Department of Pediatric Dentistry, School of Stomatology, China Medical University, Shenyang, China.
J Endod. 2013 May;39(5):719-22. doi: 10.1016/j.joen.2012.12.023. Epub 2013 Feb 10.
Regenerative endodontic treatment (RET) has been used in treating nonvital immature permanent tooth whose root formation ranged from approximately two-thirds of the full root length to almost completely developed root with open apex at least 1.1 mm in diameter according to the reported cases. However, this case report was to introduce RET in an affected tooth at an early stage of root development.
The premolar #29 in an 8-year-old girl had pulpal necrosis and apical periodontitis caused by the fracture of dens evaginatus. Its root was at the beginning of formation. Copious hemorrhagic drainage was observed after preparing of an access cavity. The canal was irrigated with 3% NaOCl solution, sterile normal saline, and chlorhexidine. Root dressing with triple antibiotic was then performed and left for 4 weeks. We used a K-file to create bleeding into the canal after flushing and drying the root canal. Mineral trioxide aggregate was carefully placed over the formed blood clot.
Clinical examination at 1, 3, 6, 9, and 12 months revealed an asymptomatic tooth. Radiographic examination revealed resolution of periapical radiolucency, increased thickening of the canal wall, and lengthening of the root, which demonstrated the continual development of the tooth root. Noticeably, the first-month postoperative radiograph showed radiopaque image in the root canal like an isolated island, which was gradually obvious during follow-up. Cone-beam computed tomography revealed that the calcification was attached with dentin wall in buccolingual direction, and the root canal was not completely obliterated.
RET is feasible for a tooth at an early stage of root development that has necrotic pulp and periapical lesion.
再生性牙髓治疗（RET）已被用于治疗非活力的未成熟恒牙，其根形成范围从大约三分之二的全长到几乎完全发育的根，根尖孔至少为 1.1 毫米，根据报道的病例。然而，本病例报告介绍了在根尖孔早期发育阶段使用 RET。
8 岁女孩的#29 前磨牙因牙尖牙釉质凹陷畸形的折断而发生牙髓坏死和根尖周炎。其根处于形成的初期。预备开髓洞后，观察到大量出血性引流。用 3%次氯酸钠溶液、无菌生理盐水和洗必泰冲洗根管。然后用三抗糊剂进行根管内封药，放置 4 周。冲洗和干燥根管后，我们用 K 锉在根管内造成出血。小心地将三氧化矿物聚合体置于形成的血栓上。
1、3、6、9 和 12 个月的临床检查显示牙齿无症状。放射学检查显示根尖周透光区消失，根管壁增厚，牙根延长，表明牙齿持续发育。值得注意的是，术后第一个月的放射影像显示根管内有一个像孤立岛一样的不透射线影像，在随访过程中逐渐明显。锥形束 CT 显示钙化在颊舌方向附着于牙本质壁，根管未完全闭塞。
对于牙髓坏死和根尖病变的早期发育的牙齿，再生性牙髓治疗是可行的。
