Aim: The aim of this article is to describe a one-visit approach to attempt revascularization in the upper right and left central incisors after traumatic injury.
Background: A single-visit conservative revascularization approach can be used to promote root growth and maturation following traumatic dental injury and loss of pulpal tissues.
Case description: An eight-year-old female patient presented in Dentalia Clinics, Jeddah, Kingdom of Saudi Arabia, in 2016 with traumatic dental injury. Upon clinical and radiographic examination, it was found that the trauma resulted in loss of pulp vitality in two upper central incisors. Local anesthesia was administered, and a rubber dam was placed. Access cavity was done for each tooth separately. 2% chlorhexidine followed by sterile saline was used for irrigation with no instrumentation. Mineral trioxide aggregate (MTA) was used as the sealing material after blood clot formation. Follow-up showed continuous root maturation in the right central incisor, at 6 months, one year, two years, and three years. Root canal treatment was done in 2019 due to the development of periapical lesion. The 6-month follow-up radiograph also showed loss of the crown of the left central incisor due to a second trauma with retained apical root fragment. The fragment was embedded inside the bone and showed continuous maturation during the three years.
Conclusion: A single-visit regenerative endodontic approach showed successful results in revascularizing the upper permanent central incisor after loss of pulpal tissue.
Clinical significance: Immature permanent teeth can be treated by a single-visit revascularization procedure to promote root maturation and increase in radicular dentin length and width.
Heithersay GS. Calcium hydroxide in the treatment of pulpless teeth with associated pathology. J Br Endod Soc 1975;8(2):74–93. DOI: 10.1111/j.1365-2591.1975.tb01000.x.
Frank AL. Therapy for the divergent pulpless tooth by continued apical formation. J Am Dent Assoc 1966;72(1):87–93. DOI: 10.14219/jada.archive.1966.0017.
Jeeruphan T, Jantarat J, et al. Mahidol study 1: comparison of radiographic and survival outcomes of immature teeth treated with either regenerative endodontic or apexification methods: a retrospective study. J Endod 2012;38(10):1330–1336. DOI: 10.1016/j.joen.2012.06.028.
Iwaya SI, Ikawa M, et al. Revascularization of an immature permanent tooth with apical periodontitis and sinus tract. Dent Traumatol 2001;17(4):185–187. DOI: 10.1034/j.1600-9657.2001.017004185.x.
Banchs F, Trope M. Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol? J Endod 2004;30(4):196–200. DOI: 10.1097/00004770-200404000-00003.
Huang GT, Sonoyama W, et al. The hidden treasure in apical papilla: the potential role in pulp/dentin regeneration and bioroot engineering. J Endod 2008;34(6):645–651. DOI: 10.1016/j.joen.2008.03.001.
Lin L, Shovlin F, et al. Pulp biopsies from the teeth associated with periapical radiolucency. J Endod 1984;10(9):436–448. DOI: 10.1016/S0099-2399(84)80266-6.
Shah N, Logani A, et al. Efficacy of revascularization to induce apexification/apexogensis in infected, nonvital, immature teeth: a pilot clinical study. J Endod 2008;34(8):919–925, discussion 1157. DOI: 10.1016/j.joen.2008.05.001.
Chueh LH, Huang GT. Immature teeth with periradicular periodontitis or abscess undergoing apexogenesis: a paradigm shift. J Endod 2006;32(12):1205–1213. DOI: 10.1016/j.joen.2006.07.010.
Jung IY, Lee SJ, et al. Biologically based treatment of immature permanent teeth with pulpal necrosis: a case series. J Endod 2008;34(7):876–887. DOI: 10.1016/j.joen.2008.03.023.
Rafter M. Apexification: a review. Dent Traumatol 2005;21(1):1–8. DOI: 10.1111/j.1600-9657.2004.00284.x.
Nygaard-Ostby B, Hjortdal O. Tissue formation in the root canal following pulp removal. Scand J Dent Res 1971;79(5):333–349. DOI: 10.1111/j.1600-0722.1971.tb02019.x.
Ostby BN. The role of the blood clot in endodontic therapy. An experimental histologic study. Acta Odontol Scand 1961;19:324–353. DOI: 10.3109/00016356109043395.
Kling M, Cvek M, et al. Rate and predictability of pulp revascularization in therapeutically reimplanted permanent incisors. Endod Dent Traumatol 1986;2(3):83–89. DOI: 10.1111/j.1600-9657.1986.tb00132.x.
Andreasen JO, Bakland LK, et al. Traumatic intrusion of permanent teeth. Part 1. An epidemiological study of 216 intruded permanent teeth. Dent Traumatol 2006;22(2):83–89. DOI: 10.1111/j.1600-9657.2006.00421.x.
Cvek M. Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with gutta-percha. A retrospective clinical study. Endod Dent Traumatol 1992;8(2):45–55. DOI: 10.1111/j.1600-9657.1992.tb00228.x.
Andreasen FM. Pulpal healing after luxation injuries and root fracture in the permanent dentition. Endod Dent Traumatol 1989;5(3):111–131. DOI: 10.1111/j.1600-9657.1989.tb00348.x.
Bukhari S, Kohli MR, et al. Outcome of Revascularization Procedure: A Retrospective Case Series. J Endod 2016;42(12):1752–1759. DOI: 10.1016/j.joen.2016.06.021.