Regenerative Endodontics-Reviving the Pulp the Natural Way: A Case Report

Abstract

Regenerative endodontic therapy (RET) offers a novel treatment option for developing teeth with pulp necrosis. In the current instance, RET was used to treat an immature mandibular permanent first molar that had been identified with irreversible pulpitis. The root canals were treated with triple antibiotic paste (TAP) and 1.5% sodium hypochlorite (NaOCl) irrigation. TAP was removed, and 17% ethylenediaminetetraacetic acid (EDTA) was used to treat the root canals during the second visit. As a scaffold, Platelet-rich fibrin (PRF) was applied. Mineral trioxide aggregate (MTA) was applied over PRF, and composite resin was used to repair the teeth. Radiographs taken from the posterior were utilized to assess the healing. The teeth displayed no signs of pain and healing after the six-month follow-up periods, and pulp sensibility tests using a cold and electric pulp tester produced no results. Conservative treatment options should be considered to save immature permanent teeth and assist in the regeneration of the root apex.

Keywords: immature permanent teeth; mineral trioxide aggregrate; platelet-rich fibrin; regenerative endodontics; triple antibiotic paste.

Figure 1. Pre-operative intraoral image

Deep occlusal caries associated with the lower right mandibular first molar can be seen (White arrow).

Figure 2. Pre-operative radiograph

Orthopantogram (OPG) shows incomplete root formation and increased periodontal ligament space with mandibular right first molar (White box).

Figure 3. Access opening done followed by copious and gentle irrigation with 20ml 1.5 % Sodium hypochlorite (White arrow)

Figure 4. Post-operative radiograph of 6 months follow up.

An increase in the root apex formation could be seen with the mandibular right first molar at 6 months follow up (White arrow).