Clinical Application of Inflammatory Vital Pulp Therapy in Immature Permanent Teeth: A Retrospective Case Series.

BACKGROUND: Management of immature permanent teeth with pulpal or periapical pathology remains challenging due to incomplete root development and open apices. Conventional treatments, such as calcium hydroxide apexification, require multiple appointments over extended periods and may weaken dentinal walls, whereas apical barrier techniques using mineral trioxide aggregate (MTA) provide apical closure but do not promote continued root development. Inflammatory vital pulp therapy (IVPT) has emerged as a biologically based approach that preserves stem cells from the apical papilla (SCAPs) to promote continued root maturation. CASE PRESENTATION: This retrospective case series included four male patients (aged 8-12 years) with immature permanent teeth diagnosed with pulpal or periapical disease. All cases were treated using a standardized IVPT protocol involving canal disinfection with double antibiotic paste while preserving apical vital tissue. Clinical and radiographic outcomes were evaluated over a mean follow-up period of 32.5 months (range: 22-48 months). RESULTS: All cases achieved resolution of clinical symptoms and periapical healing. Three cases demonstrated complete apical closure and continued root development, whereas one case showed partial success with periapical healing but incomplete apical closure and mild tooth discoloration. CONCLUSIONS: IVPT may represent a promising treatment option for immature permanent teeth with pulpal or periapical pathology. By preserving viable apical tissues and controlling infection, it supports physiological root maturation. Further studies with larger sample sizes and longer follow-up are warranted.