Regenerative Endodontic Therapy For Apical Periodontitis In Immature Teeth

Regenerative endodontic therapy for immature permanent teeth with apical periodontitis is critical for preserving pulp vitality and promoting root development. This case report demonstrates the efficacy of pulp revascularization combined with platelet-rich fibrin (PRF) in managing chronic apical periodontitis in a 10-year-old patient, offering insights into preserving immature permanent teeth. A 10-year-old female presented with recurrent swelling of the left mandibular posterior tooth for six months. Clinical examination of tooth 35 revealed a fractured dens evaginatus, Grade II mobility, buccal sinus tract with purulent discharge, and PD=6 mm. Radiographic evaluation showed an open apex with periapical radiolucency. A diagnosis of chronic apical periodontitis was established. Treatment included: (1) infection control with 2.5% NaClO irrigation and Ca(OH)₂ intracanal medication; (2) revascularization after two weeks: EDTA chemomechanical preparation, apical bleeding induction to form a blood clot, PRF scaffold placement over bioceramic material ; (3) permanent composite restoration at one week. At 3-month follow-up, sinus tract closure, absence of mobility, and resolution of periapical radiolucency were observed. One-year radiographs demonstrated apical high-density imaging, indicating continued root maturation. Revascularization promotes root development via migration and differentiation of apical stem cells, contingent on effective infection control. PRF enhances tissue regeneration through growth factor release, synergizing with the osteogenic properties of bioceramic materials to facilitate apical closure. The combination of PRF and pulp revascularization effectively resolves apical periodontitis and stimulates regeneration in immature permanent teeth, providing a minimally invasive approach for complex cases.