Authors Kah Hup Chew Conservative and Endodontic Unit, School of Dental Sciences, Health Campus, Universiti Sains https://orcid.org/0009-0009-8968-9548 Ashwini M Madawana Private Practitioner, Ministry of Health Malaysia DOI: https://doi.org/10.58397/wy875f51 Keywords: Regenerative endodontics, immature permanent tooth, pulp necrosis, apical periodontitis Abstract

Immature necrotic permanent teeth with periapical periodontitis present a significant clinical challenge because of incomplete root maturation accompanied by thin dentinal walls. Regenerative endodontic treatment was performed on an immature necrotic mandibular second premolar in a 13-year-old patient using minimal mechanical instrumentation, proper chemical disinfection protocol, modified triple antibiotic paste, apical bleeding induction, and coronal sealing. Three-year follow-up demonstrated complete healing of the periapical lesion, formation of the apical barrier, continued root development, and thickening of dentinal wall. The tooth remained asymptomatic and functional. The clinical and radiographic findings support biological principles of regenerative endodontics, emphasising disinfection protocols, stem cell preservation, and scaffold formation. This approach
promotes continued root development and improves structural integrity in immature necrotic teeth. Regenerative endodontic treatment is a predictable option for immature necrotic permanent teeth when appropriate protocols and follow-up are performed.

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