Ten‐year follow up of previously traumatized immature permanent incisors sustaining second and third traumatic injuries after revascularization treatment: Case reports

Abstract

The long‐term prognosis of previously traumatized immature permanent teeth treated with guided endodontic repair is well documented, but little is known about how these teeth respond to further traumatic injury after treatment. This case report presents the 10‐year clinical and radiographic findings of two patients with traumatized maxillary incisors who underwent guided endodontic repair treatment and sustained two further traumatic injuries. Three crown‐fractured maxillary central incisors with pulp necrosis were treated with a protocol that used 2.5% NaOCl irrigation, 3–4 weeks medication with calcium hydroxide or ciprofloxacin‐metronidazole paste, induction of apical bleeding, and coronal sealing with mineral trioxide aggregate. One tooth sustained subluxation and a crown fracture after 20 months and 7 years, respectively. Two other teeth had a luxation injury at 9 months and subluxation 6.5 years after the repair treatment. One subluxated and one luxated tooth remained free of symptoms for 10 years with radiographic evidence of progressive root canal calcification, while the other luxated incisor required root canal treatment after 7.5 years. Although teeth treated with the so‐called “regenerative” endodontic techniques do not possess true pulp tissue, the reparative tissue may respond to traumatic injuries in a similar manner to teeth with normal pulps.

Fragment rehydration, splinting, and autotransplantation: A journey to better treatment for traumatized teeth

“…33,34 More biologically based techniques are used to try and restore lost pulp tissues with regenerative endodontic procedures using platelet concentrates. 35 A randomized clinical trial compared the regenerative potential of injectable platelet-rich fibrin (i-PRF) platelet-rich plasma (PRP) scaffolds in traumatized immature maxillary anterior teeth. In this issue, Abo-Heikal et al compared the completion of root formation and the restoration of pulp sensitivity in traumatized necrotic immature maxillary anterior teeth following i-PRF versus PRP regenerative scaffolds.…”

“…Traditionally, treatment options following TDIs aimed to create a hard tissue bridge at the open apex, through apexification with mineral trioxide aggregate application 33,34 . More biologically based techniques are used to try and restore lost pulp tissues with regenerative endodontic procedures using platelet concentrates 35 . A randomized clinical trial compared the regenerative potential of injectable platelet‐rich fibrin (i‐PRF) and platelet‐rich plasma (PRP) scaffolds in traumatized immature maxillary anterior teeth.…”