Dental traumatic injuries in young patients may lead to the development of pulp necrosis, which in turn results in immature roots with open apices.
Complicated crown fractures of upper anterior teeth are one of the most common traumatic dental injuries.
Early management of the pulp with vital pulp therapy procedures will help in the completion of root development and apical closure.
Delayed treatment will result in pulp necrosis and subsequently, cessation of root canal development. This leaves the root of the tooth with thin divergent walls and an open apex.
Regenerative endodontic procedure is considered to be one of the optimal modern treatment modalities for permanent necrotic immature teeth.
The purpose of this procedure is to increase the thickness and length of the root canal walls and to facilitate continuous root development as well as to restore the function of the damaged tooth.
Successfully revascularized teeth requires no further management in case there is continuous root development and absence of apical disease.
Failed regenerative endodontic procedures result in immature roots with open apex.
Long-standing extra radicular infection, necrotic debris filling the apical canal, and bacteria colonizing the dentinal tubules have been considered the fundamental causative factors for regenerative endodontic treatment failure.
DENTAL PULP: A Novel Strategy to Engineer Pre-Vascularized Full-Length Dental Pulp-like Tissue Constructs
The treatment of nonvital permanent teeth with thin and divergent dentinal walls, large open apices, and periapical pathosis is challenging.
Dentists usually tend to believe that large unhealed periapical lesions have a low tendency to heal after root canal treatment procedures, especially in cases with clear bony borders resembling periapical cysts radiographically.
Lesions of endodontic origin can be treated by nonsurgical root canal therapy procedures.
The aspiration-irrigation technique and the decompression technique help in reducing the lesion size by lowering the hydrostatic pressure.
The use of decompression along with root canal therapy procedures provides a good approach for the treatment of large persistent periapical lesions.
PEDIATRIC DENTISTRY: Pulpotomy vs Pulpectomy in the treatment of vital pulp exposure in primary incisors
This can be achieved due to the inflammatory nature of lesions of endodontic origin. The decompression technique involves penetration of both buccal and palatal mucosa with an 18-gauge needle to aspirate the cystic fluids followed by saline irrigation.
However, several drawbacks have been reported with these techniques, such as buccal and palatal wounds, acute or chronic infection, inflammation of the tissues, and patient discomfort.
The aspiration-irrigation technique is described in the ex vivo model as a new technique to remove the smear layer in the apical region of the canal.
The technique relies on intracanal aspiration using both, aspiration needle and injection needle, to reduce irrigant extrusion through the apical foramen.
This case report aims to illustrate a case of persistent maxillary lesion that had been managed by a modified aspiration-irrigation technique through the infected root canal space using high-volume suction.
