Challenges in regenerative endodontics: A case report

Abstract

Regenerative endodontics is a part of the advanced endodontic procedure for the well being of immature teeth with root canals that are infected and it can be called as “paradigm shift” in the ideal approach of treatment for continued root maturation and apical closure. It is a procedure which is clinically oriented to disinfect the root canal system without damaging stem cell present in the apical papilla and dentinal wall. By instrumentation process bleeding induced in the apical area to induced new stem cells in this area followed by intracanal cement placement to prevent microleakage. The mechanism of REP was to make triad by biomarkers, stem cells, Scaffold which works on the regeneration of lost tissue of pulp dentine complex and further root formation. Many authors suggested that the REPS procedure is the definitive treatment of immature teeth with pulp necrosis. For a dentist it is a unique challenge to treat an immature tooth with apical periodontitis and pulpal necrosis. For endodontic treatment the options available are apexification, apical barriers and revascularization of the permanent tooth. 16 years old boy comes to a comprehensive college clinic with the complaint of pain and swelling in the lower posterior tooth region. On clinical examination lower premolar with apical periodontitis was treated with revascularization protocol irrigating with normal saline and sodium hypochlorite, an antibiotic paste (triple), mineral trioxide aggregate and then a coronal seal with a dental composite. In a follow up of one year there was an evident resolution of radiolucencies in the periapical area and root development was appreciated.