SINGLE VISIT REGENERATIVE ENDODONTIC TREATMENT (RET) IN TRAUMATIZED NECROTIC IMMATURE PERMANENT TEETH: A REPORT OF THREE CASES

Abstract

OBJECTIVE: This report is intended to describe three cases treated with single-visit regenerative endodontic therapy in three traumatized immature necrotic permanent maxillary central incisors with periapical lesions. MATERIALS AND METHODS: Three asymptomatic patients presented with traumatized immature necrotic permanent maxillary central incisors with periapical lesions (>7mm) requiring tooth restoration. Teeth responded negatively to percussion, palpation and to both thermal and electric pulp testing. Local anesthesia without vasoconstrictor was given and access cavities were prepared. A single visit regeneration protocol was applied including an irrigation sequence with 20 ml of 2.5% sodium hypochlorite, sterile saline (10 mL), 20 ml of 17% Ethylenediaminetetraacetic acid (EDTA), and finally sterile saline (10 mL). A # 20 K-file was used 2mm beyond the apical foramen to evoke bleeding. Biodentine (Septodont, France) was used as the cervical plug. Glass ionomer was flowed over the capping material then composite resin restoration was accomplished. After 12 months, clinical and radiographic outcomes were assessed using cone beam computed tomography (CBCT) and periapical radiographs. RESULTS: At the end of follow up, two cases were asymptomatic. One case presented with a sinus tract and chronic apical abscess. CBCT analysis revealed thinning of the apical diameter, root thickening and lengthening. The periapical radiolucency decreased in two cases and increased in one. The teeth presented no response to thermal or electric pulp testing. CONCLUSION: Single-visit regenerative endodontic therapy may present questionable clinical and radiographic outcomes for treatment of necrotic immature permanent teeth. Further clinical studies are needed to validate its efficacy.