Long-term follow-ups of revascularized immature necrotic teeth: three case reports

Abstract

Revascularization of immature necrotic teeth is a reliable treatment alternative to conventional apexogenesis or apexification. In case 1, a 12-year-old boy had his necrotic, immature mandibular left second premolar treated with a revascularization technique. At a24-month follow-up, periapical radiolucency had disappeared and thickening of the root wall was observed. In cases 2 and 3, a10-year-old boy had his necrotic, immature, bilateral mandibular second premolars treated with the same modality. At 48-month(in case 2) and 42-month (in case 3) follow-ups, loss of periapical radiolucencies and increases in the root wall thickness were also observed.

Figure 1

Periapical radiographs in case 1. (a) Pre-treatment periapical radiograph of the mandibular left second premolar. Note the periapical radiolucency and root immaturity (white arrows). (b) Periapical radiograph obtained immediately after placement of MTA into the root canal (white arrow). (c) Periapical radiograph obtained after gutta-percha (white arrow) obturation and composite resin restoration (black arrow). (d) Periapical radiograph obtained at the 6-week follow-up. Note the diminished periapical radiolucency (white arrow). (e) Periapical radiograph obtained at the 24-month follow-up. The root wall thickness has increased (white arrow) and apical closure is complete. MTA, mineral trioxide aggregate.

Figure 2

Intraoral photographs and periapical radiographs in case 2. (a) Pre-treatment occlusal photograph of the mandibular left second premolar. (b) Pre-treatment intraoral photograph of the tooth. Gingival swelling is evident on the buccal side (white arrow). (c) Pre-treatment periapical radiograph of the tooth. Periapical radiolucency with root immaturity is evident (white arrow). (d) Intraoral photograph obtained 2 weeks later. Buccal gingival swelling has disappeared (white arrow). (e) Periapical radiograph obtained immediately after placement of MTA into the root canal. (f) Periapical radiograph obtained after gutta-percha obturation and composite resin restoration. (g) Periapical radiograph obtained at the 2-month follow-up. Periapical radiolucency has decreased and the root wall has thickened (white arrow). (h) Periapical radiograph obtained at the 48-month follow-up. Thickening of the root wall is evident and periapical radiolucency has disappeared completely (white arrow). MTA, mineral trioxide aggregate.

Figure 3

Intraoral photographs and periapical radiographs in case 3. (a) Pre-treatment intraoral photograph of the mandibular right second premolar. Gingival swelling on the buccal side is evident (white arrow). (b) Pre-treatment periapical radiograph of the tooth. Note the periapical radiolucency with thin root walls (white arrow). (c) Intraoral photograph obtained after access cavity preparation. Note the bloody purulent discharge (white arrow). (d) Intraoral photograph obtained 1 week later. Complete reduction of gingival swelling is evident (white arrow). (e) Periapical radiograph obtained immediately after placement of MTA into the root canal. (f) Periapical radiograph obtained at the 2-month follow-up. Periapical radiolucency has decreased (white arrow). (g) Periapical radiograph obtained at the 42-month follow-up. Thickness of the root wall has increased and the periapical radiolucency has disappeared completely (white arrow). MTA, mineral trioxide aggregate.