Maturogenesis and Osseous Healing of a Necrotic Immature Premolar using Revascularization Procedure - A Case Report and Review of Literature

Author(s):

Malaz Mohamed Elrafie Mustafa*

Immature permanent teeth with pulpal necrosis present a clinical challenge to endodontists. Since debridement of pulp canal space is difficult, there is an increased possibility of root perforation and cervical root fracture, besides the presence of an open immature root apex jeopardize the apical seal of a root canal treatment resulting in subsequent failure. Regenerative endodontic Procedures provide an unconventional approach which relies on the principle of tissue engineering. The treatment outcomes of revascularization of necrotic immature permanent teeth have been shown to promote tooth maturogenesis and bone healing. This report presents a case of revascularization of a necrotic left mandibular premolar with apical periodontitis and interseptal bone defects using minimal canal instrumentation and calcium hydroxide paste as a root canal disinfectant. At a following visit, blood clot was evoked in the canal by irritating periapical tissues and the canal properly sealed with mineral trioxide aggregate, glass ionomer cement and composite resin. The case was followed for thirty-eight-month and deemed to be clinically normal with a positive response to cold test (Endo-frost, Roeko, UK). Radiographic evaluation showed root maturogenesis and complete osseous healing which was evident in the apical and interseptal bones.