Is pulp regeneration necessary for root maturation?

Abstract

Introduction: True regeneration of the dental pulp-dentin complex in immature teeth with necrotic pulps has not been shown histologically. It is not known to what extent this true tissue regeneration is necessary to achieve clinically acceptable outcomes.

Methods: This case report describes the treatment of a patient with an immature maxillary right central incisor with a history of impact trauma and enamel-dentin crown fracture. A diagnosis of pulp necrosis with acute apical abscess was established. A regenerative endodontic protocol that used a paste containing Augmentin for 5 weeks as an intracanal medicament was used.

Results: Follow-ups at 9, 12, 17, and 31 months revealed complete osseous healing of the periapical lesion and formation of the root apex, but without increase in root length. Clinically, the tooth was functional, asymptomatic, and nonresponsive to pulp vitality tests. The crown discolored over time. On reentering the root canal, no tissues were observed under magnification inside the root canal space. The root canal treatment was completed with mineral trioxide aggregate obturation.

Conclusions: Augmentin might be an acceptable choice for root canal disinfection in regenerative endodontic procedures. The protocol for regenerative endodontic treatment is not predictable for pulp-dentin regeneration. Formation of the root apex is possible without pulp regeneration.

Keywords: Augmentin; dental trauma; mineral trioxide aggregate; pulp regeneration; regenerative endodontic treatment; root development.