Maturogenesis of non-vital immature permanent teeth
A 10-year-old girl with non-contributory medical history reported to the Department of Pediatric Dentistry, Government Dental College and Hospital, Nagpur for the treatment of pain and swelling in maxillary anterior region. History revealed trauma to maxillary anterior region 6 month back while playing in school. Clinical examination revealed fractured and discolored permanent maxillary right central incisor. Soft-tissue examination in relation to permanent maxillary right central incisor showed soft-tissue swelling of 1 × 1 cm. The tooth was tender to vertical percussion and showed negative response to thermal (cold test [Polfofluorange Pharma Dental Handelsges]) and electric pulp testing (Parkell Farmingdate). Intraoral periapical radiograph of permanent maxillary right central incisor revealed incompletely formed apex with periapical rarefaction []. The tooth was diagnosed with a pulpal necrosis and chronic periapical abscess. After rubber dam isolation and gaining access to the root canal system, the canal debris was loosen with minimal instrumentation and the root canal system was slowly irrigated with 0.5% sodium hypochlorite to prevent further damage to the survived apical papilla. Minimal instrumentation within the root canal system prevents further weakening of the root canal system. A light plain cotton pellet was placed in the pulp chamber for 48 h to facilitate purulent drainage. At the next visit working length was measured using diagnostic radiograph, followed by very minimal instrumentation and copious irrigation with normal saline and the canal was dried with sterile paper points. Mixture of ciprofloxacin, metronidazole and minocycline (3 Mix) was placed in the canal and coronal access was sealed with zinc oxide eugenol cement (Dentifiss India Ltd. Mumbai). Patient was recalled after 1 week, the tooth was asymptomatic and the canal was found to be dry.\nA 23 gauge sharp sterile needle was pushed with a sharp stroke beyond the working length of the canal into the periapical tissue to intentionally induce bleeding into the canal. When frank bleeding was evident at the cervical portion of the root canal system, a tight sterile dry cotton pellet was inserted at a depth of 3-4 mm into the canal and held there for 10 min to allow clot formation. Thick paste of calcium hydroxide base (Deepti Dental Product, Raigad) was placed over the clot and the excess opening was sealed with Zinc oxide eugenol cement (Dentifiss India Ltd. Mumbai). In the subsequent visit the excess cavity was sealed with glass ionomer cement.