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RO0111

I 15 case report _ revascularisation I roots1_2011 ture while her left maxillary central incisor had been displacedintothealveolarbone(intrusion;Figs.2a& b). Thermal and electrical pulp testing was positive fortherightmaxillarycentralincisor.However,itwas impossible to perform vitality tests on the intruded incisor. The treatment plan aimed mainly at protecting the vital pulp tissue of the immature fractured tooth with bonded resin, while the intruded tooth was left for spontaneous repositioning. Instructions for a week long, soft food diet was given and an appointmentwasscheduledforthefollowingmonth. Unfortunately, the little girl did not return to my practice until one year later. At that time, there were two sinus tracts associated with the traumatised central incisors, and both thermal and electrical vitalitytestswerenegativeforbothincisors.Probing depths were within normal limits (Figs. 3a–c). The spontaneous repositioning of the left central maxil- lary incisor had succeeded, but the pulp tissue had become necrotic. I then decided to attempt revascularisation of the necrotic immature apices. The treatment plan aimed mainlyattheeffectivedisinfectionofthewidecanals, followedbybloodclotinductionandMTAplacement. Effective disinfection is one of the main issues in endodontics. Articles by Sato etal. and Hoshino etal. describe an effective disinfection procedure using a triple antibiotic paste. The effectiveness of a metron- idazole, ciprofloxacin and minocycline mixture for the disinfection of the immature necrotic open apex was demonstrated by Windley et al. However, the minocycline component of the mixture stained the dentine excessively. Therefore, many researchers suggesteitherabi-antibioticpasteregimen(without minocycline) or with cefaclor as a substitute. Back then, I thought it was not safe to place antibiotics inside the wide-open canal of an nine- year-oldchild.Therefore,Isoughttoachieveeffective disinfection by using only syringe irrigation of a 2% chlorhexidine digluconate solution. After adminis- trating infiltration anaesthesia, the incisors were isolated with Hygenic Wedjets (Coltène/Whaledent) and access was achieved. The wide canal was com- pletely necrotic in the right central incisor. In the left central incisor, however, there appeared to be vital pulptissueinthemiddlepartofthewide-opencanal. Both canals were irrigated with a 2% chlorhexidine digluconate solution. The thin dentinal walls were lightly brushed using a #110 Hedstrom file. The final rinse was accomplished using sterile water, and the canals were dried using sterile paper points. A sterile #60 K-file was used for bleeding induc- tion. Only in the left central maxillary incisor was a AD