Regenerative endodontic procedures for avulsed immature permanent tooth with severe external root resorption
Keywords:
avulsed tooth, immature root development, root resorption, regenerative endodonticAbstract
Infection-related root resorption following the reimplantation of an avulsed tooth is a common and severe adverse outcome. This condition is particularly aggressive in teeth with immature root development. Additionally, treatment procedures are highly challenging due to difficulties in root canal disinfection, halting root resorption, and managing the immature root structure. The objective of this case study is to demonstrate the application of regenerative endodontic procedures in the treatment of an avulsed immature permanent tooth with severe infection-related root resorption. The treatment protocol included thorough root canal irrigation and the use of intracanal medication with triple antibiotic paste to eliminate infection and prevent further root resorption. After a 5-month disinfection period, during which the periapical lesion decreased in size, a blood clot was induced in the root canal, followed by coronal sealing. At the 1-year follow-up, the patient remained asymptomatic. Radiographic evaluation revealed cessation of root resorption, complete resolution of the periapical lesion, and restoration of continuous alveolar bone around the root surface. These case reports suggest that regenerative endodontic procedures can offer a promising treatment outcome for avulsed immature permanent teeth affected by infection-related root resorption.
References
Bourguignon C, Cohenca N, Lauridsen E, Flores MT, O’Connell AC, Day PF, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations. Vol. 36, Dent Traumatol. 2020; 36: 314-330.
Andreasen JO, Andreasen FM, Andersson L. Textbook and Color Atlas of Traumatic Injuries to the Teeth. Stoma Edu J. 2019;6.
Souza BDM, Dutra KL, Kuntze MM, Bortoluzzi EA, Flores-Mir C, Reyes-Carmona J, et al. Incidence of Root Resorption after the Replantation of Avulsed Teeth: A Meta-analysis. Vol. 44, J Endod. 2018;44:1216–27.
Trope M. Treatment of the Immature Tooth with a Non-Vital Pulp and Apical Periodontitis. Vol. 54, Dent Clin North Am. 2010;54:313–24.
Trope M. Root Resorption due to Dental Trauma. Endod Topics. 2002;1:79–100. 6. Banchs F, Trope M. Revascularization of immature
permanent teeth with apical periodontitis: New treatment protocol? J Endod. 2004;30: 196–200.
Santiago CN, Pinto SS, Sassone LM, Hirata R, Fidel SR. Revascularization Technique for the Treatment of External Inflammatory Root
Resorption: A Report of 3 Cases. J Endod. 2015;41:1560–4.
Yoshpe M, Einy S, Ruparel N, Lin S, Kaufman AY. Regenerative Endodontics: A Potential Solution for External Root Resorption (Case Series). J Endod. 2020;46:192–9.
Lu J, Liu H, Lu Z, Kahler B, Lin LM. Regenerative Endodontic Procedures for Traumatized Immature Permanent Teeth with Severe External Root Resorption and Root Perforation. J Endod. 2020;46:1610–5.
Dadpe AM, Shah DY, Natanasabapathy V, Sureshbabu NM, Hindlekar AN, Modi K. Regenerative Endodontic Procedures in Teeth with Root Resorption: A Systematic Review. Vol. 8, Eur Endod J. 2023;8:170-86.
Lin S, Moreinos D, Wisblech D, Rotstein I. Regenerative endodontic therapy for external inflammatory lateral resorption following
traumatic dental injuries: Evidence assessment of best practices. Vol. 55, Int Endod J. 2022;55: 1165-76.
Lu J, Lu Y, Lu Z, Kahler B. Clinical and radiographic outcomes of regenerative endodontic procedures for traumatized permanent necrotic teeth with apical periodontitis and external root resorption. Int Endod J. 2023;56:802-18.
Cvek M. Prognosis of luxated non‐vital maxillary incisors treated with calcium hydroxide and filled with gutta‐percha. A retrospective clinical study. Dent Traumatol. 1992;8:45–55.
Hoshino E, Kurihara-Ando N, Sato I, Uematsu H, Sato M, Kota K, et al. In-vitro antibacterial susceptibility of bacteria taken from infected root dentine to a mixture of ciprofloxacin, metronidazole and minocycline. Int Endod J. 1996;29:125–30.
Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM. Replantation of 400 avulsed permanent incisors. 2. Factors related to pulpal
healing. Dent Traumatol. 1995;11:59-68.
Andreasen JO, Borum MK, Jacobsen HL, Andreasen FM. Replantation of 400 avulsed permanent incisors. 4. Factors related to periodontal ligament healing. Dent Traumatol. 1995;11:76 -89.
Kling M, Cvek M, Mejàre I. Rate and predictability of pulp revascularization in therapeutically reimplanted permanent incisors. Dent
Traumatol. 1986;2:83 -9.
Hargreaves KM, Giesler T, Henry M, Wang Y. Regeneration Potential of the Young Permanent Tooth: What Does the Future Hold? Vol. 34, J Endod. 2008;34:51 -6.
AAE Clinical Considerations for a Regenerative Procedure Revised 5/18/2021 [Internet]. Available from: https://www.aae.org/specialty/ wp-content/uploads/sites/2/2021/08/Clinical ConsiderationsApprovedByREC062921.pdf
Swimberghe RCD, De Clercq A, De Moor RJG, Meire MA. Efficacy of sonically, ultrasonically and laser-activated irrigation in removing a biofilm-mimicking hydrogel from an isthmus model. Int Endod J. 2019;52:515-23.
Zbanska J, Herman K, Kuropka P, Dobrzynski M. Regenerative endodontics as the future treatment of immature permanent teeth.
Vol. 11, Appl Sci. (Switzerland). 2021;11:6211.
Galler KM, Buchalla W, Hiller KA, Federlin M, Eidt A, Schiefersteiner M, et al. Influence of root canal disinfectants on growth factor
release from dentin. J Endod. 2015;41:363 -8.
Foreman PC, Barned IE. A review of calcium hydroxide. Int Endod J. 1990;23:283 -97.
Galler KM, Krastl G, Simon S, Van Gorp G, Meschi N, Vahedi B, et al. European Society of Endodontology position statement: Revitalization procedures. In: Int Endod J. 2016;49:717-23
Nagata JY, Soares AJ, Souza-Filho FJ, Zaia AA, Ferraz CCR, Almeida JFA, et al. Microbial evaluation of traumatized teeth treated with
triple antibiotic paste or calcium hydroxide with 2% chlorhexidine gel in pulp revascularization. J Endod. 2014;40:778-83.
Trope M. Endodontic considerations in dental trauma. Ingle’s endodontics Hamilton (ON): BC Decker. 2008;1330–57.
Chrepa V, Joon R, Austah O, Diogenes A, Hargreaves KM, Ezeldeen M, et al. Clinical Outcomes of Immature Teeth Treated with
Regenerative Endodontic Procedures—A San Antonio Study. J Endod. 2020;46:1074-84.
Ng YL, Mann V, Rahbaran S, Lewsey J, Gulabivala K. Outcome of primary root canal treatment: Systematic review of the literature - Part 1.Effects of study characteristics on probability of success. Vol. 40, Int Endod J. 2007;40:921 -39.
Malu K, Khubchandani M. Triple Antibiotic Paste: A Suitable Medicament for Intracanal Disinfection. Cureus. 2022;14:e29186
Chen SJ, Karabucak B, Steffen JJ, Yu YH, Kohli MR. Spectrophotometric Analysis of Coronal Tooth Discoloration Induced by Tricalcium
Silicate Cements in the Presence of Blood. J Endod. 2020;46:1913 -9.
Timmerman A, Parashos P. Bleaching of a Discolored Tooth with Retrieval of Remnants after Successful Regenerative Endodontics.
J Endod. 2018;44:93-7.
Torabinejad M, Nosrat A, Verma P, Udochukwu O. Regenerative Endodontic Treatment or Mineral Trioxide Aggregate Apical Plug in
Teeth with Necrotic Pulps and Open Apices: A Systematic Review and Meta-analysis. Vol. 43, J Endod. 2017;43:1806-20.
Colleagues for Excellence [Internet]. 2013. Available from: https://www.aae.org/specialty/ wp-content/uploads/sites/2/2017/06/
ecfespring2013.pdf
Lin J, Zeng Q, Wei X, Zhao W, Cui M, Gu J, et al. Regenerative Endodontics Versus Apexification in Immature Permanent Teeth with Apical Periodontitis: A Prospective Randomized Controlled Study. J Endod. 2017;43:1821-7.
Shivashankar VY, Johns DA, Maroli RK, Sekar M, Chandrasekaran R, Karthikeyan S, et al. Comparison of the effect of PRP, PRF and
induced bleeding in the revascularization of teeth with necrotic pulp and open apex: A triple blind randomized clinical trial. JCDR.
;11:ZC34-ZC39.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Thai Endodontic Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Thai Endod Journal is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) license, unless otherwise stated. Please read our Policies in Copyright for more information.
