From Pulp Revascularization To Apical Surgery: A Case Report

This case reports a 12-year follow-up of a traumatized immature permanent tooth (#21) treated with pulp revascularization(PR). The outcomes demonstrated successful apical closure and positive pulp vitality initially, followed by apical periodontitis after 12 years, managed with apical surgery. Histopathology revealed pulp-like tissue, emphasizing the importance of long-term monitoring and evaluating the efficacy of revascularization. A 19-year-old female presented in November 2013 with grade I looseness and tenderness (+) in tooth #21 after dental trauma. Initial management included fixation of loosened tooth. In 2014, the tooth exhibited tenderness (+/-), a negative electric pulp test, and CBCT confirmed an open apex. PR was advised but declined. In 2015, the patient underwent PR due to worsening tenderness (+) and periapical low density shadow detected by CBCT. In 2016, CBCT showed no discoloration and the periapical radiation rate decreased.In 2021, CBCT revealed complete resolution of the lesion. In 2025, a labial sinus tract emerged without tenderness, CBCT showed periapical radiolucency and apical closure. The patient chose apical surgery. Histopathology of resected apical tissue identified pulp-like tissue and inflammatory cells, but no bacteria. This case highlights the efficacy of PR in immature teeth with pulps post-trauma, promoting root maturation and apical closure. However, persistent inflammation risk necessitates long-term follow-up. Apical surgery remains a viable option for late-stage apical periodontitis. PR is suitable for immature permanent teeth with traumatic pulp necrosis, facilitating root development. However, long-term follow-up is critical to monitor delayed complications.