Treatment of incomplete root formation mandibular premolar tooth with MTA apexification: Case report
Keywords:
Apexification, Dens evaginatus, MTA, Open apexAbstract
Introduction: When pulp tissue becomes necrotic while root development is incomplete (immature nonvital tooth), root development ceases, resulting in short roots with thin root canal walls that are prone to fracture. This presents a challenge in endodontic treatment. Roots at different developmental stages require different treatment approaches. This case report presents the treatment and outcomes of a premolar with open apex and nonvital pulp in a pediatric patient using MTA apexification.
Case Report: A 12-year-old Thai female patient presented with purulent discharge from the gingiva at tooth #45, caused by fracture of dens evaginatus that penetrated the pulp horn. Treatment was performed by rubber dam isolation, access cavity preparation, root canal irrigation, working length determination, intraradicular medication, and temporary restoration. Subsequently, an apical barrier was created using MTA, followed by root canal obturation with gutta-percha and sealer, then composite resin restoration. Follow-up showed successful treatment with complete healing of the periapical lesion.
Conclusion: Treatment of nonvital teeth with open apices using MTA apexification promotes healing of periapical lesions and can prevent the loss of permanent teeth in children.
References
Kim S, Dörscher-Kim J. Hemodynamic regulation of the dental pulp in a low compliance environment. Journal of Endodontics. 1989;15(9):404-8.
Van Hassel HJ. Physiology of the human dental pulp. Oral Surgery, Oral Medicine, Oral Pathology. 1971;32(1):126-34.
Kakehashi S, Stanley H, Fitzgerald R. The effects of surgical exposures of dental pulps in germ-free and conventional laboratory rats. Oral surgery, oral medicine, oral pathology. 1965;20(3):340-9.
MÖLLER ÅJ, Fabricius L, Dahlen G, ÖHMAN AE, Heyden G. Influence on periapical tissues of indigenous oral bacteria and necrotic pulp tissue in monkeys. European Journal of Oral Sciences. 1981;89(6):475-84.
Wiebe S, Hafezi M, Sandhu H, Sims S, Dixon S. Osteoclast activation in inflammatory periodontal diseases. Oral diseases. 1996;2(2):167-80.
Orstavik D. Essential endodontology: prevention and treatment of apical periodontitis: John Wiley & Sons; 2020.
Shabahang S. Treatment options: apexogenesis and apexification. Pediatric dentistry. 2013;35(2):125-8.
Torneck CD. Effects and clinical significance of trauma to the developing permanent dentition. Dental Clinics of North America. 1982;26(3):481-504.
Shashirekha G, Jena A, Pattanaik S, Rath J. Assessment of pain and dissolution of apically extruded sealers and their effect on the periradicular tissues. Journal of Conservative Dentistry. 2018;21(5):546-50.
Flanagan TA. What can cause the pulps of immature, permanent teeth with open apices to become necrotic and what treatment options are available for these teeth. Australian Endodontic Journal. 2014;40(3):95-100.
Linsuwanont P, Sinpitaksakul P, Lertsakchai T. Evaluation of root maturation after revitalization in immature permanent teeth with nonvital pulps by cone beam computed tomography and conventional radiographs. International endodontic journal. 2017;50(9):836-46.
Huang GJ. Apexification: the beginning of its end. International endodontic journal. 2009;42(10):855-66.
Shabahang S. Treatment Options: Apexogenesis and Apexification. Journal of Endodontics. 2013;39(3):S26-S9.
Rotstein I, Simon JH. Diagnosis, prognosis and decision‐making in the treatment of combined periodontal‐endodontic lesions. Periodontology 2000. 2004;34(1):165-203.
AL-Bayaty FH, Baharudin NB, Mahmood NZN, bin Hidayat MFH. Gutta percha tracing: A reliable technique in diagnosing periodontic-endodontic lesion. Journal of International Dental and Medical Research. 2018;11(3):1086-90.
Gerald N, Jordan L. AAE consensus conference recommended diagnostic terminology. 2009.
Glickman G. Endodontic Diagnosis. Endodontics: Colleagues for Excellence. Fall 2013. American Association of Endodontists. 2013:3-5.
Levitan ME, Himel VT. Dens evaginatus: literature review, pathophysiology, and comprehensive treatment regimen. Journal of Endodontics. 2006;32(1):1-9.
Guide AD. Treatment Options for the Compromised Tooth. American endodontics association. 2011.
Yookhum N. การ รื้อ เครื่องมือ หัก ใน การ รักษา คลอง รากฟัน: รายงาน ผู้ ป่วย. Region 11 Medical Journal. 2022;36(2):84-92.
Bannapradlst E. Root Canal Filling by Using Thermoplasticized Gutta-Percha Injection. วารสาร แพทย์ เขต 4-5. 1995;14(4):371-6.
Mohammadi Z. Strategies to manage permanent non-vital teeth with open apices: a clinical update. International dental journal. 2011;61(1):25-30.
Hargreaves KM, Diogenes A, Teixeira FB. Treatment options: biological basis of regenerative endodontic procedures. Pediatric dentistry. 2013;35(2):129-40.
Suksamai S. The prevalence of dens evaginatus and apical periodontitis in dens evaginatus in a group of Thai schoolchildren. Chulalongkorn university dental journal. 2008;31(1):43-52.
Kim S, Malek M, Sigurdsson A, Lin L, Kahler B. Regenerative endodontics: a comprehensive review. International endodontic journal. 2018;51(12):1367-88.
Thomson A, Kahler B. Regenerative endodontics–biologically‐based treatment for immature permanent teeth: a case report and review of the literature. Australian dental journal. 2010;55(4):446-52.
McTigue DJ, Subramanian K, Kumar A. Case series: management of immature permanent teeth with pulpal necrosis: a case series. Pediatric dentistry. 2013;35(1):55-60.
Aggarwal V, Miglani S, Singla M. Conventional apexification and revascularization induced maturogenesis of two non-vital, immature teeth in same patient: 24 months follow up of a case. Journal of Conservative Dentistry. 2012;15(1):68-72.
Camp JH. Diagnosis dilemmas in vital pulp therapy: treatment for the toothache is changing, especially in young, immature teeth. Pediatric dentistry. 2008;30(3):197-205.
Torabinejad M, Chivian N. Clinical applications of mineral trioxide aggregate. Journal of endodontics. 1999;25(3):197-205.
Pace R, Giuliani V, Pini Prato L, Baccetti T, Pagavino G. Apical plug technique using mineral trioxide aggregate: results from a case series. International endodontic journal. 2007;40(6):478-84.
Chen MH, Chen KL, Chen CA, Tayebaty F, Rosenberg P, Lin L. Responses of immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscess to revascularization procedures. International endodontic journal. 2012;45(3):294-305.
Witherspoon DE, Small JC, Regan JD, Nunn M. Retrospective analysis of open apex teeth obturated with mineral trioxide aggregate. Journal of endodontics. 2008;34(10):1171-6.
Holden DT, Schwartz SA, Kirkpatrick TC, Schindler WG. Clinical outcomes of artificial root-end barriers with mineral trioxide aggregate in teeth with immature apices. Journal of endodontics. 2008;34(7):812-7.
Bogen G, Ricucci D. Mineral trioxide aggregate apexification: a 20‐year case review. Australian Endodontic Journal. 2021;47(2):335-42.
Vidal K, Martin G, Lozano O, Salas M, Trigueros J, Aguilar G. Apical closure in apexification: a review and case report of apexification treatment of an immature permanent tooth with biodentine. Journal of endodontics. 2016;42(5):730-4.
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