Regenerative therapy in teeth with incomplete root formation after dental trauma to tooth 21: a case report




Regerative endodontics; Tooth injuries; Dental Pulp Necrosis; Pediatric dentistry.


Endodontic treatment aims to prevent or treat periapical changes resulting from pulp injuries. In immature permanent teeth the treatment has some peculiarities. Among the treatment modalities used in these cases is regenerative therapy. This is an option for the treatment of necrotic teeth with open apex, being an alternative to apexification that is performed worldwide with great success, but does not allow the end of tooth development, often leaving the walls fragile and thin, susceptible to fractures and consequent loss. of the dental element. In addition, she needs several sessions for periodic exchanges of calcium hydroxide; having a greater risk of new contamination inside the root canal. Patient collaboration can become a negative factor due to the successive necessary consultations. With the evolution of science and new research carried out, regenerative therapy can be an advantageous replacement for apexification, as it is faster and with promising results, however, further studies are needed to improve the technique, develop a definitive protocol, as well as studies of the results achieved in the long term. This paper is intended to present a clinical case of regenerative therapy of a necrotic tooth and open apex with a diagnosis of pulp necrosis of an maxillary left central incisor of an 8-year-old child after previous trauma.

Author Biography

Hebertt Gonzaga dos Santos Chaves, Universidade Federal de Minas Gerais

Cirurgiã-dentista, especialista e mestranda em Endodontia pela Faculdade de Odontologia da Universidade Federal de Minas Gerais (UFMG).

Atua na linha de pesquisa: Imunopatologia e microbiologia das doenças bucais. Sua linha investigação principalmente dos seguintes temas: Biocompatibilidade de biomateriais, respostas imunológicas e microbiológicas em tecidos pulpares e periapicais, capeamento pulpar, pulpotomia, resposta pulpar e intracanal.


AAE (2021). Clinical Considerations for a Regenerative Procedure. American Association of Endodontists.

Alghofaily, M., Torabinejad, M., & Nosrat, A. (2022). Regenerative Endodontic Treatment Using Periapical Blood or Circulating Blood as Scaffold: A Volumetric Analysis. Journal of endodontics, (22), 42-5.

Alipour, M., Aghazadeh, Z., Hassanpour, M., Ghorbani, M., Salehi, R., & Aghazadeh, M. (2022). MTA-Enriched Polymeric Scaffolds Enhanced the Expression of Angiogenic Markers in Human Dental Pulp Stem Cells. Journal of Endodontics, 21(75), 834-89.

Alobaid, A. S., Cortes, L. M., Lo, J., Nguyen, T. T, Albert, J., Abu-Melha. A. S., Lin. L. M., & Gibbs, J. L. (2014). Radiographic and clinical outcomes of the treatment of immature permanent teeth by revascularization or apexification: a pilot retrospective cohort study. Journal of Endodontics, 40(8), 1063-1070.

Banchs, F., & Trope, M. (2004). Revascularization of Immature Permanent Teeth With Apical Periodontitis: New Treatment Protocol? Journal of Endodontics, 30(4), 196-200.

Bakhtiar, H., Ashoori, A., Rajabi, S., Pezeshki-Modaress, M., Ayati, A., Mousavi, M. R., Ellini, M. R., Kamali, A., Azarpazhooh, A., & Kishen, A. (2022). Human amniotic membrane extracellular matrix scaffold for dental pulp regeneration in vitro and in vivo. Int Endod J. 55(4), 374-390.

Betancourt, P., Bucchi, C., & Arroyo-Bote, S. (2021). Determination of crown discoloration and fluorescence induced by different medications used in regenerative endodontic procedures: An ex vivo study. Journal of clinical and experimental dentistry, 13(8), e755–e761.

Bjørndal L., Simon S., Tomson P. L., & Duncan H. F. (2019). Management of deep caries and the exposed pulp. International Endodontic Journal. 52(7),949-973.

Born C. D., Jackson T. H., Koroluk L. D., & Divaris K., (2019). Traumatic dental injuries in preschool-age children: Prevalence and risk factors. Journal of the American Dental Association. 19: 30188-30196.

Brogni, J. K., Vitali, F. C., Cardoso, I. V., Dos Santos, J. D., Prado, M., Alves, A., & Duque, T. M. (2021). A second attempt at pulp revascularisation on an immature traumatised anterior tooth: a case report with two-year follow-up. Australian endodontic journal: the journal of the Australian Society of Endodontology Inc, 47(1), 90–96.

Bukhari. S., Kohli M. R., Setzer F., & Karabucak B. (2016). Outcome of Revascularization Procedure: A Retrospective Case Series. Journal of Endodontics. 42(12), 1752-1759.

Caleza-Jiménez. C., Ribas-Pérez. D., Biedma-Perea. M., Solano-Mendoza. B., & Mendoza-Mendoza. A. (2022). Radiographic differences observed following apexification vs revascularization in necrotic immature molars and incisors: a follow-up study of 18 teeth. Eur Arch Paediatr. 7.(1).

Cehreli. Z. C., Isbitiren. B., Sara. S., & Erbas. G. (2011). Regenerative endodontic treatment (revascularization) of immature necrotic molars medicated with calcium hydroxide: a case series. Journal of Endodontics. 37(9), 1327-1330.

Cehreli. Z. C., Erbas. U. G., Eymirli. P., Mergen. I., Arslan. E., & Esenturk. G. (2022). Combined conventional and regenerative treatment in molars with coexistent closed and open apices: A case series. Aust Endod J.

Cehreli. Z. C., Unverdi. G. E., & Ballikaya. E. (2022). Deciduous Tooth Pulp Autotransplantation for the Regenerative Endodontic Treatment of Permanent Teeth With Pulp Necrosis: A Case Series. J Endod. 1:S0099-2399(22), 00068-1.

Chen. M. Y., Chen. K. L., Chen. C. A., Tayebaty. F., Rosenberg. P. A., & Lin. L.M. (2012). Responses of immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscess to revascularization procedures. International Endodontic Journal. 45(3), 294-305.

Clark. D., & Levin. L. (2019). Prognosis and complications of mature teeth after lateral luxation: A systematic review. Journal of the American Dental Association. 19, 30188-30196.

Connert. T., Weiger. R., & Krastl. G. (2022). Present status and future directions - Guided endodontics. Int Endod J. 35075661.

Deluca. M.C.C., Scarparo. R.K., Aspesi. M., Matte. B.F., Brand. L.M., Grecca. F.S., Casagrande. L., & Kopper. P. M. P. (2021). Cytotoxic, Migration, and Angiogenic Effects of Photodynamic Therapy and Photobiomodulation Associated with a Revascularization Protocol. J Endod. 47(1):69-77.

Diogenes. A, & Ruparel. N.B. (2017). Regenerative Endodontic Procedures: Clinical Outcomes. Dent Clin North Am. 61(1):111-125.

Elnawam. H., Abdelmougod., M., Mobarak. A., Hussein. M., Aboualmakarem. H., Girgis. M., & El Backly. R. (2022). Regenerative Endodontics and Minimally Invasive Dentistry: Intertwining Paths Crossing Over Into Clinical Translation. Frontiers in bioengineering and biotechnology, 10, 837639

El-Tayeb. M. M., Abu-Seida. A. M., El Ashry. S. H., & El-Hady. S. A. (2019). Evaluation of antibacterial activity of propolis on regenerative potential of necrotic immature permanent teeth in dogs. BMC Oral Health. 19(1):174.

Eramo. S., Natali. A., Pinna. R., & Milia. E. (2018). Dental pulp regeneration via cell homing. International Endodontic Journal. 51(4), 405-419.

Farhad Mollashahi. N., Saberi. E., & Karkehabadi. H. (2016). Evaluation of Cytotoxic Effects of Various Endodontic Irrigation Solutions on the Survival of Stem Cell of Human Apical Papilla. Iranian endodontic journal, 11(4), 293–297.

Galler. K. M., Buchalla. W., Hiller. K. A., Federlin. M., Eidt. A., Schiefersteiner. M., & Schmalz. G. (2015). Influence of root canal disinfectants on growth factor release from dentin. Journal of endodontics, 41(3), 363–368.

Gomes. B. P., Vianna. M. E., Zaia. A. A., Almeida. J. F., Souza-Filho. F. J., & Ferraz. C. C. (2013). Chlorhexidine in endodontics. Brazilian dental journal, 24(2), 89–102.

Hameed. M. H., Gul. M., Ghafoor. R., & Badar. S. B. (2019). Management of immature necrotic permanent teeth with regenerative endodontic procedures - a review of literature. J Pak Med Assoc. 69(10):1514-1520.

Hargraves. K. M., & Cohen. S., (2011). Caminhos da Polpa. Tradução Alcir Costa Fernandes Filho et al. Elsevier.

Hargreaves. K. M., Giesler. T., Henry. M., & Wang. Y. (2008). Regeneration potential of the young permanent tooth: what does the future hold?. Journal of endodontics. 34(7), S51–S56.

He. W. X., & Yu. Q. (2022). New advances in vital pulp therapy and pulp regeneration for the treatment of pulpitis: from basic to clinical application. Zhonghua Kou Qiang Yi Xue Za Zhi. 57(1), 16-22.

Hosseinpour. S., Gaudin. A., & Peters. O. A. (2022). A critical analysis of research methods and experimental models to study biocompatibility of endodontic materials. International endodontic journal,

Iwaya. . S. I., Ikawa. M., & Kubota. M. (2001). Revascularization of an immature permanent tooth with apical periodontitis and sinus tract. Dental Traumatology. 17(4), 185-187.

Kahler. B., Rossi-Fedele. G., Chugal. N., & Lin. L.M. (2017). An Evidence-based Review of the Efficacy of Treatment Approaches for Immature Permanent Teeth with Pulp Necrosis. Journal of Endodontics. 43(7): 1052-1057.

Kim. S. G., Malek. M., Sigurdsson. A., Lin. L. M., & Kahler. B. (2018). Regenerative endodontics: a comprehensive review. International Endodontic Journal. 51(12), 1367-1388.

Kontakiotis. E. G., Filippatos. C. G., Tzanetakis. G. N., & Agrafioti. A. (2015). Regenerative endodontic therapy: a data analysis of clinical protocols. Journal of endodontics. 41(2), 146–154.

Lin. J., Zeng. Q., Wei. X., Zhao. W., Cui. M., Gu. J., Lu. J., Yang. M., & Ling, J. (2017). Regenerative Endodontics Versus Apexification in Immature Permanent Teeth with Apical Periodontitis: A Prospective Randomized Controlled Study. Journal of endodontics. 43(11), 1821–1827.

Nageh. M., Ahmed. G. M., & El-Baz. A. A. (2021). Assessment of Regaining Pulp Sensibility in Mature Necrotic Teeth Using a Modified Revascularization Technique with Platelet-rich Fibrin: A Clinical Study. J Endod. 44(10),1526-1533.

Nageh. M., Ibrahim. L. A., AbuNaeem. F. M., & Salam. (2022). E. Management of internal inflammatory root resorption using injectable platelet-rich fibrin revascularization technique: a clinical study with cone-beam computed tomography evaluation. Clin Oral Investig. 26(2), 1505-1516.

Nagy. M. M., Tawfik. H. E., Hashem. A. A., & Abu-Seida. A. M. (2014). Regenerative potential of immature permanent teeth with necrotic pulps after different regenerative protocols. Journal of endodontics, 40(2), 192–198

Nicoloso. G. F., Goldenfum. G. M., Pizzol. T. D. S. D., Scarparo. R. K., Montagner. F., de Almeida Rodrigues. J., & Casagrande. L. (2019). Pulp Revascularization or Apexification for the Treatment of Immature Necrotic Permanent Teeth: Systematic Review and Meta-Analysis. J Clin Pediatr Dent.;43(5):305-313.

Petrino. J. A., Boda. K. K., Shambarger. S., Bowles. W. R., & McClanahan,.S. B. (2010). Challenges in regenerative endodontics: a case series. Journal of endodontics, 36(3), 536–541

Ravikumar. K., Chakravarthy. Y., Kumar. A., Samynathan. M., & Varshini. R.J. (2021). Foreign Body Removal and Revascularization of Teeth with Periapical Radiolucency: 18 Months' Follow-Up. J Pharm Bioallied Sci. 13(1), 886-889.

Soares. A., Lins. F. F., Nagata. J. Y., Gomes. B. P., Zaia. A. A., Ferraz. C. C., de Almeida. J. F., & de Souza-Filho, F. J. (2013). Pulp revascularization after root canal decontamination with calcium hydroxide and 2% chlorhexidine gel. Journal of endodontics, 39(3), 417–420.

Sismanoglu. S., & Ercal, P. (2021). The cytotoxic effects of various endodontic irrigants on the viability of dental mesenchymal stem cells. Australian endodontic journal : the journal of the Australian Society of Endodontology Inc.

Soares. A. J., Lins. F. F., Nagata. J. Y., Gomes. B. P., Zaia. A. A., Ferraz. C. C., Almeida. J. F., & Souza-Filho. F. J. (2013). Pulp revascularization after root canal decontamination with calcium hydroxide and 2% chlorhexidine gel. Journal of Endodontics. 39(3): 417-420.

Staffoli. S., Plotino. G., Nunez Torrijos. B. G., Grande. N. M., Bossù. M., Gambarini. G., & Polimeni. A. (2019). Regenerative Endodontic Procedures Using Contemporary Endodontic Materials. Materials (Basel, Switzerland), 12(6), 908.

Stambolsky. C., Rodríguez-Benítez. S., Gutiérrez-Pérez. J.L., Torres-Lagares. D., Martín-González. J., & Segura-Egea. J.J. (2016). Histologic characterization of regenerated tissues after pulp revascularization of immature dog teeth with apical periodontitis using tri-antibiotic paste and platelet-rich plasma. Arch Oral Biol. 71:122-128.

Torabinejad. M., Nosrat. A., Verma. P., & Udochukwu. O. (2017). Regenerative Endodontic Treatment or Mineral Trioxide Aggregate Apical Plug in Teeth with Necrotic Pulps and Open Apices: A Systematic Review and Meta-analysis. Journal of Endodontics. 43(11): 1806-1820.

Vieira. W.A., Pecorari. V. G. A., Gabriel. P. H., Vargas-Neto. J., Santos. E. C. A., Gomes B. P. F. A., Ferraz. C. C. R., Almeida. J. F. A., Marciano. M., & de-Jesus-Soares. A. (2021) The association of inadequate lip coverage and malocclusion with dental trauma in Brazilian children and adolescents - A systematic review and meta-analysis. Dent Traumatol. 38(1):4-19.

Widbiller. M., Althumairy. R. I., & Diogenes. A. (2019). Direct and Indirect Effect of Chlorhexidine on Survival of Stem Cells from the Apical Papilla and Its Neutralization. Journal of endodontics, 45(2), 156–160.

Wongwatanasanti. N., Jantarat. J., Sritanaudomchai. H., & Hargreaves. K. M. (2018). Effect of Bioceramic Materials on Proliferation and Odontoblast Differentiation of Human Stem Cells from the Apical Papilla. Journal of endodontics, 44(8), 1270–1275.

Zanini. M., Hennequin. M., & Cousson. P.Y. (2019). Which procedures and materials could be applied for full pulpotomy in permanent mature teeth? A systematic review. Acta Odontol Scand. 77(7),541-551.

Zhou. R., Wang. Y., Chen. Y., Chen. S., Lyu. H., Cai. Z., & Huang. X. (2017). Radiographic, Histologic, and Biomechanical Evaluation of Combined Application of Platelet-rich Fibrin with Blood Clot in Regenerative Endodontics. Journal of endodontics, 43(12), 2034–2040.



How to Cite

CHAVES, H. G. dos S.; SOUZA, L. M. L. de .; MACEDO, I. F. A.; MAIA, C. A. .; FIGUEIREDO, B.; FERREIRA, I. da C.; MAIA, G. A. .; FERREIRA, G. da C.; SILVA, V. J. de L.; CASADEI, B. de A. . Regenerative therapy in teeth with incomplete root formation after dental trauma to tooth 21: a case report. Research, Society and Development, [S. l.], v. 11, n. 7, p. e11911729033, 2022. DOI: 10.33448/rsd-v11i7.29033. Disponível em: Acesso em: 26 feb. 2024.



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