In daily clinical work, injuries to teeth are encountered quite often. Among these, the upper central incisors among the permanet teeth are often subject to injury and most of them are with immature roots.
We have encountered an eight-year-old girl who had bruised the right upper central inciror.
1) At first the right upper central incisor showed a coronal fracture with the pulp exporured by the bruising. Because the tooth had immature roots, apexogenesis was performed. At that time, Finapec APC with hytoapatite as the main constituent was applied on the pulpotomy surface. The prognosis was favorable.
2) Three months after the apexogenesis, the site was bruised again and root fracture occurred. The fracture site was under the cervical margin and an abscess was found in the labial gingive. The coronal (bone) chips were therefore removed and then apexogenesis was performed again. At the same time, orthodontic extrusion was performed with the use of a lingual arch, an orthodontic rubber band(s), and ligature wire.
3) Orthodontic extrusion was deemed to be completed at the time of extrusion to the gingival margin and completion of the root formation.
4) After completion of the root formation, apexification was performed to induce apical closure.
5) After confirming the apical closure, permanent root filling was performed with a Gutta-percha cone. The abutment tooth was thereafter rebuilt and a temporary prosthesis was applied.
6) After about two years and nine months, cold pain occurred due to periodotal disease of 1 and caries of _??_. Therefore, pulp treatment of _??_and periodontal surgery were performed. After curing of the site, measures were taken for permanent prosthesis.
As described above, apexogenesis and apexification performed in accordance with the development state of roots resulted in a favorable course. Positive treatment effects of this method were indicated.