Restorative challenges and successful outcome of apexification and revascularization in adjacent traumatized immature teeth

Aim: To describe the successful outcome of adjacent traumatized immature teeth treated with revascularization and apexification and discuss some important aspects of regenerative endodontics and restorative alternatives.

Summary: An eight-year-old male was referred for endodontic treatment of traumatized teeth #11 and #21. Although revascularization was originally planned for both fractured teeth with pulp exposure, the lack of bleeding into the root canal of tooth #21 changed the treatment plan towards apexification with an apical MTA plug. Seven months later, a glass-fiber post was placed into the root canal of tooth #21 and reinforced with a polyethylene fiber strip. Then, both teeth were restored with multi-layered composite restorations that provided a natural appearance. The three-year follow-up confirmed the absence of painful symptoms and composite infiltration, while CBCT images revealed no root fractures or periradicular lesions, and maintenance of root thicknesses and lengths. Comprehensive restorative treatment can be performed after revascularization or apexification through the collaboration of endodontic and restorative dentistry specialists, which is important to ensure successful outcomes in terms of root development, maintenance of pulp vitality, and pleasant esthetic.

Key learning points:

• Dental trauma is a common condition, particularly for children and adolescents, that can lead to several consequences (from tooth discoloration to avulsion).
• A flexible plan is crucial to treat traumatized immature teeth.
• Revascularization can lead to maintaining root development and avoiding periapical pathologies.