Late apexification in a necrotic dental element with immature root apex and periapical lesion: case report

Aim. The root apex of teeth ends his development over the three / four years after the eruption. This is due to the presence of pulp tissue and mesenchymal stem cells that reside in the apical papilla. Immature permanent teeth, which met pulp necrosis as a consequence of a trauma occurred during their development, as in the case discussed, they have an incomplete root development and physiological closure of the apical foramen. In these cases, treatment includes a check for infection and the creation of a calcified apical barrier that allows us to make a traditional closure of the root canal. This treatment is defined Apexification and it is obtained through the use of calcium hydroxide or MTA. The aim of this document is to describe a case of Apexification conducted, for a patient 15 years old, on a permanent maxillary central incisor that due to a traumatic sports event occurred 7 years before, without causing any clinical signs or symptoms, has determined necrosis before it was completed root formation. Materials and methods. Male patient, 15 years old, coming at our attention because of a trauma on a permanent maxillary left central incisor. Afterwards clinical and radiographic examinations and vitality tests, patient showed necrosis of the element with slight mobility. At the same time it has been noticed necrosis of a permanent maxillary right central incisor with periapical lesion and immature root apex. From the case, we noticed that patient had an additional trauma without any symptoms he was 8 years old. We proceed to root canal treatment of teeth using Ni-Ti rotary endodontic files PROFILE®, that allow us a non-aggressive shape of thin and fragile walls of the roots, 5,25% sodium hypochlorite such as irrigating solution and dressing with calcium hydroxide paste for a permanent maxillary left central incisor, which in a second session was performed root canal closure for, using thermo-plasticized gutta-percha technique and direct composite coronal reconstruction. The right incisor has been dressed with pure calcium hydroxide powder, which has been then replaced and checked at regular intervals for 18 months Results. Although there has not been a physiological closure of the root apex, treatment with shaping, cleaning and intermediate dressing with calcium hydroxide for that necrotic tooth with immature apex, it led to the formation of a type 3 closure apical, according to the classification of Frank, with total resolution of symptoms, complete healing for the apical lesion and the possibility of three-dimensional obturation of the root canal. Conclusions. The use of calcium hydroxide in the treatment of Apexification allowed us to obtain, moreover the regression of the apical lesion, a calcified apical barrier even in a dental element that exceeded physiological development’s timings. Checking results 1 year later, it was confirmed the success of the treatment.