Regenerative endodontic therapy in a case of external inflammatory lateral resorption following a luxation

The insurgence of external inflammatory lateral resorption (EILR) is one of the consequences of dental trauma and it can further complicate the prognosis of a compromised tooth. Long term treatment with Ca(OH)2 is the gold standard to manage EILR, and, recently, regenerative endodontic procedure (REP) has been suggested as an alternative clinical approach. The purpose of this report is to describe a case of post-traumatic EILR treated using REP.

A 9 years-old girl experienced an extrusive luxation of tooth #11. At the first visit the tooth was asymptomatic and responsive to sensitivity tests. At 3 months follow-up tooth #11 did not respond to cold and EPT, showed tenderness to palpation and a non-active sinus tract on the buccal mucosa. The radiographic examination showed a stage 3 root development, and an EILR in the distal-cervical portion of the root. A REP was performed using a calcium hydroxide medication for three weeks. Upon the second appointment the tooth and periapical tissues were asymptomatic, and the sinus tract had disappeared, medication was removed, intracanal bleeding and coagulum were obtained, MTA was positioned on the coagulum, and the crown restored with composite resin. Follow-up was established every 6 months for the first 2 years, then every 12 months for the next 5 years. At two years tooth #11 shows lack of symptoms, arrest of the resorption and presence of autologous tissue at the apex and within the root canal.

Regenerative endodontic procedures offer a less invasive option for treating immature teeth with EILR. However, the long-term effectiveness of REP is still uncertain and further studies are needed.