Revitalization of a Geminated Tooth with a Necrotic Pulp and an Open Apex Using Platelet–Rich Plasma (PRP) and Mineral Trioxide Aggregate (MTA): A Case Report

Abstract

Aim: To successfully revascularize a geminated maxillary lateral incisor with an open apex using platelet-rich plasma (PRP) and mineral trioxide aggregate (MTA). Methods: A 21-year-old male was referred for endodontic treatment of a geminated nonvital left maxillary lateral incisor (tooth #10) with asymptomatic apical periodontitis. After preparing an access cavity, its necrotic pulp was removed. The canal was irrigated with 5.25% NaOCl solution and dried with sterile paper points. A triple antibiotic mixed with distilled water was packed in the canal and left for 40 days. Ten ml of whole blood was drawn by venipuncture of the antecubital vein for preparation of PRP. After removal of the antibiotic mixture, the PRP was injected into the canal space up to the cementoenamel junction level. Three millimeters of white MTA was placed directly over the PRP clot. Two days later, the tooth was double-sealed with permanent filling materials. Results: Patient was recalled for 3, 6, 12 and 18 months clinical/radiographic follow up and is scheduled for a 24 months re-evaluation. Clinical examination, 12 months later revealed no sensitivity to percussion or palpation tests. Radiographic examination of this tooth showed appreciable regeneration of the root substance and resolution of the associated lesion. The tooth was not responsive to cold tests; however sensitivity test with an electric pulp tester (EPT) now elicited a delayed positive response. Conclusions: On the basis of short-term results of the present case, it appears that PRP has the potential of an ideal scaffold for regeneration of vital tissues in teeth with necrotic pulp and a periapical lesion.