(PR024) A Second Attempt at Pulp Revascularization on an Traumatized Immature Anterior Tooth: a Case Report With Two-year Follow-up

Pulp necrosis in traumatized immature permanent teeth may compromise root development.

Objective: This report describes the treatment of a 21-year-old woman, who complained of pain and dental crown darkening of permanent tooth #8. The medical records presented a history of dental trauma at the age of 9, and at the age of 15, the first attempt of pulp revascularization was performed, using triple antibiotic paste (TAP) as the intracanal dressing. Recent radiographs showed a periapical lesion associated with an immature root, which demonstrated the failure of the first attempt.

Methods: The second attempt at pulp revascularization included, in the first appointment, irrigation of the root canal and an association of 2% chlorhexidine (CHX) and calcium hydroxide (CH) as intracanal dressing. At the second appointment the final irrigation was performed, the introduction of a #40 K-file beyond the apex to induce apical bleeding, with blood clot formation and a 3mm MTA plug gently placed over the clot.

Results: In the six-month follow-up, the patient was asymptomatic, and the radiograph showed a slight decrease in the size of the periapical lesion, as well as a decrease in the width of the mesiodistal apex, showing possible root development.

Conclusion: The association between 2% CHX and CH as an intracanal dressing showed more favorable results than TAP, and even when a long period of time has passed after dental trauma, stem cells may remain viable and a revascularization procedure can be proposed, even in an adult patient.