Reestablishing Biology, Function, and Esthetics for Fractured, Immature Incisors

A seven-year-old boy with enamel-dentin fractures on both maxillary central incisors presented to the Piracicaba Dental School-UNICAMP seven days after the trauma. At the clinical evaluation, there were no clinical signs of pulp exposure, neither tooth was mobile, and both affected teeth presented a positive response to sensitivity tests and a negative response for percussion and palpation. The radiographic examination showed an undeveloped root and opened apex for both teeth. Indirect pulp capping was performed on the left maxillary central incisor, followed by a direct restoration. After one month, the patient complained of pain in the left central incisor, which responded negatively to sensitivity testing. Pulp revascularization was performed only on this tooth and was followed for 18 months. During this period, the left maxillary central incisor did not recover sensitivity, although radiographic examination showed apical closure, a slight increase in root length, and the formation of a mineralized barrier between the root canal and sealing material. The technique achieved its goal of restoring biological aspects, function, and esthetics of traumatized teeth when using this multidisciplinary approach.