Revitalization of immature open apex through revascularization utilizing novel combination of curcumin impregnated collagen as a scaffold. a case report

In 21 st century endodontics regeneration of apical tissues and root elongation is possible in necrotic immature permanent teeth. The purpose of this case report is to add a novel technique in regenerative endodontic therapy by using curcumin impregnated collagen for revitalization of immature non vital tooth through blood clot. An 11year old boy with the history of trauma was diagnosed with the pulpal necrosis and symptomatic apical periodontitis in tooth #21. Intra oral periapical radiograph showed open apex with large periapical pathology. Access preparation and minimal instrumentation was done to remove necrotic debris under copious irrigation with 2.5% sodium hypochlorite. Triple antibiotic paste was packed in the canal for four weeks. During second visit, Triple antibiotic paste was removed and canal was dried and collagen impregnated with curcumin was placed with Buchanan Hand Plugger Size (#2) 2 mm beyond the confines of working length and after this procedure a sterile 23-gauge needle was placed at 2 mm beyond the working length. With sharp strokes, the needle was pushed past the confines of the canal into the periapical tissue to intentionally induce bleeding into the canal. Three millimeters of Mineral trioxide (MTA) Angelis was placed in cervical part of the root canal and permanent restoration with GIC and Composite was done. Clinical examination at 6 and 12 months revealed no sensitivity to percussion and palpation in tooth #21and it responded positively to both electric pulp and cold tests. Radiographic examination showed resolution of periapical rarefaction, further root development and apical closure of the tooth #21. On the basis of successful outcome of the present case it can be stated that curcumin impregnated collagen increases the healing kinetics and may serve as a scaffold for regeneration of necrotic immature teeth.