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Traumatic injuries to an immature permanent tooth may result in cessation of dentin deposition and root maturation. Novel revascularisation endodontic procedure (REP) has been considered as an option for treatment of immature teeth with damaged pulp tissue. The continuous development of the root and the root canal has been recognised as a major advantage of this technique over traditional apexification approach. Traditional apexification procedures may resolve pathology but have not been able to prove tooth survival due to absence of continued root development and risk of root fracture. A successful REP results in resolution of signs and symptoms of pathology, radiographic signs of healing, proof of continued root development as well as presence of pulp vitality due to the regeneration of pulp tissue in the root canal. Currently, repair rather than true regeneration of the ‘pulp-dentine complex’ is achieved and further root maturation is variable. According to Glossary of Endodontic terms published by American Association of Endodontists, REP’s are biologically based procedures designed to physiologically replace damaged tooth structures, including dentin and root structures, as well as cells of the pulp-dentin complex.1,2 Apexification treatment has been a routine procedure to treat and preserve such teeth for many decades.3 Apexification is the process by which a suitable environment is created within the root canal and periapical tissue to allow for the formation of a calcific barrier across the open apex. Calcium hydroxide [Ca(OH)2] has been the material of choice for apexification as Frank reported its capacity to induce physiological closure of immature pulpless teeth in 1966.4 However, this technique has several disadvantages, including the unpredictability of apical barrier formation and the long duration of treatment, which often requires multiple visits.5 A retrospective study by Jeruphuaan et al.6 has shown a higher survival rate with regenerative endodontic treatment when compared to both mineral trioxide aggregate (MTA) and Ca(OH)2 apexification. The first evidence of regeneration of dental tissues was in 1932 by G.L. Feldman, who showed evidence of regeneration of dental pulp under certain optimal biological conditions.7 In 1971, a pioneer study in regenerative endodontics conducted by Nygaard-Ostby concluded that bleeding induced within a vital or necrotic canal led to resolution of signs and symptoms of necrotic cases and in certain cases, apical closure.8 According to Windley et al. (2005), the successful revascularisation of immature teeth with apical periodontitis is mainly dependent upon: 1. Canal disinfection 2. Scaffold placement in the canal for the growing tissues 3. Bacteria-tight sealing of the access opening.9 The purpose of this case report is to illustrate the outcome of a revascularisation endodontic procedure in a non-vital immature young permanent central incisor.

BACKGROUND Sutures require specific physical characteristics and properties such as good tensile strength, dimensional stability, lack of memory, knot security and sufficient flexibility to avoid damage to the oral mucosa. The strength and adherence of the sutured tissue increases over time. Tissue reaction characteristics involve varying degree of inflammatory reactions. Therefore, the purpose of this study was to assess clinically and histologically human gingival tissue reaction to silk & m- polytetrafluoroethylene (m-PTFE) sutures in periodontal surgical procedures. METHODS The present study is a prospective clinical randomised split mouth study. A total of 15 patients of both sexes were included in the study. All the patients were provided with thorough scaling and root planing before the commencement of the study. The patients were re-evaluated at 4 weeks and sutures were placed in the surgical area where there was a need for excision of gingival tissue as a part of routine periodontal surgery. After placement of sutures, the change of bite, change of slack, clinical changes in plaque index, modified gingival index & sulcus bleeding index and the histological changes in mean thickness of the peri sutural epithelial sleeve, proportion of inflammatory cells to peri sutural epithelial cells, diameter of the connective tissue inflammatory infiltrate (measured in mm) from the periphery of the epithelialization of the sutures from the insertion day (day 0) to the day of scheduled surgery (day 7) were recorded. RESULTS Silk sutures presented an increase in the change of bite and change of slack of the suture loop than m-PTFE. Diameter of the connective tissue infiltrate was greater around the multifilament suture (SILK) as compared to the monofilament suture (mPTFE) though the difference was not statistically significant. (P-value = 0.321). Monofilament suture (m-PTFE) showed the least amount of inflammatory infiltrate around the suture track. The proportion of inflammatory cells to epithelial cells was statistically not significant between the two suture materials (P-value = 0.82). CONCLUSIONS Though the clinical and histological parameters are statistically non-significant, mpolytetrafluoroethylene has shown better results compared to silk. Silk sutures cause a more extensive inflammatory tissue reaction in an environment characterized by moisture and infectious potential compared to m-PTFE sutures. KEY WORDS PTFE, Inflammatory Response, Sutures, Gingiva

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