 7 teeth with preoperative periapical rarefaction showed signs of healing; 1 tooth had signs of internal root resorption at 1 year with an overall success rate of 95% (19/20). ConclusionsYoung permanent teeth with carious exposure can be treated successfully with full pulpotomy using Biodentine, and clinical signs and symptoms of irreversible pulpitis are not a contraindication.

Direct pulp capping in permanent teeth in children – types of pulp exposure, therapeutic indications. Part I

Direct pulp capping, as a method allowing the preservation of viable and healthy pulp, is a key element in the treatment of immature permanent teeth. Maintaining pulp vitality is a condition for continuous root development, which is important for long-term maintenance of the tooth in the oral cavity. Therefore, the maintenance of vital pulp should be one of the main goals in the treatment of young permanent teeth and biological treatment is particularly recommended in such cases. Since young pulp has a great regenerative potential, the success rates of direct pulp capping are high. Therapeutic indications for this method include traumatic and mechanical exposure of either healthy or reversibly inflamed pulp. Accurate assessment of the clinical condition of the tooth is crucial for the choice of the most appropriate treatment option. Another crucial issue is proper understanding of the mechanisms that occur in the pulp as a result of treatment. Choice of a therapeutic agent, such as commonly used non-setting calcium hydroxide or MTA is also essential. However, other, less popular preparations should be also considered.

Orthodontic Movement after Regenerative Endodontic Procedure: Case Report and Long-term Observations

IntroductionAlthough regenerative treatment approaches in teeth with incomplete root formation and pulp necrosis have become part of the suggested therapeutic endodontic spectrum, little is known about the effect of orthodontic movement in the tissue that has been regenerated. Furthermore, as the number of adults undergoing orthodontic treatment increases, there is an increasing need to investigate the changes that these tissues may undergo during orthodontic movement. Here we describe the alterations observed after the application of orthodontic forces in a case of an apically root-fractured necrotic immature root that had been managed with regenerative endodontic procedures in the past. MethodsA 9-year-old male patient was referred after suffering the third incidence of trauma in the anterior maxilla. Radiographic evaluation revealed a periapical rarefaction associated with an apically root-fractured immature central incisor. Clinical evaluation revealed a buccal abscess and grade 3 tooth mobility. Periodontal probing was within normal limits. The tooth was accessed and disinfected by using apical negative pressure irrigation of 6% NaOCl. Intracanal dentin conditioning was achieved by using 17% EDTA for 5 minutes. A blood clot was induced from the periapical area, and calcium silicate–based cement was placed in direct contact with the blood clot at the same visit. The composite resin restoration was accomplished in the same appointment. Results and ConclusionsRecall radiographic examination after 24 months revealed healing of the periapical lesion and signs of continuous root development despite the apical root fracture. Clinical evaluation revealed normal tooth development, normal mobility, and a resolving buccal infection. The tooth was subjected to orthodontic treatment because of Class II division 1 malocclusion with an overjet of 11 mm. After completion of the orthodontic treatment, 5.5 years after the initial intervention, the radiographic image revealed marked remodeling of the periapical tissues and repair of the apical fractures, and the buccal infection had resolved completely.