Regenerative Endodontic Treatment in an Immature Permanent Tooth With Necrotic Pulp and Periradicular Lesion

Managing necrotic immature permanent teeth with an open apex presents a treatment challenge. Regenerative endodontic procedures have emerged as biologically based approaches for these cases, suggesting an alternative to conventional apexification. This report describes successful revascularization of an immature mandibular second premolar with a chronic apical abscess. Following canal disinfection with NaOCl irrigation and applying a calcium hydroxide as an intracanal medicament, a scaffold was created by inducing a blood clot within the canal. During follow-up sessions, the tooth remained asymptomatic and clinically functional. Radiographic evidence demonstrated ongoing apical root development with increases in both root length and dentinal-wall thickness, along with signs of apical closure. The treatment outcome supports the premise that conservative pulp revascularization can promote complete root maturation by preserving the vitality of dental pulp stem cells and providing a conducive environment for pulp regeneration.