Apexification-induced Revascularization and Orthodontic Treatment in Immature Maxillary Central Incisors: A Case Report with 11-year Follow-up

Aim and background: Regenerative endodontic treatment in a necrotic immature tooth allows for the continuation of root development.This case report describes the successful regenerative endodontic and orthodontic treatment in a traumatically injured immature maxillary central incisor with pulpal necrosis and apical abscess.Case description: Patient presented with traumatically injured immature maxillary central incisors exhibiting pulpal necrosis and an apical abscess.Routine access opening was done in both the central incisors, following which cleaning and shaping were performed using circumferential filing.Intracanal medication was done with calcium hydroxide.Obturation was done using gutta-percha and zinc oxide eugenol sealer, after the formation of a calcific barrier at the end of 1 year.The patient returned after a period of 7 years wanting correction for her protruding teeth.The intraoral periapical radiograph revealed root development, and obturation was short of the apex.The patient underwent fixed orthodontic treatment for 2 years.Conclusion: This case report describes a necrotic immature maxillary central incisor that showed continued root development after an apexification procedure.Fixed appliance orthodontic treatment did not cause any untoward effects.Both teeth were asymptomatic and functional during the follow-up period of 11 years.Clinical significance: Orthodontic treatment did not influence regenerative treatment outcome in teeth with an immature root apex.