Efficacy Of Blood Clot Scaffold In The Regenerative Endodontic Treatment Of A Traumatized Immature Necrotic Central Incisor With Complicated Crown Fracture: A Case Report With A 9-month Follow-up

Introduction: Regenerative Endodontic Procedure (REP) is an innovative approach comprising principle of tissue engineering to restore damaged tissues of pulp-dentin complex. Its application in an immature necrotic permanent incisor subjected to complicated crown fracture might be worthy.
Body: A 9-year-old Egyptian boy came to clinic suffering from severe pain and swelling after fracture of maxillary right central incisor during playing. The tooth had positive response upon percussion and palpation with no mobility Radiographic examination showed fracture of almost two-thirds of the clinical crown with immature root Cvek’s classification stage II (almost ½ root length) with ill-defined periapical lesion and disrupted lamina dura. Based on clinical and radiographic findings, the tooth was diagnosed as non-vital pulp with immature root and asymptomatic apical periodontitis. Endodontic regeneration using blood clot scaffold was done in two visits. After minimal instrumentation using H-file #50 in scraping motion on root canal walls, 20ml 1,5% NaOCl irrigation, a double antibiotic paste (ciprofloxacin and metronidazole) paste was used as intracanal medication. At the 2nd visit, 17% EDTA irrigation was followed by intentional over-instrumentation into periapical area using K-file #20 to induce intracanal bleeding and Blood clot scaffold formation. A 3 mm layer of Neo putty MTA was used as coronal plug just below cementoenamel junction followed by glass ionomer restoration and final composite restoration.
Conclusion: Regenerative Endodontic Procedure should be preferred in cases where the root development is severely deficient to allow continuation of root development and strengthening of the weakened dentinal tissues to prevent suspected root fracture.