Riboflavin Activated Chitosan Scaffold: A Novel Approach for Pulp Revascularization of Immature Necrotic Teeth: A Case Report

Abstract

Background:

Regenerative endodontic procedures (REPs) have redefined the management of immature permanent teeth with necrotic pulp by promoting biological regeneration rather than simple apical barrier formation. However, predictable root maturation remains inconsistent, prompting the exploration of advanced scaffold materials to achieve more predictable regenerative treatment outcomes.

Aim:

To report the clinical and radiographic criteria of a successful regenerative endodontic procedure using a riboflavin-activated chitosan scaffold in an immature permanent tooth with pulpal necrosis.

Method:

A 17-year-old patient with a previously traumatized immature right maxillary central incisor presented with pulpal necrosis, periapical pathology associated with an open apex. After minimal instrumentation, the canal was disinfected using 1.5% sodium hypochlorite and 17% EDTA, followed by placement of calcium hydroxide as an intracanal medicament. At the subsequent visit, intracanal bleeding was induced to provide endogenous stem cells and growth factors. A chitosan scaffold was prepared, incorporated with riboflavin, photo-crosslinked, and injected into the canal, where it was mixed with blood in situ. The canal was coronally sealed with Biodentine and restored with composite resin. Clinical and radiographic follow-up was performed to evaluate success of the procedure.

Conclusion:

Within the limitations of this case report, the riboflavin-activated chitosan scaffold supported periapical healing and continued root development in an immature necrotic tooth. This photo-cross linked scaffold might have enhance the biological predictability of regenerative endodontic therapy. Further long-term clinical and histological studies with larger sample size are required to confirm its regenerative potential.