I clinical report _ pulp revascularisation The future of endodontics: pulp revascularisation Author_Dr Philippe Sleiman, Lebanon new method for treatment of teeth with irritated, inflamed or necrotic pulp. Its main advantage lies in the possibility of further root development and reinforcement of dentinal walls by deposition of hard tissue, strengthening the root against fracture.6 This method depends mainly on pulp re-growing over the remaining pulp tissue. It is based on the presence of undifferentiated mesenchymal cells in the pulp and in the dentine that will give rise to stem cells, which upon injury differentiate into odontoblastoid cells that are later responsible for the formation of dentine bridges. The novelty of the clinical case presented here is that it is one of the few published thus far that demonstrates the use of a dual antibiotic paste and tissue engineering for apexification. Fig. 1 _The conventional way to treat immature teeth with peri-radicular abscesses is to resort to the apexification method in which calcium hydroxide is used as intra-canal medication after instrumentation of the thin canal walls.1,2 Calcium hydroxide has proven to be an effective intra-canal medication, as it creates an environment conducive to the formation of a hard-tissue bridge at the apex.3,4 However, it has one main disadvantage owing to its high pH: it will digest tissues within immediate contact with it and thereby destroy tissues with the potential to differentiate into new pulp, which altogether results in teeth with thin and weak roots that are susceptible to fracture.5 Fig. 2 _Clinical case A young female patient was referred to the office, suffering from pain in her lower molar. The X-ray revealed a lesion on both roots, with the mesial canals not yet in full formation regarding length and diameter (Fig. 1). After discussing the case with the patient’s parents and explaining the new technique, I opened the molar in very clean conditions. The distal root showed signs of light bleeding, so the pulp was relatively vital. The mesial roots did not show signs of bleeding, but the remaining pulp was clearly visible under the microscope. After copious irrigation using chlorhexidine in both the mesial and distal roots, SmearClear solution (SybronEndo) was placed and a passive activation with a #10 K-file Pulp tissue regeneration has been recognised as a 22 I roots 4_ 2009