Mineral trioxide aggregate for apexification in non-vital teeth with open apices: A case report

Management of immature non-vital teeth poses challenge for the clinician owing to the thin root canal walls and open apices which may show apical divergence. Apexification is the technique of inducing the apical closure with a root end filling material for non-vital immature young permanent teeth. Traditionally, Calcium hydroxide was the material of choice for apexification of immature permanent teeth but introduction of MTA has shown remarkable promise as an alternative to calcium hydroxide. This report presents a case of apexification of anterior two young permanent teeth with open apices using MTA and Gutta percha followed by esthetic build up using cast metal posts and full coverage restorations.

Effectiveness of MTA apical plug in dens evaginatus with open apices

Background The present study aims to evaluate the effectiveness of mineral trioxide aggregate (MTA) application in treating dens evaginatus affected teeth with apical lesions and open apices using haemostatic collagen membrane to prevent the apical extrusion of MTA. Methods Twelve patients with 14 dens evaginatus affected teeth with apical lesions and open apices were treated with MTA apical plug and haemostatic collagen membrane. Clinical symptoms of subjective pain, pain of palpation, percussion, sinus tract, and the apical lesions' radiographic parameter were recorded at every 3-month interval up to 9 months after treatment. Paired t-test or Wilcoxon signed-rank test was used for statistical analysis with P < 0.05 as the threshold for considering results to be statistically significant. Results No patient experienced clinical symptoms 3 months after endodontic treatment. In addition, there was a significant difference in the dimensions of the apical lesions' before compared to 3 months after endodontic treatment. Conclusions The combination of MTA apical plug and haemostatic collagen membrane effectively treated dens evaginatus affected teeth with apical lesions, and open apices.

APEXIFICATION REVISITED

Pulpal necrosis in permanent teeth with immature roots leads to development of roots which are very short, thin walled and an inadequate crown-root ratio, which overshadows their survival prognosis. Traditionally, the apexication procedure has consisted of multiple and long-term applications of calcium hydroxide to create an apical barrier to aid the obturation. Recently, articial apical barriers such as those made with mineral trioxide aggregate (MTA) have been used in teeth with necrotic pulps and open apices. More recently, procedures referred to as regenerative endodontics have received much attention as an option for these teeth. This paper reviews the past, present and recent concepts used for apexication.

Assessment of dens invaginatus and its characteristics in maxillary anterior teeth using cone-beam computed tomography

This cone-beam computed tomographic (CBCT) study aimed to evaluate the prevalence of dens invaginatus (DI) and its characteristics in maxillary anterior teeth in a Saudi population. A total of 505 CBCT scans were evaluated, including a total of 2790 maxillary anterior teeth. The patients’ demographic data, including age and sex, were recorded. The presence of DI and the related characteristics including bilateral occurrence; DI type according to Oehlers classification; and presence of periapical radiolucency, open apex, and/or nearby impacted teeth were analyzed. The associations between DI and the other factors were analyzed using the chi-square and fisher exact tests. DI was detected in 7.3% of the patients and 1.6% of the teeth examined. Most of the DI-affected teeth were maxillary lateral incisors (76.1%), followed by mesiodens (19.6%) and maxillary central incisors (4.3%), while no DI was observed in the maxillary canines. Bilateral DI was found in 24.3% of the affected patients. Oehlers type I DI was the most frequent (80%). Periapical radiolucencies, open apices, and nearby impacted teeth were observed in 10.9%, 4.3%, and 30% of the invaginated teeth, respectively. DI was significantly associated with tooth type (P < 0.0001) but not with sex (P > 0.05). Although most of the DI cases are limited to the crown, CBCT imaging is essential for DI evaluation and management.

Apice closure in Pulp Revascularization Therapy. Case report and literature review

Background: Endodontic Regenerative Procedures, especially pulp revascularization therapy, have become a real option for the treatment for immature permanent teeth with open apices. This sort of approach has saved many teeth that otherwise would have been extracted. The technique is simple and effective, and can be accomplished by any odontologist. Objective: This article aimed to make a literature review to give support for a case report of an Endodontic Regenerative Procedure of a twelve-year-old male patient with immature open apice of tooth 21. Methodology: Articles were researched concerning pulp revascularization to reach root end formation. On line searches were accomplished, whose database include BVS/BIREME, Web of Science, PUBMED Central, Science Direct, Higher Level Personnel Improvement Coordinator (CAPES), The Cochrane Library, and PROSPERO). Results: the articles researched showed that Endodontic Regenerative Procedures are efficient in stimulating root end formation. The case report described matched the results offered by the articles, showing an immature open apice tooth that had its root end completely formed after pulp revascularization therapy. Conclusion: Pulp revascularization therapy is an efficient and practical treatment for immature teeth with open apices.

Intraradicular rehabilitation of a necrotic, immature tooth using MTA, a fiber post and composite resin - A case report

Endodontic treatment of necrotic, immature teeth with open apices can present challenges to debridement, disinfection, and optimal obturation. These teeth may have widely flared canals and thin radicular dentinal walls that are susceptible to fracture. Management of the open apex can be performed using a mineral trioxide aggregate (MTA) apical plug. To ensure a better prognosis in such structurally compromised teeth, internal radicular reinforcement using fiber posts and a self-adhesive cement has been suggested. The present case report illustrates the management of a necrotic, immature maxillary right central incisor in a 10-year-old patient using the MTA apical barrier technique and canal reinforcement using a fiber post.

EFFECT OF CHITOSAN GEL ON SMEAR LAYER,Ca/P RATIO AND PUSH-OUT BOND STRENGTH OF RESIN SEALERS AT DIFFERENT TIME INTERVALS.

OBJECTIVE: Comparative evaluation of smear layer removal, calcium phosphate ratio and bond strength of AH Plus sealer to radicular dentin after the use of 0.2% chitosan and 17% EDTAas lubricant and nal rinse at different time intervals(1min and 2min). METHODOLOGY: 75 premolars were prepared using Pro-Taper rotary le. 30 samples were used for testing smear layer removal and Ca/Pratio and 45 samples for testing bond strength. 1ml of 3%NaOCl was used for irrigation of all the samples throughout the preparation. The teeth were randomly divided into 3 groups according to the type of lubricant-17% EDTAgel or 0.2% chitosan gel and the nal irrigant -17%EDTA solutions, 0.2%chitosan solution for 1min and 2min. 30 samples were sectioned longitudinally. One half of the section was used for smear layer analysis using SEM and the other half of the section was used for Ca/Pratio analysis using EDX. 45 samples were obturated with F3 gutta-percha cones using AH plus sealer and sectioned. The samples were subjected to push-out testing using UTM and failure was evaluated using SEM. RESULTS: Smear layer removal and push-out bond strength was found to be highest in EDTA group followed by Chitosan(2min) and Chitosan(1min)groups. EDX analysis showed that the Ca/Pratio of EDTAgroup is signicantly lower than chitosan group. CONCLUSION:Within the limitations of the study it can be inferred that 0.2%chitosan gel lubricant and nal rinse can be used as an alternative to EDTAespecially in teeth with thin dentinal walls, open apices, and root resorption.

Age Estimation Using the Cameriere Methods of Open Apices: A Meta-Analysis

Purpose: To evaluate the actual variability of the mean difference between chronological and dental age using the Cameriere method of open apices and to test its accuracy in variable age groups. Method: We selected studies that contained data about the mean, standard deviation, and number of cases for chronological age, dental age and gender. We used a random-effects model. Statistical significance was estimated, at a p < 0.05, using prediction intervals. For the analysis of publication bias we used the funnel plot and Egger’s regression test for plot asymmetry. I2 was used to test the presence of heterogeneity between studies. The Z test was used to test for statistical differences between subgroups, with p < 0.05 being considered statistically significant. We also used 95% for confidence intervals and prediction intervals. Results: In boys, the average difference between chronological and dental age was 0.44 (0.26–0.63) years, while in girls the average difference between chronological and dental age was 0.34 (0.19–0.49) years. In the 6–7 years age group and in the 14–15 years age group, there was a statistically significant difference between dental and chronological age. Our study shows that the Cameriere method is useful for estimating the chronological age, with errors of less than one year. Conclusions: The Cameriere method of evaluating dental age using open apices is sufficiently accurate for forensic practice, at least in the 7–14 age-interval.