Regenerative Endodontic Procedures for Traumatized Teeth after Horizontal Root Fracture, Avulsion, and Perforating Root Resorption

Introduction Traumatic injury to the teeth can cause horizontal root fractures and inflammatory root resorptions (external and internal). Traditionally, traumatized teeth with horizontal root fractures resulting in pulp necrosis and inflammatory root resorptions are treated with conventional root canal therapy. Methods A 15-year-old boy had a history of traumatic injury to mature tooth #8 resulting in horizontal root fracture and pulp necrosis of the coronal fragment. A 7-year-old girl suffered an avulsion injury to immature tooth #9, which developed inflammatory replacement resorption and subsequently root fractured 15 months later. Another 16-year-old boy also suffered a history of traumatic injury to mature tooth #8, resulting in perforating root resorption. All teeth were treated with regenerative endodontic procedures using chemomechanical debridement, calcium hydroxide/triple antibiotic paste dressing, EDTA rinse, induction of periapical bleeding into the canal space, and a coronal mineral trioxide aggregate plug. In the tooth presenting with horizontal root fracture, only the coronal fragment was treated to preserve pulp vitality in the apical fragment for possible pulp tissue regeneration. Results After regenerative endodontic procedures, clinical signs/symptoms subsided, and inflammatory osteolytic lesions resolved in all traumatized teeth. Two teeth were followed for 19 months and 1 tooth for 5 years. At the last review of the teeth with horizontal root fractures, the first case showed healing by calcified tissue and the second case showed healing by fibrous connective and hard tissue. Tooth with perforating root resorption demonstrated a decrease in size of the resorptive defect. Conclusions Based on these case reports, regenerative endodontic procedures have the potential to be used to treat traumatized teeth with horizontal root fracture and inflammatory root resorption.