REGENERATIVE ENDODONTIC TREATMENT OF IMMATURE PERMANENT TOOTH WITH NECROTIC PULP: CASE REPORT

Year 2025, Volume: 5 Issue: 1, 40 - 44, 29.04.2025

Ayşenur Doğan , Berna Aslan

https://doi.org/10.61139/ijdor.1589194

Abstract

Regenerative endodontic therapy is a treatment approach that aims to restore the functions of the pulp-dentin complex and promote root development in immature teeth with necrotic pulp. This method can potentially reduce the fracture risk in immature teeth by thickening the root canal walls and maintaining root growth. This case report presents a 24-month follow-up of an immature permanent tooth with necrotic pulp treated with a regenerative endodontic approach. As part of the regenerative endodontic treatment protocol, 1.5% sodium hypochlorite and 17% ethylenediaminetetraacetic acid were used as irrigation solution, and a dual antibiotic paste (1:1 ciprofloxacin: metronidazole) was applied as intracanal medication. After induction of bleeding into the root canal, a mineral trioxide aggregate was applied as a coronal plug on the formed blood clot, and the tooth was restored with composite material. At the 24-month clinical and radiographic follow-up, it was observed that the tooth responded positively to cold and electric pulp testing, and was not sensitive to percussion/palpation, periapical radiography showed healing of the periapical lesion and increased root growth. In conclusion, regenerative endodontic treatment can be considered a good alternative to traditional apexification treatment, especially in immature permanent teeth, to help thicken the root canal walls and restore the physiologic function of the tooth.

Keywords

Immature Tooth , MTA , Necrotic Pulp , Regenerative Endodontic Treatment

Regenerative Endodontic Treatment of Immature Permanent Tooth With Necrotic Pulp: Case Report

Abstract

Rejeneratif endodontik tedavi, nekrotik pulpalı immatür dişlerde pulpa-dentin kompleksinin işlevlerini yeniden kazandırmayı ve kök gelişimini desteklemeyi hedefleyen bir tedavi yaklaşımıdır. Bu yöntem, immatür dişlerde kök kanal duvarlarının kalınlaşmasını ve kök gelişiminin devam etmesini sağlayarak kırık riskini azaltma potansiyeline sahiptir. Bu olgu sunumunda, rejeneratif endodontik yaklaşımla tedavi edilen nekrotik pulpalı immatür daimî dişin 24 aylık takibi paylaşılmaktadır. Rejeneratif endodontik tedavi protokolü kapsamında irrigasyon solüsyonu olarak %1,5 sodyum hipoklorit ve %17 etilendiamintetraasetik asit kullanılmış, kanal içi medikaman olarak da ikili antibiyotik patı (1:1 siproflaksasin : metronidazol) uygulanmıştır. Kök kanalı içine doğru kanamanın indüklenmesinin ardından oluşan kan pıhtısı üzerine koronal tıkaç olarak mineral trioksit agregat uygulanmış ve diş kompozit materyal ile restore edilmiştir. 24 aylık klinik ve radyografik takiplerde dişin soğuk ve elektrik pulpa testine pozitif yanıt verdiği, perküsyon/palpasyona duyarlı olmadığı, periapikal radyografide periapikal lezyonun iyileştiği ve kök gelişiminde artış olduğu gözlenmiştir. Sonuç olarak, rejeneratif endodontik tedavi özellikle immatür daimî dişlerde, dişin kök kanal duvarlarının kalınlaşmasına yardımcı olması ve dişin fizyolojik işlevini yeniden kazandırmak amacıyla geleneksel apeksifikasyon tedavisine iyi bir alternatif olarak düşünülebilir.

Keywords

İmmatür Diş , MTA , Nekrotik Pulpa , Rejeneratif Endodontik Tedavi

References

• 1. Shabahang S., Treatment options: apexogenesis and apexification. Pediatric dentistry, 2013; 35(2): p. 125-128.
• 2. Huang G. T., Apexification: the beginning of its end. Int Endod J, 2009; 42(10): p. 855-66.
• 3. DEmiriz L. And Çetiner S., Nekrotik Pulpalı İmmatür Dişlerde Tedavi Yaklaşımları. ADO Klinik Bilimler Dergisi, 2011. 5(1): p. 770-781.
• 4. Galler K. M., Krastl G., Simon S., Van Gorp G., Meschi N., Vahedi B., et al., European Society of Endodontology position statement: Revitalization procedures. Int Endod J, 2016; 49(8): p. 717-23.
• 5. Tzanetakis G. N., Giannakoulas D. G., Papanakou S., Gizani S., And Lygidakis N., Regenerative endodontic therapy of immature permanent molars with pulp necrosis: a cases series and a literature review. Eur Arch Paediatr Dent, 2021; 22(3): p. 515-525.
• 6. Taşdemır T., Koşar T., Baltacioğlu E., And Çelık D., Nekrotik Pulpalı İmmatür Daimî Dişlerin Rejeneratif Endodontik Tedavisi: İki Olgu Sunumu. Turkiye Klinikleri. Dishekimligi Bilimleri Dergisi, 2021; 27(3): p. 526-530.
• 7. Wang X., Thibodeau B., Trope M., Lin L. M., And Huang G. T., Histologic characterization of regenerated tissues in canal space after the revitalization/revascularization procedure of immature dog teeth with apical periodontitis. J Endod, 2010; 36(1): p. 56-63.
• 8. Banchs F. And Trope M., Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol? J Endod, 2004; 30(4): p. 196-200.
• 9. AAO E., AAE clinical considerations for a regenerative procedure. American Association of Endodontists (AAE), 2016.
• 10. Hoshino E., Kurihara‐Ando N., Sato I., Uematsu H., Sato M., Kota K., et al., In‐vitro antibacterial susceptibility of bacteria taken from infected root dentine to a mixture of ciprofloxacin, metronidazole and minocycline. Int Endod J, 1996; 29(2): p. 125-130.
• 11. WINdley Iii W., Teixeira F., Levin L., Sigurdsson A., And Trope M., Disinfection of immature teeth with a triple antibiotic paste. J Endod, 2005; 31(6): p. 439-443.
• 12. Reynolds K., Johnson J., And Cohenca N., Pulp revascularization of necrotic bilateral bicuspids using a modified novel technique to eliminate potential coronal discolouration: a case report. Int Endod J, 2009; 42(1): p. 84-92.
• 13. Kim J.-H., Kim Y., Shin S.-J., Park J.-W., And Jung I.-Y., Tooth discoloration of immature permanent incisor associated with triple antibiotic therapy: a case report. J Endod, 2010; 36(6): p. 1086-1091.
• 14. Thibodeau B. And Trope M., Pulp revascularization of a necrotic infected immature permanent tooth: case report and review of the literature. Pediatric dentistry, 2007; 29(1): p. 47-50.
• 15. Nosrat A., Li K. L., Vir K., Hicks M. L., And Fouad A. F., Is pulp regeneration necessary for root maturation? J Endod, 2013; 39(10): p. 1291-1295.
• 16. Maniglia-Ferreira C., De Almeida-Gomes F., Pinto M. M., De Sousa Barbosa F. T., De Farias Filho D. M., and ALBUQUERQUE N. L., In vitro evaluation of the antimicrobial effects of different intracanal medications in necrotic immature teeth. Eur Arch Paediatr Dent, 2016; 17(4): p. 251-5.
• 17. Baez V., Corcos L., Morgillo F., Imperatrice L., And Gualtieri A. F., "Meta-analysis of regenerative endodontics outcomes with antibiotics pastes and calcium hydroxide. The apex of the iceberg". J Oral Biol Craniofac Res, 2022; 12(1): p. 90-98.
• 18. Egusa H., Sonoyama W., Nishimura M., Atsuta I., And Akiyama K., Stem cells in dentistry–part I: stem cell sources. Journal of prosthodontic research, 2012; 56(3): p. 151-165.
• 19. Taweewattanapaisan P., Jantarat J., Ounjai P., And Janebodin K., The Effects of EDTA on Blood Clot in Regenerative Endodontic Procedures. J Endod, 2019; 45(3): p. 281-286.
• 20. Pang N. S., Lee S. J., Kim E., Shin D. M., Cho S. W., Park W., et al., Effect of EDTA on attachment and differentiation of dental pulp stem cells. J Endod, 2014; 40(6): p. 811-7.
• 21. Torabinejad M. And Turman M., Revitalization of tooth with necrotic pulp and open apex by using platelet-rich plasma: a case report. J Endod, 2011; 37(2): p. 265-8.
• 22. Petrino J. A., Boda K. K., Shambarger S., Bowles W. R., And Mcclanahan S. B., Challenges in regenerative endodontics: a case series. J Endod, 2010; 36(3): p. 536-541.