Management of an Immature Necrotic Permanent Molar with Apical Periodontitis Treated by Regenerative Endodontic Protocol Using Calcium Hydroxide and MM-MTA: A Case Report with Two Years Follow Up (original) (raw)
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European Archives of Paediatric Dentistry, 2020
Purpose Currently, mineral trioxide aggregate (MTA) apexification is recommended as the preferred treatment for permanent anterior immature necrotic teeth. Apexification treatment does not enable further development and maturation of the teeth, resulting in short roots with thin root canal walls, that often are prone to cervical fractures. This study presents the regenerative endodontic procedure (REP) as an alternative treatment for immature necrotic molars with apical periodontitis or a chronic apical abscess. REP enables periapical healing as well as root lengthening and widening of the dentinal root canal walls. Case series results Six immature first molars teeth (five mandibular, one maxillary) with apical periodontitis or chronic apical abscess were treated with REP. Patients underwent periodic follow-up visits every 3 months the first year and twice a year thereafter. The final clinical examination revealed no symptoms, no gingival pockets, and no sensitivity to percussion. Cold sensitivity tests were negative. Radiographs revealed full periapical healing in all the treated molars, remarkable root lengthening, and dentinal wall thickening. Conclusion REP with PRF is feasible and may have some advantages over MTA apexification since it facilitates root elongation, dentinal thickening of the root canals walls, and narrowing of the apical foramen.
International Arab Journal of Dentistry, 2017
This case report describes the treatment of a necrotic immature permanent central incisor with symptomatic apical periodontitis, which was not treated with conventional apexification techniques. Instead, a regenerative approach based on the literature’s methods for regeneration was provided. The root canal was gently debrided of necrotic tissue with a large diameter file, irrigated with 5,25% NaOCl and then medicated with 2% chlorhexidine. After 21 days, the tooth was asymptomatic. The canal was accessed and irrigated with saline solution and a tissue scaffold was created with PRF (Platelet-Rich Fibrin) prepared using centrifugation. The final restoration was completed immediately with MM-MTA and a composite resin. The tooth was controlled every three months over a period of 2 years and has remained symptom free. Radiographic examination shows healing of the apical radiolucency suggesting that appropriate biologic responses can occur with this type of treatment of the necrotic immat...
Case Reports in Dentistry, 2020
The regenerative endodontic procedure (REP) is considered a viable treatment option for immature teeth with necrotic pulp and periapical radiolucency which can facilitate continued root formation. In this report, an immature necrotic mandibular molar received REP in three appointments wherein chemomechanical debridement was performed with a sequential application of nonsetting calcium hydroxide (in the whole canal) and triple antibiotics paste (in the root’s middle third) dressings in the first and second appointments, respectively. In the third appointment, blood clots were created in the root canals. MTA was placed over the blood clots and the tooth was restored with a composite filling and stainless-steel crown. Recall appointments were performed for two years where the tooth was deemed asymptomatic clinically and a complete root formation with significant periapical healing was evident radiographically. More cases are required to warrant the feasibility of this disinfection prot...
Introduction: Revascularization is a valuable treatment in immature necrotic teeth that allows the continuation of root development. In this article we describe successful revascularization treatment of 2 necrotic immature first mandibular molars. Methods: The clinical and radiographic examinations showed extensive coronal caries, immature roots, and periapical radiolucencies in mandibular first molars of a 9-year-old boy and an 8-year-old girl. The exam findings suggested revascularization treatment in both cases, which was started with irrigation of the canals by using NaOCl 5.25% for 20 minutes, followed by 3 weeks of triple antibiotic (metronidazole, ciprofloxacin, and minocycline) paste dressing. Next, the antibiotic paste was removed, bleeding was induced in the canals, and calcium enriched mixture (CEM) cement was placed over blood clots. Results: In radiographic and clinical follow-ups both cases were asymptomatic and functional, periapical radiolucencies were healed, and roots continued to develop. Conclusions: Revascularization is a realistic treatment in immature necrotic molars. In addition, placing CEM cement as a new endodontic biomaterial over the blood clot formed inside the canals provided good seal and favorable outcomes. (J Endod 2011;37:562-567)
Journal of Oral Science, 2014
Endodontic therapy is indicated for cases of traumatic tooth dislocation associated with pulp necrosis and/or inflammatory resorption. Here we describe the management of a maxillary left lateral permanent incisor that suffered lateral luxation, leading to pulp necrosis and root resorption, in a 13-year-old boy. The traumatized tooth was treated successfully by intracanal medication with calcium hydroxide, 2% chlorhexidine gel and zinc oxide for 12 months without any need to change the dressing, followed by conventional root canal filling. The postoperative course was uneventful and a stable clinical outcome was obtained with evidence of periapical lesion repair and stabilization of the resorption process. (
MM-MTA® for a Complete Endodontic Obturation of an Avulsed Immature Permanent Incisor: A Case Report
The purpose of this report was to present the treatment of an avulsed immature necrotic permanent central incisor using the new mineral trioxide aggregate (MMMTA ®, Micro-Mega, Besançon, France) as an orthograde root filling. In such cases, the canal remains large, with thin and fragile walls, and the apex architecture remains divergent. This case demonstrates the efficacy of MTA in this particular situation as an effective material to support regeneration of apical tissue in immature necrotic teeth. External inflammatory resorption was detected after 3 months of the endodontic treatment. At the one-year followup, there were no clinical symptoms with radiographic healing of periradicular tissues, new hard-tissue formation in the apical area of the affected tooth and stabilization of the resorption.
Journal of Endodontics, 2011
Introduction: Revascularization is an emerging regenerative treatment protocol with little published data available in immature molar teeth. The present case series demonstrates the outcome of revascularization treatment with intracanal medicament of calcium hydroxide in immature necrotic molars. Methods: Immature necrotic permanent first molars (n = 6) of patients 8-11 years old were treated by a revascularization protocol that used 2.5% NaOCl irrigation, medication with calcium hydroxide placed in the coronal third of the root canals, induction of apical bleeding, and coronal sealing with white mineral trioxide aggregate. Among the treated teeth, 4 molars had undergone prior root canal instrumentation by the referring dentists. National Institutes of Health Image-J program with TurboReg plug-in was used for standardization of the radiographs and to determine the increase in root length and root width. Results: After a follow-up period of 10 months, all teeth demonstrated radiographic evidence of complete periapical healing, progressive thickening of dentinal walls, and continued apical development in the absence of clinical symptoms. Two uninstrumented molars showed a positive response to cold testing at 9 months. Conclusions: On the basis of a follow-up period of 10 months, the present cases demonstrate a favorable outcome of the revascularization procedure in immature necrotic molars by using calcium hydroxide medication in the coronal third of the root canals.
Journal of Endodontics, 2013
Introduction: The aim of this study was to investigate the capacity of endodontic regenerative procedures combining an induced blood clot, platelet-rich plasma (PRP), and bone marrow aspirate (BMA) to regenerate dental pulp in canine closed-apex necrotic teeth. Methods: Apical periodontitis was induced in 20 upper and lower premolars of 2 dogs. After biomechanical preparation, enlargement to a #60 file, and disinfection with a triantibiotic paste for 28 days, the roots were randomly assigned to 4 treatment groups: blood clot (BC), BC + PRP gel, BC + BMA gel, and BC + BMA/ PRP gel. Negative controls were also included. After a 3-month follow-up period, the animals were killed. Results: Histologic analysis showed the presence of newly formed vital tissues (connective, cement-like, and bone-like tissue) in 23 of the 32 treated roots (71.87%). There was no statistically significant difference between the treatment groups. Conclusions: New vital tissues were formed and characterized as connective, cementum-like, or bone-like, but not as pulp-like tissue; PRP and/or BMA did not improve the tissue ingrowth. (J Endod 2013;39:1549-1556
Journal of Pediatric Dentistry
The treatment of immature necrotic permanent teeth with wide open apices often poses a significant challenge for the clinician. The lack of an apical stop complicates the obturation and achievement of good apical seal in such teeth. The treatment of choice for necrotic teeth with immature root is apexification, which is induction of apical closure to produce more favorable conditions for conventional root canal filling. The most commonly advocated medicament is calcium hydroxide. But the disadvantages of long treatment time, tooth fracture risk and incomplete calcification of apical bridge have led to the development of newer biocompatible materials which can complete apexification in a single visit. Although different materials are available, Mineral Trioxide Aggregate (MTA) remains the material of choice for forming an immediate apical barrier because of its superior clinical properties and high success rate. This case series highlights the use of MTA for formation of hard tissue ...
Journal of Medical and Dental Practice, 2020
Apexification with calcium hydroxide as an apical barrier technique was the treatment of choice for immature necrotic teeth with incomplete roots and large apical foramina. However, long treatment time required for formation of apical barrier, multi-visit treatment sessions necessitating patient compliance and tooth fracture susceptibility are the disadvantages of this approach. Mineral trioxide aggregate is the most popular material for synthetic apical barriers alternative to traditional apexification treatment method with calcium hydroxide. This report demonstrates management of an immature maxillary first molar with necrotic pulp and apical pathosis which was successfully treated using one step apexification procedure with MTA for apical barrier formation. The follow-up period shows, that the use of MTA for apical plugging appears to be a valid treatment option for immature permanent teeth.