Apical Surgery and Resurgery After Recurrent Failure in Traumatised Immature Teeth: Reflections on Management Based on Two Case Reports

This study reports two cases of traumatised non-vital immature teeth (IT). Both underwent surgical and nonsurgical treatments after healing failure. In the first case, both maxillary central incisors underwent revascularization as the first treatment option. Failure was detected in tooth #8 after 15 months, while tooth #9 showed periapical healing and further root development. Apical microsurgery was performed because of persistent cystic fluid during nonsurgical retreatment. In the second case, there was recurrent endodontic treatment failure in tooth #9 after nonsurgical mineral trioxide aggregate (MTA) apical plug placement and apical surgery (AS). Endodontic resurgery comprised debridement, apical and lateral root surface planning and removal of remaining MTA from the bone lesion. For both cases, histopathological examination revealed the presence of inflammatory cysts. Periapical healing was observed 1 year after treatment. Apical surgery, and even resurgery, should be considered as alternatives to tooth extraction in growing patients with IT and recurrent healing failure.