Non-surgical endodontic management of immature permanent mandibular first molar: a 3 year follow-up.

BACKGROUND: Deep carious lesions in immature permanent molars with pulp necrosis pose a serious challenge to contemporary paedodontic practice. A further complex clinical scenario is an immature permanent molar with varying root formation in both roots. This case report demonstrates the successful management of an immature permanent mandibular first molar. CASE REPORT: An 8-year-old boy was referred for endodontic management of 36 by a general practitioner. After clinical and radiographic evaluation, a diagnosis of recurrent chronic periapical abscess with abrupt root closure in the mesial root and cessation of root closure in the distal root was made. Apexification was undertaken in three appointments. In the first appointment, under local analgesia and isolation, the mesial canals were prepared to size #F3 with rotary Protaper Universal and the distal canal was left unprepared. Both canals were irrigated with 5% sodium hypochlorite and calcium hydroxide intracanal medicament was placed. One week later, the mesial canals were obturated and a 4 mm white MTA apical plug was placed in the distal canal. Partial extrusion of the MTA was seen periapically. After 24 h, the hard-setting of the MTA plug was verified, remainder of the distal canal was obturated and core filling was placed followed by a preformed metal crown as an intermediate restoration. FOLLOW-UP: The patient was asymptomatic and showed resolution of the lesion, normal thickness of the PDL space with continuity of the lamina dura after 12 months. Extruded MTA was partially resorbed. Three years follow-up showed complete resorption of the extruded MTA and an intact lamina dura.