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CC BY 4.0 · Eur J Dent 2025; 19(01): 255-264
DOI: 10.1055/s-0044-1791218
Case Report

Successful Regenerative Endodontic Therapy of a Dens Evaginatus Mandibular Second Premolar with an Acute Apical Abscess and Extensive Periapical Bone Loss: A Case Report

Francesco J. DeMayo 
1   Division of Comprehensive Oral Health – Endodontics, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
,
Jackson T. Seagroves
1   Division of Comprehensive Oral Health – Endodontics, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
,
Takashi Komabayashi 
1   Division of Comprehensive Oral Health – Endodontics, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
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Abstract

Regenerative endodontics is a rapidly growing field within dentistry that aims to replace damaged tooth structures and cells of the pulp–dentin complex. This case report presents the successful management of an immature permanent second mandibular premolar with an acute apical abscess and extensive apical bone loss caused by a dens evaginatus. This tooth was unexpectedly treated with long-term calcium hydroxide (Ca(OH)2) that was replenished several times over 6 months. During the treatment process, this tooth became reinflamed developing a chronic apical abscess after resolution of the initial acute apical abscess, which resulted in the replacement and prolonged use of Ca(OH)2. The final regenerative procedures were completed using a bioceramic fast set putty placed directly over the blood clot and an occlusal composite restoration. At the 6-month follow-up, the patient was asymptomatic with a fully healed radiographic lesion, new periodontal ligament, and the apex closed with thickening of the mesial and distal aspects of the root. At the 15-month follow-up, the patient remained asymptomatic with continued evidence of radiographic development of the apical aspect of this tooth, displaying root end closure and thickening. This is a unique case report of the management of a complex infection process in an immature tooth with regenerative techniques with repeated and long-term use of Ca(OH)2. This novel report provides dental practitioners with a new potential protocol for the management of these immature cases with advanced periapical infections that require extensive disinfection to have successful outcomes.

Keywords

acute apical abscess - necrotic pulp - permanent - regenerative endodontics


Publication History

Article published online:
11 October 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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