Regenerative endodontic therapy after autogenous transplantation of mandibular third molar

Abstract

Autogenous tooth transplantation involves moving a tooth from its original position to replace a missing tooth. Complications, such as pulp necrosis, can occur following autotransplantation of teeth with incomplete root formation. There are insufficient studies on managing pulp necrosis in autotransplanted immature teeth by regenerative endodontic treatment (RET). In this case, a 21-year-old woman developed a sinus tract 3 months after autotransplantation of an immature third molar that replaced the lower left mandibular first molar. She presented with pain while chewing in the area of her autografted third molar. Based on clinical findings and periapical radiolucency in radiographic findings, the tooth was diagnosed with necrotic pulp and apical periodontitis. It was decided to perform RET for the tooth. The tooth underwent chemomechanical debridement and calcium hydroxide dressing in the first session. After 2 weeks, the patient’s pain and sinus tract were resolved. In the second session, the periapical tissue was stimulated by inserting a K-file 2 mm over the apex to induce bleeding in the root canal. Mineral trioxide aggregate was placed over the blood clot, and the tooth received final restoration. After 11 months of recall appointments, the apical foramen size had decreased the thickness of the apical dentin wall increased, there was no periapical pathosis, and the periodontal ligament space width was normal. This case report provides valuable insights into the pulpal management of autotransplanted immature teeth.