International Journal of Dental Sciences and Research
ISSN (Print): 2333-1135 ISSN (Online): 2333-1259 Website: Editor-in-chief: Marcos Roberto Tovani Palone
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International Journal of Dental Sciences and Research. 2021, 9(1), 15-19
DOI: 10.12691/ijdsr-9-1-4
Open AccessCase Report

Revascularization of an Immature Necrotic Mandibular Second Molar Using Calcium Hydroxide: A 3-year Follow Up

Hanin Alsalhi1, and Nasser Alkatheeri2

1Restorative Dental Science Department, College of Dentistry, Qassim University, Qassim, Saudi Arabia

2Endodontic Department, National Guard Health Affair, Riyadh, Saudi Arabia

Pub. Date: January 20, 2021

Cite this paper:
Hanin Alsalhi and Nasser Alkatheeri. Revascularization of an Immature Necrotic Mandibular Second Molar Using Calcium Hydroxide: A 3-year Follow Up. International Journal of Dental Sciences and Research. 2021; 9(1):15-19. doi: 10.12691/ijdsr-9-1-4


Endodontic intervention in necrotic immature permanent teeth is usually a clinical challenge. With appropriate case selection and optimal disinfection, regenerative endodontic procedure (REP) can be effective and a desirable result can be obtained. In this report, an immature necrotic mandibular second molar had been treated by REP in two visits. In the first visit, a nonsetting calcium hydroxide was used as intracanal medication after irrigation with 1.5% (NaOCl). In the second visit, blood clots were created in the root canals. MTA was placed over the blood clots and the tooth was restored with a composite filling and stainless-steel crown. A clinical and radiographic follow up was performed for three years where the tooth was deemed a symptomatic with a complete root formation.

revascularization regenerative endodontic procedure Calcium hydroxide immature tooth

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[1]  Camp J, Fuks A, Pediatric endodontics: endodontic treatment for the primary and young permanent dentition. In: Cohen S, Hargreaves K, Keiser K, eds. Pathways of the pulp. 9th ed., Mosby Elsevier, St Louis, 2006, 822-82.
[2]  Sheehy EC, Roberts GJ. “Use of calcium hydroxide for apical barrier formation and healing in non-vital immature permanent teeth: a review,” Br Dent J, 183(7). 241-6. Oct.1997.
[3]  Abbot P. “Apexification with calcium hydroxide: when should the dressing be changed? the case for regular dressing changes,” Aust Endod J, 24(1). 27-32. Apr.1998.
[4]  Rafter M. “Apexification: a review,” Dent Traumatol, 21(1). 1-8. Feb.2005.
[5]  Andreasen JO, Farik B, Munksgaard EC. “Long-term calcium hydroxide as a root canal dressing may increase risk of root fracture,” Dent Traumatol, 18(3). 134-7. Jun.2002.
[6]  D. Witherspoon, J. Small, J. Regan, and M. Nunn, “Retrospective analysis of open apex teeth obturated with mineral trioxide aggregate,” Journal of Endodontics, 34(10). 1171-1176. Oct.2008.
[7]  Smith AJ, Cooper PR. “Regenerative Endodontics: Burning Questions,” J Endod. 1(9S). S1-S6. Sep.2017.
[8]  Kim SG, Zhou J, Solomon C, Zheng Y, Suzuki T, Chen M, et al. “Effects of growth factors on dental stem/progenitor cells,” Dent Clin North Am., 56(3). 563-75. Jul.2012.
[9]  K. Hargreaves and A. Law, “Regenerative endodontics,” in Pathways of the Pulp, K. Hargreaves and S. Cohen, Eds., Mosby Elsevier, St Louis, 2011, 602-619.
[10]  B. Thibodeau and M. Trope, “Pulp revascularization of a necrotic infected immature permanent tooth: case report and review of the literature,” Pediatric Dentistry, 29(1). 47-50. Jan-Feb.2007.
[11]  Reynolds K, Johnson JD, Cohenca N. “Pulp revascularization of necrotic bilateral bicuspids using a modified novel technique to eliminate potential coronal discolouration: a case report,” Int Endod J. 42 (1). 84-92. Jan.2009.
[12]  Shin SY, Albert JS, Mortman RE. “One step pulp revascularization treatment of an immature permanent tooth with chronic apical abscess: a case report,” Int Endod J. 42 (12). 1118-26. Dec.2009.
[13]  Petrino JA, Boda KK, Shambarger S, Bowles WR, McClanahan SB. “Challenges in regenerative endodontics: a case series,” J Endod, 36 (3). 536-41. Mar. 2010.
[14]  Hoshino E, Kurihara-Ando N, Sato I, Uematsu H, Sato M, Kota K, et al.” In-vitro antibacterial susceptibility of bacteria taken from infected root dentine to a mixture of ciprofloxacin, metronidazole and minocycline,” Int Endod J. 29 (2). 125-30. Mar.1996.
[15]  Chueh LH, Huang GT. “Immature teeth with periradicular periodontitis or abscess undergoing apexogenesis: a paradigm shift.” J Endod, 32(12). 1205-13. Dec.2006.
[16]  Pierson DJ. “How to read a case report (or teaching case of the month).” Respir Care, 54(10). 1372-8. Oct.2009.
[17]  Nicoloso GF, Goldenfum GM, Da Silva T, Scarparo RK, Montagner F, Rodrigues J, Casagrande L, “Pulp Revascularization or Apexication for the Treatment of Immature Necrotic Permanent Teeth: Systematic Review and Meta- Analysis,” The Journal of Clinical Pediatric Dentistry, 34(5). 1053-4625. Jan.2019.
[18]  Jeeruphan T, Jantarat J, Yanpiset K, Suwannapan L, Khewsawai P, Hargreaves KM. “Mahidol study 1: comparison of radiographic and survival outcomes of immature teeth treated with either regenerative endodontic or apexification methods: a retrospective study.” J Endod, 38(10). 1330-6. Oct 2012.
[19]  Trevino EG, Patwardhan AN, Henry MA, Perry G, Dybdal-Hargreaves N, Hargreaves KM, et al. “Effect of irrigants on the survival of human stem cells of the apical papilla in a platelet-rich plasma scaffold in human root tips.” J Endod, 37 (8). 1109-15. Aug.2011.
[20]  Ring KC, Murray PE, Namerow KN, Kuttler S, Garcia-Godoy F. “The comparison of the effect of endodontic irrigation on cell adherence to root canal dentin.” J Endod. 34 (12). 1474-9. Dec.2008.
[21]  Q. Al Khasawnah, F. Hassan, D. Malhan et al., “Nonsurgical Clinical Management of Periapical Lesions Using Calcium Hydroxide- Iodoform-Silicon-Oil Paste,” BioMed Research International, 2018(12). Feb.2018.
[22]  S. Chuensombat, S. Khemaleelakul, S. Chattipakorn, and T. Srisuwan, “Cytotoxic effects and antibacterial efficacy of a 3-antibiotic combination: an in vitro study,” Journal of Endodontics, 39(6). 813-819. Jun.2013.
[23]  Alobaid AS, Cortes LM, Lo J, Nguyen TT, Albert J, Abu-Melha AS, Lin LM, Gibbs JL. “Radiographic and clinical outcomes of the treatment of immature permanent teeth by revascularization or apexification: a pilot retrospective cohort study.” J Endod., 40(8). 1063-70. Aug.2014.
[24]  G. T. Huang, “Apexification: the beginning of its end,” Inter- national Endodontic Journal, 42(10). 855-866. Sep.2009.
[25]  Bose R, Nummikoski P, Hargreaves K. “A retrospective evaluation of radiographic outcomes in immature teeth with necrotic root canal systems treated with regenerative endodontic procedures.” J Endod. 35(10). 1343-9. Oct.2009.
[26]  Chueh LH, Ho YC, Kuo TC, Lai WH, Chen YH, Chiang CP. “Regenerative endodontic treatment for necrotic immature permanent teeth.” J Endod, 35(2). 160-4. Feb.2009.
[27]  Lovelace TW, Henry MA, Hargreaves KM, Diogenes A. “Evaluation of the delivery of mesenchymal stem cells into the root canal space of necrotic immature teeth after clinical regenerative endodontic procedure,” J Endod, 37(2). 133-8. Feb. 2011.
[28]  Kim, S., Fan, F-C., Chen, R. Y. Z., Simchon, S., Schuessler, G. B. and Chien, S. “Effects of changes in systemic hemodynamic parameters on pulpal hemodynamics,” J. Endodont., 6(1), 394-399. Jan.1980.
[29]  Ding R, Cheung G, Chen J, Yin X, Wang Q, Zhang C. “Pulp revascularization of immature teeth with apical periodontitis: a clinical study,” J Endod, 35(5).745-9. May.2009.
[30]  Banchs F, Trope M. “Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol?” J Endod, 30(4).196-200. Apr.2004.
[31]  Torabinejad M, Parirokh M. “Mineral trioxide aggregate: a comprehensive literature review—part II: leakage and biocompatibility investigations.” J Endod, 36(2). 190-202. Feb. 2010.
[32]  M. Vallés, M. Mercadé, F. Duran-Sindreu, J. L. Bourdelande, and M. Roig, “Color stability of white mineral trioxide aggregate,” Clinical Oral Investigations, 17(4). 1155-1159. May 2013.
[33]  AAE and AAOMR joint position statement, “Use of cone beam computed tomography in endodontics 2015 update,” Journal of Endodontics, 41(9). 1393-1396. Oct.2015.
[34]  Alasqah M, Khan S, Alfouzan K, Jamleh A,"Regenerative Endodontic Management of an Immature Molar Using Calcium Hydroxide and Triple Antibiotic Paste: a Two-Year Follow-Up", Case Reports in Dentistry, 2020 (10). Feb.2020.