Regenerative endodontic therapy assisted by a concentrated growth factor scaffold for bilateral symmetrical dens...

To evaluate the therapeutic efficacy and long-term outcomes of regenerative endodontic therapy (RET) assisted by a concentrated growth factor (CGF) scaffold in the management of chronic apical periodontitis associated with pulp necrosis of immature permanent teeth caused by bilateral apical fractures.

A 10-year-old girl presented with bilateral mandibular second premolars (teeth #35 and #45) complicated with chronic periapical periodontitis secondary to apical fractures. At the first visit, infection control was achieved through debridement and root canal preparation, after which a calcium hydroxide dressing was placed. At the second visit, tooth #35 underwent RET using an induced blood clot as a scaffold, with the canal sealed by mineral trioxide aggregate (MTA). Tooth #45 received RET using CGF gel prepared from autologous venous blood as a scaffold, and the canal orifice was sealed with the bioceramic material iRoot BP Plus. Both teeth were restored with resin. Postoperative follow-ups were conducted at 2, 6, 12, and 24 months, as well as at 3-5 years.

Both teeth demonstrated resolution of periapical radiolucency, progressive periapical healing, and continued root development. Complete root canal calcification was observed in tooth #35 within 3-5 years. In tooth 45, calcification and apical development within the root canal were observed at 6 months, with fusion occurring after 1 year, and complete canal closure by 4-5 years. Throughout the follow-up period, both teeth remained asymptomatic and functional.

RET assisted by a CGF scaffold effectively controlled infection, promoted root wall thickening, and facilitated continued root development, offering advantages over conventional apexification and apical barrier techniques. This case highlights the potential clinical value of CGF as a bioactive scaffold in managing pulp necrosis of immature permanent teeth associated with apical deformities.