Can Revascularization Serve as a Treatment Alternative to Apexification for Management of Immature Non-vital Permanent tooth? - A Review

Pulpal necrosis is a relatively common sequel following dental trauma which arrests the further root development in an immature permanent tooth resulting in wide open apices. The immature root with a necrotic pulp and apical periodontitis presents multiple challenges to successful treatment. Various treatment modalities for management such teeth include calcium hydroxide apexification, MTA apexification, and endodontic surgeries. Apexification using calcium hydroxide although shown some success but it is less popular nowadays due to limitations like multiple visits, formation of porous barrier. Mineral trioxide aggregate (MTA) apexification is a commonly used treatment option for management of immature non-vital teeth. However, it doesnot strengthen the remaining root structure and the tooth remains fracture prone and non-vital. Regenerative endodontic procedures are designed to replace damaged structures, including dentin and root structures, as well as cells of the pulp-dentin complex. Thickening of root dentin and reestablished tooth vitality are the significant outcome with revascularization which cannot be achieved with apexification procedure. Considering the advantages, if the proper case selection protocol is followed revascularization can be used as an alternative to apexification for management of immature non-vital teeth. Key-words: Apexification, revascularization, immature teeth