Revascularization of an immature permanent tooth – a case report

Background: Regenerative endodontic procedures and biological principles have now replaced the conventional apexification procedures in the treatment of immature, necrotic teeth. Stem cells from the pulp and ⁄ or periodontium contribute to continued root development when regenerative procedures are followed. Report: A maxillary anterior tooth with a necrotic pulp and immature apex was irrigated with sodium hypochlorite with minimal instrumentation and then dressed with tri-antibiotic paste consisting of ciprofloxacin, metronidazole and tetracycline. At a subsequent visit a blood clot was evoked in the canal by irritating periapical tissues and the canal sealed with mineral trioxide aggregate followed by glass ionomercement. Results: Evaluation revealed continued apical development and closure; and narrowing of the canal space. Conclusions: Initial management of immature teeth with necrotic pulp should involve irrigation with sodium hypochlorite. However, intracanal medicaments such as calcium hydroxideare contraindicated as they inhibit root growth. Regenerative endodontics with continued root growth may reduce the risk of fracture and premature tooth loss associated with traditional ‘apexification’ procedures where the root remains thin and weak.