Iranian Endodontic Journal

Abstract

Regenerative endodontic procedures (REPs) have emerged as a biologically driven approach for managing immature teeth with necrotic pulp and open apices, providing an alternative to traditional apexification techniques. This case report describes the successful treatment of a three-rooted immature mandibular first molar with necrotic pulp and chronic apical periodontitis in a 9-year-old patient using REPs. The treatment followed the guidelines set by the American Association of Endodontists and utilized a two-visit protocol. Concentrated growth factor (CGF) was employed as a biological scaffold in the root canals, while calcium-enriched mixture (CEM) cement was used for the coronal seal. Radiographic evaluations conducted at 6, 12, and 15 months revealed progressive periapical healing, significant root elongation, increased thickness of the root walls, and partial apical closure. Clinically, the patient remained asymptomatic during all follow-ups. This case highlights the potential of CGF and CEM cement-enhanced REPs to promote continued root development and achieve predictable outcomes in immature teeth with necrotic pulps, offering a biologically based alternative to conventional apexification.