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CASE REPORT
Year : 2022  |  Volume : 12  |  Issue : 4  |  Page : 468-473

Regenerative endodontic therapy for management of an immature permanent tooth with recurrent post-treatment apical periodontitis: A case report


1 EndoChat Research Group, Rio de Janeiro, Brazil; Private practice, Rio de Janeiro, Brazil
2 EndoChat Research Group, Rio de Janeiro, Brazil; Department of Endodontics, Francisco Marroquín University, Guatemala City, Guatemala; Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Brazil
3 Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Brazil; Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, Rio de Janeiro, Brazil
4 EndoChat Research Group, Rio de Janeiro, Brazil; Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Brazil; Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, Rio de Janeiro, Brazil

Correspondence Address:
Prof. Flávio R. F. Alves
Rua Professor José de Souza Herdy, 1160, Duque de Caxias, Rio de Janeiro 25071-202
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jispcd.JISPCD_71_22

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This case report describes the treatment outcome and further retreatment of an immature permanent maxillary right central incisor with necrotic pulp and chronic apical abscess using regenerative endodontic therapy (RET). The patient had a history of traumatic injury. The initial periapical radiographic and cone-beam computed tomographic (CBCT) examinations revealed tooth #8 had incomplete root formation, thin dentinal walls, and pulp necrosis associated with a large apical periodontitis lesion. RET was conducted in two visits and included a disinfection protocol with 5.25% NaOCl irrigation and medication with a double antibiotic paste (metronidazole and ciprofloxacin). At the second visit, a blood clot was induced, and the cervical third was sealed with a mineral trioxide aggregate plug and the coronal portion with light-cure composite. The tooth was asymptomatic at the 12-, 24-, and 36-month follow-ups, and radiographs showed continued root development with healed periradicular tissues. However, the 4-year radiographic follow-up revealed a recurrent apical periodontitis lesion. A second attempt of RET was conducted in one visit using 1% NaOCl irrigation and stimulation of a blood clot. A double seal with silicate-based cement and composite was placed. At the 24-month follow-up, the tooth remained asymptomatic, and both radiographic and CBCT examinations showed apical closure and complete repair of the periradicular tissues. When a tooth develops recurrent apical periodontitis, a second attempt of RET is a feasible option to control infection, helping to promote tooth retention associated with healthy periradicular conditions.


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