Cervical Level Biological Repair of the Access Opening after Regenerative Endodontic Procedures: Three Cases with the Same Repair Pattern.

INTRODUCTION: This article describes the regenerative endodontic procedures applied in 3 cases of maxillary incisor necrosis that resulted in continuous root development, dentinal wall thickening, and cervical level biological repair of the access openings that was verified radiographically in 2 cases and clinically in 1 case. METHODS: Three maxillary central incisors in 2 different patients were rendered necrotic after having dentin enamel fracture traumatic dental injuries. All teeth were treated with single- or multiple-visit regenerative endodontic procedures. RESULTS: The 5- and 9-year follow-up evaluations revealed similar continuous root development, dentin wall thickening, and hard tissue biological repair of the wide access cavities. In the 9-year follow-up case, the calcium silicate cement was removed because of unacceptable discoloration. The hard tissue biological repair was visualized under the microscope and checked for its continuity with the axial walls, its resistance to displacement, and the presence of possible gaps. The repair tissue seemed to be yellowish in appearance with some brown niches of irregular texture, did not have detectable gaps, was firmly connected with the axial dentinal walls through a demarcated white line, and resisted all displacement forces applied. The tooth was restored with bonded composite resin restoration after internal bleaching. The 10-year follow-up revealed satisfactory esthetics and uneventful soft and hard tissue healing. CONCLUSIONS: Cervical-level hard tissue repair of the access opening after the application of regenerative endodontic procedures in necrotic immature maxillary incisors might reinforce the weakened tooth structure to a great extent and warrants further investigation.