Management of necrotic pulp of immature permanent incisor tooth: A regenerative endodontic treatment protocol: case report
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It is possible that a paradigm shift may be in the offing in the approach to treatment of immature teeth with necrotic pulp, away from traditional apexification procedures and to a biologically-based endodontic protocol intended to produce regeneration, based on the deliberate introduction of bleeding into the canal space to provide a scaffold and allow the ingress of stem cells. METHODS: A patient presented with a maxillary right central incisor tooth with an open apex and periapical radiolucency. The tooth was irrigated with sodium hypochlorite and then dressed with tri-antibiotic paste consisting of ciprofloxacin, metronidazole and amoxicillin. At a subsequent visit a blood clot was produced in the canal by irritating periapical tissues and the canal then sealed with mineral trioxide aggregate and glass ionomer cement. RESULTS: The patient was pain free, the draining sinus was resolved in two weeks, root maturation continued and apical closure occurred after two months. The tooth became responsive to cold pulp vitality testing. CONCLUSIONS: Continued root growth invoked by regenerative endodontics may reduce the risks of fracture and premature tooth loss otherwise associated with traditional CaOH2 apexification procedures. Randomised, prospective clinical trials and long term studies are required before the technique becomes standard practice.