Case report/clinical technique
Regenerative Treatment of an Immature, Traumatized Tooth With Apical Periodontitis: Report of a Case

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Abstract

This case report describes the treatment of a necrotic immature permanent central incisor with complete crown fracture, suspected root fracture, and sinus tract, which was not treated with conventional apexification techniques. Instead, a regenerative approach based on the trauma literature's methods for revascularization was provided. The root canal was gently debrided of necrotic tissue with a sharp spoon excavator and irrigated for only one third of its length with NaOCl and then medicated with calcium hydroxide. After 15 days the sinus tract had healed, and the tooth was asymptomatic. The tooth was accessed, calcium hydroxide was removed, bleeding was stimulated to form an intracanal blood clot, and mineral trioxide aggregate was placed coronally to the blood clot. After 8 months, a coronal calcified barrier was radiographically evident and accompanied with progressive thickening of the root wall and apical closure. Two and a half years after treatment was initiated, the tooth remained asymptomatic, and the sinus tract had not reappeared. The progressive increase in the thickness of the dentinal walls and subsequent apical development suggest that appropriate biologic responses can occur with this type of treatment of the necrotic immature permanent tooth with sinus tract.

Section snippets

Case Report

A 9-year-old girl presented at the Department of Conservative Dentistry and Endodontics of the University of Cagliari. The patient was accompanied by her mother, who reported that her daughter had suffered a traumatic injury to the maxillary central incisors about 1 month earlier. She did not have symptoms immediately after the accident, but subsequently she reported losing coronal fragments from the maxillary right central incisor. They then decided to visit a dentist. The medical history of

Discussion

The traditional approach for treating this case of a necrotic immature permanent tooth with sinus tract would have been either apexification with calcium hydroxide medication or apexification with MTA (3, 4). However, the apexification treatment does not lead to a further thickening of dentinal walls or an increased root length. Moreover, complete instrumentation of the root canal system would have prevented any possible repair of a horizontal fracture (1, 3). A more conservative approach for

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