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

18
Kahler et al. emphasize that additional interventions are not
required when there is clear evidence of resolution of periapi-
cal pathology, even in the absence of significant root matura-
tion. This understanding supports the clinical management
adopted in the present report.
The protocol described in this case followed the recom-
mendations of the American Association of Endodontists
(AAE) that were in effect at the time of treatment. 19,20 Ade-
quate disinfection of the root canal system is essential; how-
ever, conventional chemomechanical preparation may further
21
weaken thin dentinal walls. Therefore, according to Wei et al. ,
minimal instrumentation may be indicated. Sodium hypochlo-
rite at low concentrations does not exert deleterious effects on
stem cells derived from the apical papilla, and its neutraliza-
tion before bleeding induction by a final rinse with sterile sa-
line solution is recommended. 22,23
The use of 17% EDTA in regenerative endodontic proce-
dures plays an essential role by neutralizing sodium hypochlo-
rite and inducing the release of growth factors from dentin,
particularly transforming growth factor beta (TGF-β). To fur-
24
ther enhance canal disinfection, a bi-antibiotic paste was used
in this case, as it effectively inhibits bacterial growth within
the root canal system. 24
Once a suitable environment for cellular activity has been
established, a scaffold must be introduced to enable interac-
tion between stem cells and growth factors. In the present
case, a blood clot was used as the scaffold, as it has demon-
strated satisfactory clinical outcomes, does not require addi-
tional equipment or resources, is easy to obtain, and presents
Figure 7. Six-year follow-up radiograph obtained on similar clinical and radiographic results when compared with
July 30, 2024.
other scaffolds, such as platelet-rich fibrin and platelet-rich
plasma. 6,25,26 MTA was used as a coronal barrier to protect the
scaffold due to its biologically active properties, lack of cyto-
toxicity, and adequate marginal sealing ability. 16,27
The literature indicates that regenerative endodontic treat-
ment results in high rates of periapical lesion resolution, with
several clinical series reporting healing of periapical pathology
even in the absence of complete root maturation. 10,17,18 How-
ever, outcomes related to root development are heterogeneous,
and only a limited number of cases demonstrate significant
29
dentinal wall thickening or measurable root elongation. Fail-
ure rates are reported and are mainly associated with per-
sistent infection, difficulty in inducing bleeding, loss of coronal
sealing, or development of canal obliteration due to calcifica-
tion. 10,17,30 Even in cases of treatment failure, reintervention
using traditional techniques, such as MTA apexification or
conventional root canal obturation, remains a predictable and
viable alternative for tooth preservation. 17,18
Regenerative endodontic treatment represents a promising
Figure 8. Clinical photograph showing the restored alternative for treating teeth with incomplete root develop-
tooth and ongoing orthodontic treatment at the
six-year follow-up (July 30, 2024). ment, despite the different possible clinical outcomes associ-
ated with this therapeutic approach. Long-term follow-up is
essential to properly assess periapical healing, root matura-
tion, and the survival rate of teeth treated with regenerative
to loss of coronal sealing associated with caries development endodontic procedures, as treatment failure may occur due to
and the consequent risk of recontamination of the root canal factors such as persistent infection, external or internal re-
28
system. sorption, and caries development. In cases of treatment fail-
Although the initial objective of this case, thickening of ure, characterized by the persistence of clinical symptoms and
dentinal walls and apical closure, was not fully achieved, periapical pathology, reintervention remains feasible using