Tratamento endodontico regenerativo em pré molar inferior imaturo com necrose utilizando materiais biocerâmicos: relato de caso clínico

Abstract

This study reports a clinical case of regenerative endodontic treatment (RET) in an immature permanent tooth with pulp necrosis and chronic apical abscess in a 12-year-old female patient. The patient had a history of recurrent abscesses and previous unsuccessful emergency treatments, including prior hospitalization. Clinical and radiographic examination revealed pulp necrosis associated with an open apex in tooth 45. Initial management included coronal reconstruction with composite resin to enable proper isolation and access. During canal exploration, an impacted cotton pellet was identified in the apical region, requiring referral for removal under clinical microscopy. After removal, the canal was irrigated following the American Association of Endodontists protocol, using 2.5% sodium hypochlorite and 17% EDTA. Intracanal medication with a bioceramic material (Bio-C Temp) was placed due to its antimicrobial and regenerative properties. After 15 days, irrigation with EDTA was performed to promote smear layer removal and release of dentin-derived growth factors. Apical bleeding was induced to form a blood clot scaffold, followed by placement of a fibrin matrix and a bioceramic barrier (Bio-C Repair) in the middle third. The tooth was then coronally sealed with glass ionomer cement and composite resin. The patient remained asymptomatic, with no postoperative complications. The case is under periodic clinical and radiographic follow-up at 3, 6, 12, 18, and 24 months to assess apical closure, root development, and absence of infection. This case highlights the effectiveness of RET associated with bioceramic materials in managing immature teeth with necrotic pulp, promoting favorable clinical outcomes and continued root development.