ABSTRACT
Background: Immature necrotic permanent teeth are frequently found in anterior teeth caused by traumatic dental injuries. To have satisfying treatment results, apical closure, root wall thickness and dimensions, and teeth discoloration must be considered. Therefore holistic treatment planning would make a difference in long-term achievement. The study showed two cases of immature necrotic permanent teeth treated by different holistic approaches. Case reports: Case 1: A 16-year-old male presented with anterior tooth discoloration due to falling from a slide in elementary school. The tooth had been treated before. Clinical examination showed discoloration and fracture on the middle third of the left maxillary central incisor with a horizontal line, while radiographic examination showed open apex and periapical radiolucency on the tooth. Previously initiated therapy was diagnosed for the case. Case 2: A 30-year-old female presented with anterior teeth discoloration due to stumbled from stairs more than 15 years ago. Clinical examination showed discoloration and fracture on the incisal of the two maxillary central incisors. Open apex and periapical radiolucency was found in radiographic examination. Asymptomatic apical periodontitis et causa pulp necrosis was diagnosed for the case. Case Management: The treatment plan consists of root canal treatment with mineral trioxide aggregate (MTA) as an apical plug, followed by intracoronary bleaching. Case 1 was restored by fiber post and lithium disilicate crown, while case 2 was restored using composite resin as direct restoration. Conclusion: The holistic treatment of immature necrotic permanent teeth following the case will restore the teeth's functions and give satisfying results.
