Two-Year Outcomes of Regenerative Therapy in an Immature Maxillary Molar With Periapical Abscess: A Case Report

Trauma or caries in teeth with incomplete root formation can lead to pulp necrosis. Endodontic treatment in such cases requires specific clinical protocols that differ from conventional approaches due to the anatomical and developmental characteristics of immature teeth. This case report describes the clinical management of a maxillary second molar (tooth #17) with incomplete root development and a periapical abscess, treated through pulp revascularization. A 13-year-old male patient presented with spontaneous, throbbing pain in the upper right facial region, accompanied by infraorbital swelling. Intraoral examination revealed extensive loss of tooth structure in tooth #17 and the presence of a palatal abscess. Cold pulp testing was negative, while percussion testing was positive, supporting the diagnosis of periapical abscess. Due to the extensive tooth structure, a crown lengthening procedure was performed. Endodontic access was achieved under rubber dam isolation, and three root canals were identified and carefully emptied. Irrigation was performed with 2.5% sodium hypochlorite 4 mm short from the working length, followed by 3 min of EDTA application. Ultracal was used as intracanal medicament for 30 days. At the second appointment, clot induction was achieved with a #20 file, and the cervical third was sealed with Biodentine, followed by composite resin restoration. After a 2-year clinical, radiographic, and tomographic follow-up, the tooth remained asymptomatic, with radiographic evidence of continued root maturation and apical closure, suggesting a favorable outcome of the regenerative protocol.