Regenerative endodontic treatment of permanent teeth after completion of root development: a report of 2 cases

Clinical regenerative endodontic treatment has been focused on immature necrotic teeth, but it should be extended to mature teeth as an alternative to conventional endodontic treatment. There have been no clinical reports to attempt to revascularize pulp in the entire root canals of mature necrotic teeth. The present report describes the treatment of mature, necrotic, permanent incisors with apical periodontitis by using regenerative endodontic therapy.

In this case report, modified regenerative endodontic procedures were used to enhance the probability of pulp revasuclarization in mature necrotic teeth. At the first appointment, the root canals were mechanically instrumented to the apices with a large apical size by using the step-back technique and irrigated copiously with antimicrobial solution. Intracanal medicaments (calcium hydroxide or ciprofloxacin) were placed in the root canals. At the following appointment, the root canals were irrigated with antimicrobial solution, and bleeding was induced into the root canals by passing hand files beyond apices. Collagen membranes were placed in the canals as a matrix against which mineral trioxide aggregate was placed. Glass ionomer was used to restore the teeth. The resolution of apical radiolucency and regression of clinical signs and symptoms were observed at recall appointments.

The present report presents modified regenerative endodontic procedures for mature necrotic permanent teeth. Further clinical studies with a large number of cases are needed to investigate the outcome of regenerative endodontic therapy for mature necrotic teeth.