3. Treatments for Traumatized and Diseased Immature Teeth: Pulpotomy, Cvek Partial Pulpotomy, Apexification, Apexogenesis, and Regenerative Endodontics

Young patients with developing immature permanent teeth present special problems to save their teeth following dental traumatic injury or caries decay. As a consequence, the endodontic treatments for traumatized immature permanent teeth with an exposed pulp can vary considerably among dentists. The apexification procedure is the most common and highest standard of care for immature teeth with a necrotic pulp or irreversible pulpitis. However the development of the teeth will cease at an immature stage of development, thus weak dentinal walls and short roots will remain. For teeth with very thin dentinal walls which are likely to fracture and need strengthening, a revascularization procedure can be used to disinfect the root canal with antibiotics and revitalize new tissue formation. The revascularization procedure is so called because it accomplishes tissue formation within the root canal by blood revascularization from the periapical tissues through the open apex. Alternatively, the necrotic and irreversible pulpitis tissues can be debrided, the root canal disinfected, and a scaffold placed inside the root canal to promote tissue formation in a regenerative endodontic procedure. Regenerative endodontic procedures should never be used to preserve deciduous (baby) teeth. There is little evidence to support the use of an endodontic revascularization procedure on an avulsed and replanted tooth, but it could strengthen the root canal walls of immature teeth and save them from being unrestorable following a fracture