Fig. 1

the fistula is located in the border between the attached gengiva and mucosa.

in the pre-op x-rays is clear the periapical lesion and the immature apex , the root walls are very thin with a reverse anatomy of the apical one third of the root

Fig. 2

After 6 months the x-ray shows a different situation, the lesion is healing and the root walls are thicker 

Fig. 3

After 12 months the lesion is healed and the apex is going to complete its growth, the root is longer and the tooth looks like the other central incisor

Fig. 4

intra-op x-ray after the application of the MTA , the material was placed over an area of reactive hard tissue located in the middle one third of the root

Fig. 5

Post operative x-ray.

The endodontic treatment has been finalized by a back packing with warm gutta-percha and a final restoration in composite

Fig. 6

2 years follow up.

The situation is stable , the periapical tissue is healthy and the tooth has completed its growth 

Fig. 7

4 years follow up

Fig. 8

6 years follow up. The radiologic situation shows a perfect continuity of the ligament, the apex looks normal according to the classic anatomy of an adult central incisor


Regenerative procedures constitute an emerging field in Endodontics, because the importance of the root formation is a strategic point in dentistry. Some authors seem opposed to apply the revascularization in infected, non vital immature teeth because it would be too risky trying to revascularize an infected root canal system. We disagree: pulp cells that survived infection can proliferate under the influence of the Hertwig’s epithelial root sheath even during the necrosis inflammation process.


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