Root Maturity as a Determinant of Post-traumatic Endodontic Outcomes: A Comparative Case Report

Tooth avulsion and intrusion are severe traumatic dental injuries that often lead to tooth loss and root resorption. The main determinants of prognosis include root maturity, extra-alveolar time, and the timing and type of treatment. This study presents a comparative analysis of the healing responses in two pediatric cases following delayed and complicated replantation, with a focus on how the maturity of the tooth root influenced the outcomes. The case report details two pediatric cases with significantly different healing trajectories after replantation. Case 1 involves an eight-year-old boy with an avulsed immature permanent left central incisor (21) that was replanted after approximately six hours of extra-oral time. A revascularization procedure was performed two weeks post-replantation. While limited external resorption was noted at three months, it spontaneously arrested by the six-month follow-up. Case 2 presents a 10-year-old boy with severe intrusion of mature maxillary central incisors (11, 21), which were surgically repositioned and replanted. Root canal treatment was initiated at the second week, but radiographic evidence of progressive resorption was observed on both teeth by the end of six weeks. The immature tooth (Case 1) demonstrated a favorable healing response, characterized by revascularization and the spontaneous arrest of resorption. In contrast, the mature teeth (Case 2) experienced ongoing, progressive resorption despite conventional endodontic intervention. Root maturity significantly influences the regenerative potential and resorption outcome in replanted teeth. Immature teeth with open apices possess a greater capacity for healing and may benefit from regenerative endodontic approaches, even in instances of delayed replantation. Conversely, mature teeth with closed apices have a more guarded prognosis, with a higher propensity for progressive resorption following severe traumatic injuries.