Regenerative endodontic procedures for traumatized immature permanent teeth with severe external root resorption and root perforation

Abstract External root resorption (ERR) is often a complication of traumatic injury to the teeth. Traditionally, external inflammatory root resorption (EIRR) is usually treated with calcium hydroxide. The outcome of ERR especially replacement resorption is unpredictable. The purpose of the present case report is to describe regenerative endodontic procedures (REPs) for one replanted avulsed tooth with severe external root resorption and root perforation (tooth #9) and one extruded tooth (tooth #8). A 9-year-old girl was referred for the treatment of teeth #8 and #9 four months after the initial trauma. Clinical examination showed that tooth #9 had a sinus tract present near the periapical area and was tender to percussion and palpation and did not respond to pulp sensibility tests. Tooth #8 responded to pulp sensibility tests. Periapical radiographic and CBCT examination showed that tooth #9 had a periapical radiolucent lesion and severe ERRs with a root perforation. Tooth #9 was diagnosed having a necrotic pulp and symptomatic apical periodontitis. Regenerative endodontic procedures (REPs) were initiated. Tooth #8 became non-responsive to pulp sensibility tests and developed a periapical lesion 12 months after REPs of tooth #9 and was also treated with REPs. Clinical symptoms and apical lesions resolved for both teeth after REPs. The severe ERRs were arrested and root perforation was repaired for tooth #9. Teeth #8 and #9 showed canal obliteration by hard tissue formation after REPs and were in function 18 months and 30 months respectively. REPs may be used to manage traumatized immature permanent teeth with a necrotic pulp and apical periodontitis associated with severe ERR and root perforation.