DOCSLIB.ORG

The Effect of MTA on the Apexification and Periapical Healing of Teeth With

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Effect of MTA on the Apexification and Periapical Healing of Teeth With The effect of mineral trioxide aggregate on the apexification and periapical healing of teeth with incomplete root formation W. T. Felippe, M. C. S. Felippe & M. J. C. Rocha School of Dentistry, Federal University of Santa Catarina, Floriano´polis, SC, Brazil Abstract 5 months later, and blocks of the teeth and surrounding tissues were submitted to histological processing. The Felippe WT, Felippe MCS, Rocha MJC. The effect of sections were studied to evaluate seven parameters: mineral trioxide aggregate on the apexification and periapical formation of an apical calcified tissue barrier, level of healing of teeth with incomplete root formation. International barrier formation, inflammatory reaction, bone and root Endodontic Journal, 39, 2–9, 2006. resorption, MTA extrusion, and microorganisms. Results Aim To evaluate the influence of mineral trioxide of experimental groups were analysed by Wilcoxon’s aggregate (MTA) on apexification and periapical heal- nonparametric tests and by the test of proportions. The ing of teeth in dogs with incomplete root formation and critical value of statistical significance was 5%. previously contaminated canals and to verify the Results Significant differences (P < 0.05) were found necessity of employing calcium hydroxide paste before in relation to the position of barrier formation and MTA using MTA. extrusion. The barrier was formed in the interior of the Methodology Twenty premolars from two 6-month canal in 69.2% of roots from MTA group only. In group old dogs were used. After access to the root canals and 2, it was formed beyond the limits of the canal walls in complete removal of the pulp, the canal systems remai- 75% of the roots. MTA extrusion occurred mainly in ned exposed to the oral environment for 2 weeks. Canal roots from group 2. There was similarity between the preparation was then carried out using Hedstro¨m files, groups for the other parameters. under irrigation with 1% sodium hypochlorite, 1 mm Conclusions Mineral trioxide aggregate used after short of the radiographic apex. After drying, the canals of root canal preparation favoured the occurrence of the two premolars in each dog were left empty (control apexification and periapical healing. The initial use of group). The other eight teeth in each animal were divided calcium hydroxide paste was not necessary for apex- into two experimental groups. The apical thirds of the ification to occur, and has shown to be strongly related canals of group 1 were filled with MTA. In the teeth of to the extrusion of MTA and formation of barriers group 2, the canals were dressed with a calcium beyond the limits of the root canal walls. hydroxide–propylene glycol paste. After 1 week, the Keywords: apexification, mineral trioxide aggregate, paste was removed and the apical third was filled with open apices, periapical healing. MTA. All teeth were restored with reinforced zinc oxide cement (IRM) and amalgam. The animals were killed Received 16 March 2005; accepted 15 August 2005 root development ceases. Consequently, the canal Introduction remains large, with thin and fragile walls, and the When teeth with incomplete root formation suffer apex remains open. These features make instrumen- pulp necrosis, the formation of dentine stops, and tation of the canal difficult and hinder the formation of an adequate apical stop. In such cases, in order to Correspondence: Wilson Tadeu Felippe, Presidente Coutinho, allow the condensation of the root filling material 179/702 Centro Floriano´polis, CEP: 88.015-230, SC, Brazil and to promote an apical seal, it is imperative to (Tel./fax: +55 0 48 224 1647; e-mail: [email protected]). create an artificial apical barrier or induce the closure 2 International Endodontic Journal, 39, 2–9, 2006 ª 2006 International Endodontic Journal Felippe et al. MTA apexification of the apical foramen with calcified tissue (apexifica- with a mixture of xilasine (Rompum, Abbott, Sa˜o Paulo, tion). SP, Brazil) and cetamine cloridrate (Ketamin, Aster, Calcium hydroxide pastes have become the material Sa˜o Paulo, SP, Brazil), the dogs were anaesthetized of choice to induce apexification (Leonardo et al. 1993, intravenously with 5% sodium thiopental solution Felippe et al. 2005). Despite its efficacy, this dressing (Thionembutal, Abbott) at the dose of 5-mg Kg)1 body has several disadvantages, such as variability of treat- weight. During the operative procedures, the animals ment time, number of appointments and radiographs, received an infusion of saline solution and intravenous difficulty in patient follow-up, delayed treatment anaesthetics, as required. (Shabahang et al. 1999) and possibility of increased Pre-operative radiographs were exposed to confirm tooth fracture after calcium hydroxide use for extended the presence of open apices. After endodontic access periods (Andreasen et al. 2002). and determination of canal length, pulp tissue was Studies have indicated mineral trioxide aggregate removed with K-files (Dentsply Maillefer, Ballaigues, (MTA) as an alternative to calcium hydroxide (Tittle Switzerland). Size 60 Hedstro¨m files (Dentsply Maillefer, et al. 1996, Shabahang et al. 1999). MTA is a powder Ballaigues, Switzerland) were introduced up to the aggregate, containing mineral oxides (Lee et al. 1993). radiographic apex and were used in a filing action to Besides its noncytotoxicity (Osorio et al. 1998), it has remove the remnants of apical pulp tissue totally. The good biological action (Torabinejad et al. 1995c,d, canals were irrigated with distilled water and after Torabinejad et al. 1998) and stimulates repair (Regan haemostasis, a cotton pellet was placed in the entrance et al. 2002, Economides et al. 2003), because it allows of each canal and the teeth were left without a coronal cellular adhesion, growth and proliferation on its restoration for 2 weeks. surface (Zhu et al. 2000). When used in dogs’ teeth After this period, radiographs were exposed that with incomplete root formation and contaminated demonstrated the presence of apical pathosis of variable canals, MTA often induced the formation of apical size associated with all roots. The canals were cleaned barrier with hard tissue (Tittle et al. 1996, Shabahang under aseptic conditions to the radiographic apex using et al. 1999). size 50–60 K-files. Hedstro¨m files sizes 70 and 80 were From experimental studies described in the literature subsequently used 1 mm short of the radiographic (Tittle et al. 1996, Shabahang et al. 1999), clinical apex, using gentle filing movements. During prepar- protocols (Shabahang & Torabinejad 2000), as well as ation, the canals were irrigated with 1% sodium clinical cases (Torabinejad & Chivian 1999, With- hypochlorite solution. After drying with sterile paper erspoon & Ham 2001, Giuliani et al. 2002, Levenstein points, the canals of two premolars of each dog were 2002, Maroto et al. 2003), MTA was placed into canals left unfilled (control group); the coronal restoration only after the use of calcium hydroxide paste for consisted of reinforced zinc oxide cement (IRM) and 1 week. Therefore, the reaction of the apical tissues amalgam. For the other eight premolars in each when this material is applied immediately after canal animal, the canals were dried with sterile paper points. preparation, in teeth with incomplete root formation, is The teeth were randomly assigned to two experimental not known. groups. The aim of this study was to evaluate the effect of In group 1, 16 canals were filled with a mixture of MTA on apexification and periapical healing in dogs’ MTA (Pro Root MTA, Dentsply Tulsa Dental, Tulsa, OK, teeth with incomplete root formation and contamin- USA) with distilled water, in a proportion of 3 : 1. The ated canals, and to verify whether calcium hydroxide MTA was placed into the canals with a lentulo-spiral, paste was required prior to the use of MTA. introduced 3 mm short of the radiographic apex and condensed in the apical third by gentle packing with paper points. The teeth were radiographed to check the Material and methods MTA apical plug and a sterile cotton pellet was then The research project was approved by the Animal placed in the access cavity. The coronal restoration Ethics Screening Committee of the Federal University of consisted of IRM and amalgam. Santa Catarina (Floriano´polis, SC, Brazil). In group 2, 16 canals received a calcium hydroxide The procedures were performed as described by paste (pure calcium hydroxide, 0.612 mg, Reagen, Rio Felippe et al. (2005). A total of 40 root canals from 20 de Janeiro, RJ, Brazil) mixed with propylene glycol maxillary and mandibular premolars of two 6-month (0.4 mL, Quimidrol, Joinville, SC, Brazil). The paste was old Beagle dogs were used. After intramuscular sedation placed into the canals with a lentulo-spiral, introduced ª 2006 International Endodontic Journal International Endodontic Journal, 39, 2–9, 2006 3 MTA apexification Felippe et al. 3 mm short of the radiographic apex. The teeth were some disruption of structure, or (iii) severe – extensive radiographed for complete filling of the canals, and inflammatory cell infiltrate with replacement of tissues, sealed with IRM. After 1 week the canals were abscess irrigated with saline solution, and a size 80 K-file • Bone resorption: characterized by the presence of was introduced 1 mm short of the radiographic apex clastic cells on the bone surface and enlargement of the and gently manipulated to remove the paste. Irriga- periodontal space tion was repeated until the solution was clear of any • Root resorption: characterized by the presence of calcium hydroxide residue. After drying, the apical clastic cells on the root surface or by perceptible 3–4 mm of the canals was filled with MTA. All other exposed dentine surface procedures and the coronal restoration were similar to • Extrusion of MTA: presence of material beyond the group 1. limits of the root walls Five months after mechanical canal preparation, • Microorganisms: presence of microorganisms in the the animals were killed and the jaws dissected and root canal, inside dentinal tubules or in the periodontal fixed in 10% formol solution.
Load more

Recommended publications
  • Apexification of Immature Permanent Incisors Using MTA and Calcium Hydroxide- Case Report
    IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 19, Issue 4 Ser.7 (April. 2020), PP 33-37 www.iosrjournals.org Apexification of Immature Permanent Incisors using MTA and Calcium hydroxide- Case Report Tanu Rajain1, Kesang Tsomu2, Ritu Namdev3 1Post Graduate Trainee 2nd year , Department of Pedodontics and Preventive Dentistry, PGIDS , Rohtak, Haryana. 2Post Graduate Trainee 3rd year , Department of Pedodontics and Preventive Dentistry, PGIDS , Rohtak, Haryana. 3Senior Professor and Head, Department of Pedodontics and Preventive Dentistry, PGIDS , Rohtak, Haryana. Corresponding Author: Dr. Tanu Rajain , Department of Pedodontics and Preventive Dentistry, Pt. B.D. Sharma PGIMS , Rohtak , Haryana- 124001, India. Abstract- In young pediatric patient the endodontic management of immature non vital permanent teeth is a great challenge to dentist. There is difficulty in debridement and obturation as the walls of the root canals are frequently divergent and open apexes are present. Apexification is a technique to generate a calcific barrier in a root with an open apex or the sustained apical development of an incomplete root in teeth with necrotic pulp. The most commonly advocated medicament is calcium hydroxide although recently considerable interest has been expressed in the use of MTA. In this case series both calcium hydroxide and MTA were used successfully for apexification procedure in teeth with open apex. Keywords- Young permanent maxillary incisor, open apex, calcium hydroxide, mineral trioxide aggregate, apexification. ----------------------------------------------------------------------------------------------------------------------------- ---------- Date of Submission: 04-04-2020 Date of Acceptance: 20-04-2020 ----------------------------------------------------------------------------------------------------------------------------- ---------- I. Introduction Dental trauma in the young adolescent patient is most common to the anterior dentition.
    [Show full text]
  • June 2000 Issue the Providers' News 1 To
    To: All Providers From: Provider Network Operations Date: June 21, 2000 Please Note: This newsletter contains information pertaining to Arkansas Blue Cross Blue Shield, a mutual insurance company, it’s wholly owned subsidiaries and affiliates (ABCBS). This newsletter does not pertain to Medicare. Medicare policies are outlined in the Medicare Providers’ News bulletins. If you have any questions, please feel free to call (501)378-2307 or (800)827-4814. What’s Inside? "Any five-digit Physician's Current Procedural Terminology (CPT) codes, descriptions, numeric ABCBS Fee Schedule Change 1 modifiers, instructions, guidelines, and other material are copyright 1999 American Medical Association. All Anesthesia Base Units 2 Rights Reserved." Claims Imaging and Eligibility 2 ABCBS Fee Schedule Change Reminder: Effective July 1, 2000 Arkansas Blue Cross Claims Payment Issues 3 Blue Shield is updating the fee schedule used to price professional claims. The update includes changes in the Coronary Artery Intervention 2 Relative Value Units used to calculate the maximum allowances as well as the implementation of Site-Of - CPT Code 99070 2 Service (SOS) pricing. Dental Fee Schedule 2 Under SOS pricing, a given procedure may have different allowances when provided in a setting other Electronic Filing Reminder 2 than the office. Health Advantage Referral Reminder 2 The Place Of Service reported in block 24b on the HCFA 1500 claim form indicates which allowance should be Type of Service Corrections 3 applied. An “11” in this field indicates that the service was delivered in the office setting. Any value other than Attachments “11” in block 24b will result in the application of the SOS A Guide to the HCFA - 1500 Claim Form pricing, if there is an applicable SOS allowance for that (Paper Claims) 7 service.
    [Show full text]
  • Analysis of Clinical Studies Related to Apexification Techniques
    Introduction A. Agrafioti, D.G. Giannakoulas*, C.G. Filippatos, E.G. Kontakiotis Teeth with necrotic pulp and open apex bring about several challenges to clinicians due to the lack of natural Department of Endodontics, School of Dentistry, National and apical constriction and the thin root walls that are Kapodistrian University of Athens, Athens, Greece prone to fracture [Trope, 2006, Camp, 2008]. In order *School of Dentistry, National and Kapodistrian University of to confine filling materials into the root canal space and Athens, Athens, Greece prevent overfilling, the placement of an artificial apical barrier and/or the closure of the apex are necessary email: [email protected] before obturation of the root canal system [Trope 2006]. The traditional approach to handle cases with open apex DOI: 10.23804/ejpd.2017.18.04.03 is the multiple-visit apexification treatment with the use of calcium hydroxide (CH) as intracanal medicament [Seltzer, 1988]. The frequency of changes of CH from the root canal constitutes a controversial topic as there are studies Analysis of clinical that propose that a single placement of this medicament is enough to achieve predictable outcomes [Chawla studies related 1986], whereas others claim that multiple replacements of CH could lead to a more rapid formation of a calcified to apexification tissue barrier [Abbot 1998]. The time required for the calcified tissue barrier to form varies from 5 to 20 months techniques [Sheehy and Roberts, 1996] and seems to be influenced by several factors such as opening of the apex, frequency of intracanal medication replacement, age of the patient and the presence of periapical radiolucency [Mackie et al., ABSTRACT 1988; Finucane and Kinirons, 1999; Kleier and Barr, 1991].
    [Show full text]
  • Single-Visit Apexification Using Calcium Phosphate Cement 1CS Deviprasad, 2G Praveena, 3Manoj C Kuriakose, 4Neethu Rajeev, 5Athira a Hari
    CEJ CS Deviprasad et al 10.5005/jp-journals-10048-0012 CASE REPORT Single-visit Apexification using Calcium Phosphate Cement 1CS Deviprasad, 2G Praveena, 3Manoj C Kuriakose, 4Neethu Rajeev, 5Athira A Hari ABSTRACT a search for alternatives, such as artificial apical barrier An immature tooth with pulpal necrosis and periapical pathology techniques, with their potential for more rapid treatment; imposes a great difficulty to the endodontists. Endodontic and regeneration techniques, with their potential for treatment options for such teeth consist of conventional continued tooth development. apexification procedure with and without apical barriers and Artificial apical barrier technique consists of a barrier revascularization. Calcium phosphate is a calcium silicate-based material which is packed into the apical portion of the cement that exhibits physical and chemical properties similar to those described for certain Portland cement derivatives. This root canal against which the obturating material can be article demonstrates the use of calcium phosphates as an apical condensed. Clinicians have tried several materials to form matrix barrier in root end apexification procedure. This case apical barrier in the past. These include calcium hydroxide report presents apexification and follow-up of a case with the powder, calcium hydroxide mixed with different vehicles, use of calcium phosphate as an apical barrier matrix. collagen, tricalcium phosphate, osteogenic protein, bone Keywords: Apexification, Apical barrier, Calcium phosphate growth factor, and oxidized cellulose. cement. Among the various materials used as artificial apical How to cite this article: Deviprasad CS, Praveena G, Kuriakose MC, barrier, mineral trioxide aggregate (MTA) is currently Rajeev N, Hari AA. Single-visit Apexification using Calcium considered as one of the most promising material.4 Min- Phosphate Cement.
    [Show full text]
  • Survey of Charges–Endodontics This Survey Represents the Most Frequently Billed Procedure Codes
    Professional Relations Dept. 601 S.W. Second Avenue Portland, OR 97204-3156 503-243-3965 (fax) www.odscompanies.com Survey of Charges–Endodontics This survey represents the most frequently billed procedure codes. DIAGNOSTIC _____ $_________ ______________________________ CLINIC ORAL EVALUATIONS _____ $_________ ______________________________ D0140 $_________ Limited oral evaluation ENDODONTIC THERAPY D0150 $_________ Comprehensive oral evaluation (INCLUDES ALL CLINICAL PROCEDURES, I.E. EXTIR- D0484 $_________ Consultation on slides prepared else- PATION, TREATMENTS, ENDODONTICS, X-RAYS, where CULTURES & FOLLOW-UP CARE) D0485 $_________ Consultation, including preparation of slides from biopsy material supplied by D3310 $_________ Anterior (excluding final restoration) referring source D3320 $_________ Bicuspid (excluding final restoration) D3330 $_________ Molar (excluding final restoration) Additional codes D3332 $_________ Incomplete endodontic therapy _____ $_________ ______________________________ D3333 $_________ Internal root repair of perforation defects _____ $_________ ______________________________ D3346 $_________ Retreatment of previous root canal _____ $_________ ______________________________ therapy-anterior D3347 $_________ Retreatment of previous root canal RADIOGRAPHS therapy-bicuspid D3348 $_________ Retreatment of previous root canal D0210 $_________ Intraoral-complete series therapy-molar D0220 $_________ Intraoral-periapical first film D0230 $_________ Intraoral-periapical each additional film Additional codes D0240
    [Show full text]
  • Non-Surgical Endodontics
    UnitedHealthcare® Dental Coverage Guideline Non-Surgical Endodontics Guideline Number: DCG009.07 Effective Date: February 1, 2021 Instructions for Use Table of Contents Page Related Dental Policy Coverage Rationale ....................................................................... 1 • Surgical Endodontics Definitions ...................................................................................... 3 Applicable Codes .......................................................................... 4 Description of Services ................................................................. 5 References ..................................................................................... 5 Guideline History/Revision Information ....................................... 5 Instructions for Use ....................................................................... 6 Coverage Rationale Vital Pulp Therapy Direct Pulp Cap Direct Pulp Capping is indicated for permanent teeth for the following: Tooth has a vital pulp or been diagnosed with reversible pulpitis All caries has been removed Mechanical exposure of a clinically vital and asymptomatic pulp occurs If bleeding can be controlled at the site of exposure Indirect Pulp Cap Indirect Pulp Capping is indicated for primary teeth or permanent teeth with immature apices for the following: Tooth has a vital pulp or been diagnosed with reversible pulpitis Tooth has a deep carious lesion that is considered likely to result in pulp exposure during excavation Therapeutic Pulpotomy Therapeutic Pulpotomy
    [Show full text]
  • Pulp Revascularization: an Alternative Treatment to the Apexification of Immature Teeth
    http://dx.doi.org/10.1590/1981-8637201400040000082673 REVISÃO | REVIEW Pulp revascularization: an alternative treatment to the apexification of immature teeth Revascularização pulpar: tratamento alternativo à apicificação de dentes jovens com rizogênese incompleta Maria Tereza Pedrosa ALBUQUERQUE1 Juliana Yuri NAGATA2 Adriana de Jesus SOARES2 Alexandre Augusto ZAIA2 ABSTRACT Pulp revascularization can be considered as a current alternative treatment to apexification, recommended for immature teeth cases, requiring endodontic treatment. Apexification involves long-term periodic exchanges of a calcium hydroxide paste into the root canal to induce the formation of a calcified barrier. Despite being the most classically therapy employed for these cases, the permanence of calcium hydroxide for long periods of time and also the successive changes may lead to a weakening of the root due to its hygroscopic properties and the proteolytic activities of calcium hydroxide, increasing the risk of fractures and contamination of the pulp space. Thus, a constant search for new treatment alternatives that provide the end of root development have been done to avoid the risk of future root fractures. So, revascularization has emerged as a new treatment option for cases of undeveloped teeth, that provides not only apical closure, as apexification, but also increase the dentin walls thickness. In the literature, there is an assortment of treatment protocols employing pulp revascularization procedure in attempt to attain the best way to achieve success. Assuming the diversity of protocols for revascularization treatment, it is important to go deep in the literature to collect, describe and discuss these protocols guiding new researches in this field and also conducting the clinicians.
    [Show full text]
  • Regenerative Endodontics for Upper Permanent Central Incisors After Traumatic Injury: Case Report with a 3-Year Follow-Up Loai Alsofi
    CASE REPORT Regenerative Endodontics for Upper Permanent Central Incisors after Traumatic Injury: Case Report with a 3-year Follow-up Loai Alsofi ABSTRACT Aim: The aim of this article is to describe a one-visit approach to attempt revascularization in the upper right and left central incisors after traumatic injury. Background: A single-visit conservative revascularization approach can be used to promote root growth and maturation following traumatic dental injury and loss of pulpal tissues. Case description: An eight-year-old female patient presented in Dentalia Clinics, Jeddah, Kingdom of Saudi Arabia, in 2016 with traumatic dental injury. Upon clinical and radiographic examination, it was found that the trauma resulted in loss of pulp vitality in two upper central incisors. Local anesthesia was administered, and a rubber dam was placed. Access cavity was done for each tooth separately. 2% chlorhexidine followed by sterile saline was used for irrigation with no instrumentation. Mineral trioxide aggregate (MTA) was used as the sealing material after blood clot formation. Follow-up showed continuous root maturation in the right central incisor, at 6 months, one year, two years, and three years. Root canal treatment was done in 2019 due to the development of periapical lesion. The 6-month follow-up radiograph also showed loss of the crown of the left central incisor due to a second trauma with retained apical root fragment. The fragment was embedded inside the bone and showed continuous maturation during the three years. Conclusion: A single-visit regenerative endodontic approach showed successful results in revascularizing the upper permanent central incisor after loss of pulpal tissue.
    [Show full text]
  • Pulp Therapy for Primary and Immature Permanent Teeth
    BEST PRACTICES: PULP THERAPY Pulp Therapy for Primary and Immature Permanent Teeth Latest Revision How to Cite: American Academy of Pediatric Dentistry. Pulp therapy 2020 for primary and immature permanent teeth. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2020:384-92. Purpose as: normal pulp (symptom free and normally responsive to The American Academy of Pediatric Dentistry AAPD( ) intends vitality testing), reversible pulpitis (pulp is capable of healing), these recommendations to aid in the diagnosis of pulp health symptomatic or asymptomatic irreversible pulpitis (vital versus pathosis and to set forth the indications, objectives, inflamed pulp is incapable of healing), or necrotic pulp.3 The and therapeutic interventions for pulp therapy in primary and clinical diagnosis derived from:4-7 immature permanent teeth. 1. a comprehensive medical history. 2. a review of past and present dental history and Methods treatment, including current symptoms and chief Recommendations on pulp therapy for primary and immature complaint. permanent teeth were developed by the Clinical Affairs 3. a subjective evaluation of the area associated with the Committee – Pulp Therapy Subcommittee and adopted in current symptoms/chief complaint by questioning 1991.1 This document by the Council of Clinical Affairs is the patient/parent on the location, intensity, a revision of the previous version, last revised in 2014.2 This duration, stimulus, relief, and spontaneity. revision included a new search of the PubMed / 4. an objective extraoral examination as well as examina- MEDLINE database using the terms: pulpotomy, pulpectomy,® tion of the intraoral soft and hard tissues. pulpectomy primary teeth, indirect pulp treatment (IPT), 5.
    [Show full text]
  • Comparison of Apexification with Mineral Trioxide Aggregate
    ������������������ Comparison of Apexification With Mineral Trioxide Aggregate and Calcium Hydroxide Omar A.S. El Meligy, BDS, MSc, PhD1 David R. Avery, DDS, MSD2 Abstract Purpose: The aim of this study was to compare mineral trioxide aggregate (MTA) with calcium hydroxide [Ca(OH)2] clinically and radiographically as materials used to induce root-end closure in necrotic permanent teeth with immature apices (apexification). Methods: Fifteen children, each with at least 2 necrotic permanent teeth requiring root- end closure (apexification), were selected for this study. All selected teeth were evenly divided into 2 test groups. In group 1, the conventional calcium hydroxide apexification (control) was performed, whereas in group 2, the MTA apexification (experimental) was done. The children were recalled for clinical and radiographic evaluations after 3, 6, and 12 months. Results: The follow-up evaluations revealed failure due to persistent periradicular inflam- mation and tenderness to percussion detected at 6 and 12 months postoperative evaluation in only 2 teeth treated with Ca(OH)2. The remaining 13 teeth appeared to be clinically and radiographically successful 12 months postoperatively. None of the MTA-treated teeth showed any clinical or radiographic pathology. Conclusions: Mineral trioxide aggregate showed clinical and radiographic success as a ma- terial used to induce root-end closure and is a suitable replacement for calcium hydroxide for the apexification procedure. (Pediatr Dent 2006;28:248-253) KEYWORDS: MINERAL TRIOXIDE AGGREGATE, CALCIUM HYDROXIDE, APEXIFICATION Received September 27, 2005 Revision Accepted December 21, 2005 oot-end closure, also known as apexification, is alkaline pH that may be responsible for stimulating apical defined as the process of creating an environment calcification.7 Rwithin the root canal and periapical tissues after pulp Despite its popularity for the apexification procedure, death that allows a calcific barrier to form across the open Ca(OH)2 therapy has some inherent disadvantages, in- apex.
    [Show full text]
  • Pulpotomy and Apexification
    DR.SK Reader, CONS & ENDO FAQS q Vital pulp therapy – (10 marks) q Management of a traumatized incisor/young permanent teeth at 7-8 years (10 marks) q Pulpotomy (5 marks) q Apexogenesis (5 marks) q Apexification (5 marks) q Cervical pulpotomy (2 marks) VITAL PULP THERAPY q Treatment initiated on an exposed pulp to repair and maintain the pulp vitality – Grossman q Main decisive factors for pulp therapy – 1. Inflammation 2. Vitality VITAL PULP THERAPY q PULP CAPPING • DIRECT • INDIRECT q PULPOTOMY q APEXOGENESIS (IN CASE OF IMMATURE APEX) NON VITAL PULP THERAPY q PULPECTOMY q APEXIFICATION (IN CASE OF IMMATURE APEX) PULPOTOMY DEFINITION Complete removal of the coronal portion of the pulp, followed by placement of a suitable dressing/medicament that will promote healing and preserve the tooth vitality - (Finn,1985) (Deciduous and Young Permanent Teeth) RATIONALE Ø Pulp exposure by trauma or operative procedures, or caries ingress – Inflammation Ø Surgical excision of the infected and inflamed coronal pulp, the vital uninfected pulpal tissue can be left behind and preserved in the root canal- aids in repair and apexogenesis Ø Removal of the inflamed portion of the pulp affords temporary, rapid relief of pulpalgia OBJECTIVES (AAPD Guidelines) Ø Radicular pulp should remain asymptomatic without adverse clinical signs or symptoms such as sensitivity, pain, or swelling Ø No evidence of pathologic external root resorption Ø Internal root resorption can be self limiting and stable Ø The clinician should monitor the internal resorption, removing the affected tooth if perforation causes loss of supportive bone and/or clinical signs of infection and inflammation Ø No harm to the succedaneous tooth CASE SELECTION 1.Visual and tactile examination of carious dentin and associated periodontium 2.
    [Show full text]
  • Apexification
    Dental Traumatology 2005; 21: 1–8 Copyright Ó Blackwell Munksgaard 2005 All rights reserved DENTAL TRAUMATOLOGY Apexification: a review Rafter M. Apexification: a review. Dent Traumatol 2005; 21: 1–8. Mary Rafter Ó Blackwell Munksgaard, 2005. University of Michigan School of Dentistry, Ann Arbor, MI, USA Abstract – This paper reviews the rationale and techniques for treatment of the non-vital immature tooth. The importance of careful case assessment and accurate pulpal diagnosis in the treatment of immature teeth with pulpal injury cannot be overemphasized. The treatment of choice for necrotic teeth is apexification, which is induction of apical closure to produce more Key words: apexification; apexogenesis; calcium favorable conditions for conventional root canal filling. The most hydroxide; mineral trioxide aggregate; one-visit commonly advocated medicament is calcium hydroxide, although apexification recently considerable interest has been expressed in the use of Mary Rafter BDent Sc FFD RCSI MS, Division of mineral trioxide aggregate. Introduction of techniques for one-visit Endodontics, University of Michigan School of apexification provide an alternative treatment option in these Dentistry, 1011 N University, Ann Arbor, MI 48109- 1078, USA cases. Success rates for calcium hydroxide apexification are high Tel.: +734 763 3380 although risks such as reinfection and tooth fracture exist. Fax: +734 936 1597 Prospective clinical trials comparing this and one-visit apexification e-mail: [email protected] techniques are required. Accepted 25 March, 2004 The completion of root development and closure of Hertwig’s epithelial root sheath begins to disinteg- the apex occurs up to 3 years after eruption of the rate and lose its continuity and close relationship to tooth (1).
    [Show full text]