Management of Intruded Immature Maxillary Central Incisor with Pulp Necrosis and Severe External Resorption by Regenerative Approach

Introduction

Intrusive luxation is one of the most severe traumatic injuries of permanent teeth that may adversely affect the pulp and the periodontium. Pulp necrosis and root resorption are the main pathologic entities associated with this injury. The present report describes the endodontic management of an intruded immature maxillary central incisor presented with pulp necrosis and severe inflammatory root resorption by using the regenerative approach.

Methods

A 7-year-old boy with dental trauma to the anterior maxillary region was referred for the management of a traumatized maxillary central incisor. Clinical examination revealed an uncomplicated crown fracture, whereas radiographic examination showed that the tooth was immature, confirming the intrusion that was calculated between 3 and 4 mm. The tooth was left to re-erupt, but after 2 months the boy presented with intraoral swelling. Radiographic examination showed initial signs of root resorption. The tooth was treated by using a regenerative endodontic approach.

Results

Clinical and radiographic examinations during the initial follow-up period showed resolution of the signs and symptoms as well as inhibition of the resorption process. At the follow-up examinations, the tooth remained free of signs and symptoms and completely functional. The radiographic recall examinations showed a gradual thickening of the root canal walls but incomplete apical closure.

Conclusions

The present case shows that severely injured teeth with uncertain prognosis may have a considerable percentage of chance to remain functional and free of signs and symptoms by using a regenerative endodontic procedure, confirming the efficacy of this procedure as a viable treatment option.