Revascularization Therapy For Traumatized Immature Permanent Tooth With Pulp Necrosis

This case illustrates the successful application of pulp revascularization in an immature permanent tooth with arrested root development secondary to traumatic injury. The procedure demonstrates significant advantages over conventional apexification in promoting physiological root formation and restoring normal apical architecture. An 11-year-old patient presented with a discolored and fractured maxillary right central incisor (#11) three years post traumatic intrusion. Clinical examination confirmed pulp necrosis (negative response to cold testing, grayish discoloration), while the adjacent tooth (#21) maintained normal vitality. Radiographic assessment revealed incomplete root formation (Nolla stage 8) with periapical radiolucency and external root resorption. The revascularization protocol involved disinfecting the canal system, inducing apical bleeding to the cervical third level, placing a 3mm iRoot BP (Innovative Bioceramix) apical plug over the blood clot, and sealing the access cavity with composite resin. At 12-month follow-up, the tooth exhibited positive response to vitality testing, radiographic evidence of continued root development with apical closure, and resolution of the periapical lesion. These findings confirm revascularization's superiority in maintaining tooth vitality and promoting natural root formation compared to traditional apexification techniques. The case highlights the importance of proper case selection and meticulous technique execution. Revascularization represents an ideal biological approach for managing necrotic immature permanent teeth, offering predictable outcomes in root development and long-term tooth survival when performed following established protocols.