Management of an Immature Necrotic Permanent Molar with Apical Periodontitis Treated by Regenerative Endodontic Protocol Using Calcium Hydroxide and MM-MTA: A Case Report with Two Years Follow Up

Jessy Ajram, Issam Khalil, Richard Gergi, Carla Zogheib, Jessy Ajram, Issam Khalil, Richard Gergi, Carla Zogheib

Abstract

Traditionally, immature teeth diagnosed with necrotic pulp and periapical periodontitis were treated by apexification with long-term calcium hydroxide or in one session with mineral trioxide aggregate (MTA) or Biodentine apical plug. However, these teeth become fragile and susceptible to root fracture. Regenerative endodontic procedure is a new therapeutic approach that promotes continuation of root growth in immature necrotic teeth potentially preventing root fracture. Only few case reports have shown the success of this procedure on molar cases. The current case report demonstrates a regeneration of a lower first molar with necrotic pulp and chronic apical abscess treated with Micro Mega-MTA (MM-MTA), a new endodontic biomaterial that has not been described previously. Calcium hydroxide was used as an intracanal medicament for two weeks. Next, calcium hydroxide was removed and after blood clot creation, MM-MTA® was placed over it. Apical healing and continuation of root growth were evident at nine months follow-up. CBCT at two years follow-up confirmed apical closure and complete healing. This case shows that a regenerative endodontic procedure for management of an immature necrotic permanent molar is feasible and can be successfully done using Ca(OH)₂ and MM-MTA.

Keywords: Cone Beam Computed Tomography; MM-MTA; calcium hydroxide; immature necrotic permanent tooth; regenerative endodontic treatment.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(A) Preoperative radiograph. (B) Placement of Ca(OH)2 in the pulp chamber. (C) Postoperative radiograph after root canal disinfection, bleeding induction, placement of MM-MTA over blood clot, placement of coronal restoration.
Figure 2
Figure 2
(A) Recall radiograph at three months. (B) Recall radiograph at nine months. (C) Recall radiograph at twelve months.
Figure 3
Figure 3
Radiographs at two years (A) Recall 2D radiograph at two years. (B,C) cone-beam computed tomography (CBCT) images in oblique view of the mesial and distal roots.

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