Clinical Report: Immature Necrotic Tooth Healed with Revascularisation
A narrowed canal lumen due to severe calcification showed on CBCT image.
HKU Faculty of Dentistry has achieved clinical success in a patient who had received regenerative endodontic treatment for an open apex with necrotic pulp and chronic apical abscess.
The patient was a 12-year-old boy who was referred to Prince Philip Dental Hospital for root canal treatment of tooth 15, after complaining of swelling on the upper right region for 3 months.
Clinical examination revealed a fractured tubercle (den evaginatus) of tooth 15, and a draining sinus tract on the buccal attached gingiva between tooth 14 and tooth 15. Further examination revealed immature root formation of tooth 15, with a periapical radiolucency measuring approximately 5mm in diameter.
Revascularization or regenerative procedures was recommended for the boy as these had the advantage of allowing continued growth of immature root, and the resolution of periapical lesion with absence of any clinical signs or symptoms.
In this case, the regenerative procedures involved the removal of necrotic pulpal remnants, the debridement of the canal walls and the dressing of the canal with calcium hydroxide medicament for bacteria eradication. After the buccal sinus tract was noted to have healed and the tooth was asymptomatic, the root canal was irrigated with sterile saline before bleeding was induced.
The induced-bleeding was done by overinstrumentation of the canal length, after which a blood clot was formed at the middle third of the root.
According to Dr Chengfei Zhang, Clinical Associate Professor in Endodontics, the concept of revascularization is such that it focuses on gaining of blood supply into the disinfected root canal space, which triggers a process similar to wound healing in surgical procedures.
Dr Zhang said the treatment was deemed successful because no clinical signs or symptoms were detected in follow-up visits (at 4, 7, 18, 26 and 66 months postoperatively), with the periapical lesion healed and the apical closure observed.
But he said the severe calcification of the canal noted at the 36-month and 66-month follow-up would need further studies to examine the mechanism.
In conclusion, the revascularization procedure involving an immature tooth with pulpal necrosis and chronic apical abscess had achieved clinical success, but long-term root canal calcification may be one of the treatment outcomes of revascularized teeth, possibly a consequence associated with regenerative endodontic procedure.
C. M. L. She, G. S. P. Cheung,and C. F. Zhang. Long-Term Follow-Up of a Revascularized Immature Necrotic Tooth Evaluated by CBCT. Case Reports in Dentistry. Volume2016. http://dx.doi.org/10.1155/2016/4982458