Regenerative endodontic treatment (revascularization) for necrotic immature premolar

Abstract

Regenerative endodontic treatment may encourage continued root development and thus, is a suggested alternative technique for management of traumatized immature permanent teeth with pulp necrosis. On the other hand, ideal treatment method for necrotic immature premolar teeth has not yet been determined. Therefore, present article describes cases of successful revascularization in necrotic immature premolar, which had a lateral luxation injury from attempted extraction of wrong tooth by undergraduate dental student. The displaced tooth was manually repositioned and splinted to the neighboring teeth for 4 weeks using a semi-rigid splint. Two month after the traumatic injury, the next control was made, and the premolar was defined as necrotic and discoloration in the tooth was identified. The patient reported sensitivity to palpation and discomfort upon percussion. Revascularization therapy was performed over multiple appointments. Coverage over the access was intact and radiographic examination revealed the apexes appeared to be closing during subsequent visits over 24-month. The tooth had no mobility, no pain on percussion or palpation, and positive reaction to the cold test, during the recall period. In addition, the lamina dura and periodontal ligament were within normal limits at 24-month after the first intervention for revascularization treatment. The favorable results in this case of necrotic immature tooth show that regenerative endodontic treatment is a viable alternative to apexification or artificial apical barrier techniques for traumatized premolar teeth.