Vital Pulp Therapy In Immature Permanent Tooth With Apical Periodontitis

Emerging evidence reveals vital pulp therapy (VPT) to be an option in treating immature teeth with irreversible pulpitis. This case reports VPT of an immature permanent premolar with apical periodontitis in a 11-year-old girl. The patient presented with 3-day history of gingival swelling and fistula on 14, which had received resin composite restoration for a central cusp 2 month prior. The tooth exhibited cold sensitivity but no spontaneous pain. Clinical examination revealed an intact resin restoration with percussion (๢), a gingival fistula discharging pus upon palpation, and delayed response to cold test. Periapical radiograph demonstrated incomplete root development (Nolla stages 8) with periapical translucency. 14 was diagnosed with chronic apical periodontitis. Given ambiguous pulp vitality status, diagnostic cavity preparation was performed. Significant pain upon pulp exposure suggested partial vitality. Subsequently, under local anesthesia and rubber dam isolation, the coronal and partial radicular pulp were removed until firm, pink tissue remained. The pulp was covered with iRoot BP Plus and restored with resin composite. Complete fistula resolution occurred within two weeks. At 3- and 9-month follow-ups, the tooth remained asymptomatic with stable function. Radiographs showed reduced apical radiolucency and evidence of root development, though early root canal calcification was evident. This case underscores that partial pulp vitality may persist in immature permanent teeth with apical periodontitis. A key challenge lies in accurately assessing pulp status. Long-term monitoring is needed to address calcification risks. VPT can be an option in treating immature permanent teeth with apical periodontitis.