Healing After Dental Trauma: A Report of Two Cases on the Regeneration of Traumatized Immature Permanent Teeth.

These case reports describe traumatic dental injuries affecting maxillary permanent central incisors in young children, which may lead to pulp necrosis with or without apical periodontitis. Immature teeth with necrotic pulp are very challenging to treat because of their short and thin dentinal walls, open apices, and broad root canals that make them weak and prone to fracture, which can ultimately render the tooth unrestorable and require extraction. Apexification has traditionally been the treatment of choice for such cases; however, recently, regenerative and revascularization procedures have shown encouraging results, including improved radicular dentin thickness and increased root length. The primary aim of this case report was to describe Regenerative endodontic procedures (REPs) performed on three post-trauma immature permanent maxillary central incisors with necrotic pulp. Each tooth was treated using a different biocompatible material, all of which resulted in favorable clinical and radiographic outcomes. This report includes two patients aged 8-10 years, presenting with three maxillary central incisors diagnosed with pulp necrosis. All teeth were managed following the established REPs guidelines. Blood clot revascularization (BCR) was performed in two teeth, followed by placement of white, putty consistency mineral trioxide aggregate (MTA) in one tooth and capsule Biodentine in the other. In the third tooth, platelet-rich fibrin (PRF) was used as the scaffold, followed by white putty consistency MTA placement. At the 12-month follow-up, both cases were clinically asymptomatic and radiographic evaluation showed advancing root development. The PRF treated tooth also exhibited a positive response to sensibility testing using an electric pulp tester. These case reports suggest that, with appropriate case selection, REPs can regenerate and revitalize post-trauma immature permanent teeth with necrotic pulps and act as a beneficial alternative to apexification.