Procedimiento endodóntico regenerativo en premolar necrótico con ápice abierto y periodontitis apical: Reporte de caso

Abstract

Apical periodontitis (AP) in immature permanent teeth with pulp necrosis presents a significant clinical challenge, as it compromises both function and root development. Traditionally, these cases were managed through apexification, a procedure that does not promote thickening of dentinal walls or physiological closure of the root apex. Regenerative endodontic procedures (REP) have emerged as a promising alternative that supports continued root development, improves the structural prognosis of the tooth, and reduces the risk of fracture. This report describes the case of an 11-year-old female patient diagnosed with pulp necrosis and symptomatic AP in the lower left premolar (tooth #34). An REP was performed using irrigation with 1.5% sodium hypochlorite and 17% EDTA, intracanal medication with a triple antibiotic paste, induction of bleeding, placement of a collagen sponge, and sealing with NeoMTA 2 bioceramic cement. At 7-, 9-, and 23-month follow-ups, the patient remained asymptomatic, with radiographic and tomographic evidence of periapical healing, root lengthening, and thickening of the dentinal walls, with no coronal discoloration. This case demonstrates the effectiveness of REP as a viable therapeutic option in young patients, provided proper case selection and adherence to established clinical protocols. Effective canal disinfection, the use of biocompatible biomaterials, and leveraging the regenerative potential of stem cells in younger patients are key factors for treatment success.