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rev port estomatol med dent cir maxilofac . 2026;67(1):40-46 41

ant spray (Endo Frost Roeko, Wilcos, Rio de Janeiro, Brazil), and
Introduction
the response was negative.
Endodontic treatment of teeth with incomplete root develop- Periapical radiographic examination revealed an extensive
ment and apical periodontitis is challenging because, in most radiolucent area associated with the tooth, incomplete root
cases, these teeth present thin dentinal walls, which preclude development, and thin radicular walls (Figure 2). The periapical
any type of canal enlargement and conventional obturation of lesion was classified as score 5 according to the Periapical In-
the root canal system. 1
Traditionally, teeth with incomplete root development
were treated through apexification with repeated replacement
of calcium hydroxide–based intracanal medicaments or by
placement of a mineral trioxide aggregate (MTA) apical plug
followed by root canal obturation. However, in these approach-
es, dentinal walls remained thin and fragile. With the advent
of cell-based tissue engineering in endodontics, it became
possible to change this scenario. 1
Regenerative endodontic treatment has emerged as a prom-
ising alternative for the endodontic treatment of teeth with pulp
necrosis and incomplete root development, as it may enable
2
thickening of the internal dentinal walls in some cases. The
concept underlying this approach is that the periapical environ-
ment can provide mesenchymal stem cells, biological mediators,
and favorable conditions for the formation of new tissues with-
in the root canal space. Studies have demonstrated that cells
derived from the apical papilla, periodontal ligament, and even
bone marrow are capable of migrating, proliferating, and con-
tributing to angiogenic processes and cellular differentiation Figure 1. Initial clinical photograph showing crown
discoloration and fracture on June 3, 2018.
associated with tissue repair and dentinal development. 3-5
For the success of this technique, several steps are consid-
ered fundamental: adequate disinfection of the root canal
system, application of a scaffold to organize host stem cells,
and effective coronal sealing. 6-8 The literature also emphasiz-
es the importance of long-term follow-up, since root matura-
tion, formation of mineralized tissues, and resolution of peri-
apical changes may occur gradually over several years. 1,9
Despite promising results, regenerative endodontic treatment
may yield different outcomes, including resolution of periapical
10
radiolucency without complete root development. Treatment
failure is also possible, characterized by persistence of symptoms
and periapical radiolucency, requiring further intervention. 11
Although this therapeutic approach has been extensive-
ly investigated in recent years, there is still considerable
variability in treatment protocols, material selection, and
12
clinical indications. This study aims to report a clinical
case, written according to the CARE guidelines, of a patient
13
presenting with symptomatic apical periodontitis and in-
complete root development in the maxillary right central
incisor, treated with regenerative endodontic treatment and
followed for 6 years.

Case report

A 12-year-old male patient, systemically healthy, attended the
endodontic clinic accompanied by his mother for emergency
care. He reported pain in the labial mucosa adjacent to the
maxillary right central incisor, with a history of trauma one
year earlier. Clinical examination revealed a fractured, dark- Figure 2. Diagnostic periapical radiograph showing
incomplete root development and apical periodontitis
ened crown associated with edema of the labial mucosa (Fig- on June 3, 2018.
ure 1). Cold sensitivity testing was performed using a refriger-