Regenerative Endodontic Procedure on an Immature Necrotic Molar: A Case Report with a 5-Year Review

Abstract

BACKGROUND The regenerative endodontic procedure (REP) for managing necrotic immature permanent teeth has the advantage of promoting root growth over the traditionally used apexification techniques. However, there is limited evidence on the long-term outcome of standardized REPs performed on immature molars. This case report presents the 5-year clinical and radiographic outcomes of REP performed on an immature mandibular first molar. CASE REPORT A healthy 7-year-old girl with a carious right mandibular first molar was referred to the endodontic clinic for evaluation and treatment. Clinical examination showed large occlusal caries, no tenderness to palpation and percussion tests, and no response to cold and electric pulp tests. Radiographic examination showed deep caries, apical radiolucency related to the open apices, and wide root canal space. Accordingly, the tooth was diagnosed with necrotic pulp and asymptomatic apical periodontitis. The REP was performed following the American Association of Endodontics guidelines, which comprise minimal instrumentation, disinfection with sodium hypochlorite irrigant, use of triple antibiotic paste, induced intracanal bleeding, and application of a coronal mineral trioxide aggregate plug. The patient missed the scheduled follow-up appointments but presented at the clinic 5 years later with an asymptomatic tooth. Clinical and radiographic examination revealed no tenderness to percussion and palpation test, no response to cold test, positive response to electric pulp test, apical healing, apical closure, root lengthening, and canal wall thickening and calcification. CONCLUSIONS While true pulp regeneration is unachievable, the REP, following the current protocol, is clinically successful in achieving root maturation and tooth retention.

Figure 1.

Preoperative radiographs showing deep caries, highlighting periapical radiolucency (black arrows) related to immature roots (white arrows) of tooth number 46.

Figure 2.

Periapical radiograph showing MTA plug in the coronal third (4 weeks after the initial visit).

Figure 3.

Periapical radiograph after restoring the tooth with a composite filling (8 weeks after the initial visit).

Figure 4.

After 5 years, periapical radiograph shows complete periapical healing, apical closure, increased root length, increased dentin thickness, and narrowed canal spaces.

Figure 5.

After 5 years, the panoramic radiograph indicates that the root length of tooth number 46 closely matches that of its counterpart tooth.