A Two-visit Regenerative Endodontic Approach for a Necrotic Immature Mandibular Molar Using 3D Ultrasonic Activation and Bioceramic Putty: A Case Report

Abstract

Revascularization, as a component of regenerative endodontic procedures (REPs), is increasingly important in immature molars because it offers a biological alternative that aims to stimulate continued root lengthening and wall thickening, restoring the biological functions of the pulp-dentin complex, including immune defense, proprioception, and sensory responses, which are lost in traditional root canal therapy. While conventional root canal treatment (RCT) is the standard, it often results in tooth brittleness and an increased risk of future fractures or reinfection because the pulp is replaced with inorganic material. In molars, this controversy is compounded by anatomical complexities and varied canal configurations that make achieving the imperative sterile environment significantly less predictable than in anterior teeth. This case report presents a successful two-visit approach, using revascularization for an immature necrotic mandibular left molar. An 8-year-old female was referred with severe pain in her left mandibular molar. The extraoral examination revealed a swelling related to the lower left molar area. Intraorally, a badly decayed lower left molar and an opened pulp chamber. Clinical and radiographic examinations revealed pulp necrosis, symptomatic apical periodontitis, and a large periapical lesion. A two-visit protocol was performed; the root canal was disinfected. At 12-month follow-up, the tooth was asymptomatic, responded to sensibility tests, and exhibited complete root formation.