The treatment of permanent immature necrotic teeth in young patients is a challenge for clinicians. These cases are complex but not only because they are immature teeth with thin dentinal walls and open apices but because they are often associated with patient’s behavioral problems.
Apexification and MTA apical seals have been successfully used in the past with some commonly encountered complications such as: root fractures, overfills and poor seals inducing reinfections. Regenerative endodontics protocols (REP) are novel biological procedures to induce the healing of the periapical lesion and an apical root development by achieving root lengthening and root thickening without a traditional endodontic seal.