Management of permanent teeth with necrotic pulps and open apices according to the stage of root development (original) (raw)

Evolution of apical formation on immature necrotic permanent teeth

American journal of dentistry

Purpose: To evaluate the evolution of apical formation on 28 necrotic immature permanent teeth treated with calcium hydroxide at different stages of root development. Methods: Apical formation in 28 necrotic incisors was carried out (27 upper and one lower incisors), in children between the ages of 6 and 13 years old (11 males, 10 females). Following anesthesia and rubber dam isolation, the chamber was opened and the coronal and root pulp tissue was removed. Next, after measuring the canal, the root canal was irrigated with 5% sodium hypochlorite. Once the canal was dried, it was filled with the CaOH 2 powder mixed with physiologic saline solution to a dense consistency but malleable. This paste was compressed into the canal using a cotton pellet. The canal was completely filled up to the apex. Finally, the cavity opening was sealed with zinc oxide-eugenol (IRM) and glass-ionomer (Vitrebond). Follow-up appointments were made every 3 months in order to evaluate the evolution of the periapical radiolucency and the formation of the apical barrier. Results: The duration of the apical induction was 8.6 ± 5.36 months. Increase or lack of growth in the length of the root canal and the type of root end closing was as follows: cementoid tissue (85.72%); osseous tissue (14.28%), with a 100% overall success rate. The evolution of these teeth was monitored over a 2-year period with re-infections occurring in 7.1 percent of the cases. (Am J Dent 2010;23:269-274).

Steinig_et_al-2003-Australian_Endodontic_Journal.pdf

Endodontic treatment of the pulpless tooth with an immature root apex poses a special challenge for the clinician. The main difficulty encountered is the lack of an apical stop against which t o compact an interim dressing of calcium hydroxide (Ca(OH),), or the final obturation material. In these situations the unpredictability of the result, the difficulty in creating a leak-proof temporary restoration for the duration of treatment, and the difficulty in protecting the thin root from fracture may lead to complications when using traditional (Ca(OH),-based) apexification techniques. Furthermore, given the increased mobility of today's society, lengthy treatment protocols are fraught with problems, and may not be followed through t o completion. This may lead t o ultimate failure of the case.

Apical Closure of Nonvital Permanent Teeth: 15 Months Follow-up Study of Four Cases

Journal of International Oral Health, 2015

Obtaining a complete seal of the root canal system is a major problem in performing root canal treatment in nonvital teeth with incomplete root development and wide open apices. The aim was to study apexification using mineral trioxide aggregate (MTA), clinically and radiographically over a period of 15 months. MTA was used in four cases of teeth with incomplete root development in order to achieve an apical seal and the remaining canal was obturated with gutta-percha. Clinical and radiographic assessments of teeth were done. The clinical and radiographic results indicated that apexification procedure was predictable by using MTA. The total number of patients' visits and the total time duration required to obtain an apical barrier using MTA was markedly less than that of conventional techniques using calcium hydroxide.

Root canals‑from concretion to patency

Teeth with calcification provide an endodontic treatment challenge; traumatized teeth usually develop partial or total pulpal obliteration which is characterized by apparent loss of the pulp space radiographically and a yellow discoloration of the clinical crown. Since only 7-27% of such teeth develop pulp necrosis with radiographic signs of apical periodontitis, it is difficult to decide whether to treat these teeth immediately upon detection of the pulpal obliteration or to wait until signs and symptoms of pulp and/or apical periodontitis occur. This article reviews the etiology, prevalence, classification, mechanism, diagnosis as well as treatment options for teeth with pulp obliteration and the various management approaches and treatment strategies for overcoming potential complications. A search of articles from "PubMed" and "Medline" from 1965 to present was done with the keywords dental trauma, discoloration, pathfinding instruments, pulp canal obliteration, and root canal treatment was conducted. A total of 94 abstracts were collected, of which 70 relevant articles were read and 31 most relevant articles were included in this article.

Apical Anatomy in Mesial and Mesiobuccal Roots of Permanent First Molars

Journal of Endodontics, 2005

The purpose of this in vitro study was to investigate the canal configuration types, and the prevalence and location of anatomical variations in the mesiobuccal (MB) and mesial roots of permanent maxillary and mandibular first molars after instrumentation. The number and the type of canals were determined before instrumentation using conventional methods. All root canals from the 47 MB roots and 42 mesial roots were then instrumented to size #30 with ProFile .04 taper rotary instruments in a crown-down method and then filled with a single gutta-percha cone and sealer. Transverse 1 mm-thick cross-sections at 2, 3, 4, and 5 mm from the apex were obtained, stained and examined using a stereomicroscope. The canal configuration types and the prevalence and location of isthmi and accessory canals in roots with two canals were evaluated. The prevalence of two canals was 80.8% in the maxillary MB roots and 95.2% in the mandibular mesial roots. There were six types of canal configurations in the instrumented root apices. The prevalence of anatomical variations was highest at the apical 4 mm level, and was more frequent in mandibular first molars, and in roots with Weine type III canal. 2 test showed that the prevalence of the anatomical variations was statistically higher in the maxillary MB roots with Weine type III canals than in those with Weine type II canals (p Ͻ 0.05). Different canal configurations were often found at different levels in the same root. The results indicate that anatomical variations persist following instrumentation of roots with two canals in first molars. These anatomical variations should be considered during surgical or nonsurgical endodontic procedures of the permanent first molars.

Endodontic management of dilacerated and bayonet shaped roots

Successful root canal therapy requires a thorough knowledge of root anatomy and root canal morphology which may be quiet variable. The significance of internal root canal morphology has been emphasized by studies demonstrating that variations in canal morphology may affect the endodontic outcome. Consequently, in treating each tooth the clinician must assume that complex anatomy occurs often enough to be considered normal. Root dilaceration is one of the variations that may complicate the endodontic therapy. It is important for a clinician to have complete knowledge of internal anatomy relationships, careful interpretation of radiographs; proper access preparation and a detailed exploration of the interior of the tooth to achieve a successful treatment outcome. This paper reports successful endodontic therapy of severe dilaceration of the root of mandibular first molar and bayonet shaped root of maxillary first premolar and highlights the clinical considerations to be followed during the endodontic procedures to get the successful outcome. RESUMO Um tratamento de canal bem sucedido requer conhecimento profundo da anatomia da raiz dentária e morfologia do canal radicular, que pode ser variável. A importância da morfologia interna do canal radicular tem sido enfatizada por estudos que demonstram que as variações na morfologia do canal podem afetar o resultado do tratamento endodôntico. Consequentemente, no tratamento de cada dente, o clínico deve assumir que uma anatomia complexa ocorre com frequência suficiente para ser considerada normal. A dilaceração da raiz dentária é uma das variações que podem complicar o tratamento endodôntico. É importante para o clínico ter conhecimento completo das relações da anatomia interna, fazer uma interpretação cuidadosa de radiografias; preparar adequadamente o acesso e realizar uma exploração detalhada do interior do dente para conseguir um resultado de tratamento bem sucedido. Este artigo relata casos de terapia endodôntica bem sucedida de dilaceração severa da raiz do primeiro molar inferior e de raiz em forma de baioneta de um primeiro pré-molar superior e destaca as considerações clínicas a serem seguidas durante os procedimentos endodônticos para se obter êxito no tratamento. Termos de Indexação: Cavidade pulpar. Tratamento do canal radicular. Raiz dentária.

Primary human teeth and their root canal systems

Endodontic Topics, 2010

A thorough knowledge of dental anatomy of both the permanent and primary dentition is essential for all treatment aspects of these teeth. All too often, the study of the anatomy of primary teeth is given secondary importance due to the fact that these teeth will exfoliate eventually. Rather than premature extraction, the retention of primary teeth through restorative or endodontic means is evolving amongst dental practitioners and endodontic and pediatric dental specialists. Thus, knowledge of the normal and abnormal anatomy of primary teeth is required in making diagnosis and treatment decisions in young patients. In rare incidences, as in cases of absent permanent premolars, primary teeth may be retained in the permanent arch and if the pulp becomes diseased, endodontic treatment may be among the treatment options. This article provides a comprehensive review of normal and abnormal morphology of the primary teeth with an emphasis on the roots and root canal systems of each of the teeth in the primary dentition.