Fig. 1

A healthy 10 years old patient arrived in the office 2 weeks after suffering a traumatic accident while riding a bike which led to the coronal fracture of 1.1 involving enamel and dentine, creating a small opening to the pulp chamber. 

The tooth had second degree mobility and was sensitive to palpation.

Following vitality tests and paraclinical examination pulp necrosis and subluxation are confirmed.

Treatment plan

Because an incomplete root with a large foramina is observed on the periapical radiographic image, regenerative endodontics is proposed as a treatment option to the patient and his parents. After obtaining their agreement, the treatment plan includes regenerative endodontics and also stabilization of the tooth using a flexible immobilization.

Fig. 2

Necrotic pulp is removed from the root canal using rotary files

Fig. 3

Irrigation is performed using NaOCl 5,25% and EDTA

Fig. 4

After drying, Ca(OH)2 is placed in the root canal

Fig. 5

After a month Ca(OH)2 is removed and canals irrigated with NaOCl 5,25% and EDTA.

Fig. 6

After drying the canal bleeding is promoted using a #10 K-file in patency

Fig. 7

A coronal plug of bioceramic putty material is placed before restoring the tooth

Fig. 8

One year follow-up shows the closing of the apical foramina 

Fig. 9

3 years follow-up shows a thickening of the root canal walls.

Fig. 10

1.1 responded after 3 years to both cold test and electric test at similar values to 2.1

Fig. 11
Dr. Cristian Giucoane graduated the Dental Medicine Faculty from UMF "Victor Babes" Timisoara, Romania in 2019. Since then his practice is limited to endodontics working in different clinics from Romania. Since 2021 he is a key oppinion leader for Dentsply Sirona.
In 2022 he was offered an ambassador position from Ectopic Society doing his best trying to promote good practice and moral values throughout the country.
Later that year he founded Endodontic Events Association which organised the first international endodontic congress in Romania, Endo Resto Summit.
In 2023 he received the title of Endodontics specialist from Spitalul Clinic Municipal Timisoara.
In 2024 the University of Siena welcomes him as a tutor in the Endodontics Master of Science programme coordinated by Prof. Simone Grandini.
Since the fall of 2024 he is a fellow member of Style Italiano Endodontics after winning the bootcamp in Athens.
Now he is an endodontist in Dr. Baldea Dental Clinic in Timisoara.

Conclusions

Regenerative endodontics can be performed with everyday materials being a good treatment option for immature teeth where the pulp isn’t viable.

This treatment should be performed in the most aseptic conditions to offer a successful outcome.

The procedure isn’t standardized, different clinicians can use many different materials and grafts in order to obtain success in these cases.

Bibliography

1. Henry F Duncan, Lise-Lotte Kirkevang, Ove A Peters. Treatment of pulpal and apical disease: The European Society of Endodontology (ESE) S3-level clinical practice guideline. Int Endod J. 10.1111/iej.13974

2. Thanawan Jeeruphan, Jeeraphat Jantarat, Kallaya Yanpiset, Lalida Suwannapan, Phannarai Khewsawai, Kenneth M Hargreaves. Mahidol study 1: comparison of radiographic and survival outcomes of immature teeth treated with either regenerative endodontic or apexification methods: a retrospective study. J Endod. 10.1016/j.joen.2012.06.028

3. Jiacheng Lin, Qian Zeng, Xi Wei, Wei Zhao, Minyi Cui, Jing Gu, Jiaxuan Lu, Maobin Yang, Junqi Ling. Regenerative Endodontics Versus Apexification in Immature Permanent Teeth with Apical Periodontitis: A Prospective Randomized Controlled Study. J Endod. 10.1016/j.joen.2017.06.023