Apexification of an Immature Necrotic Mandibular Second Premolar with Calcium Hydroxide and Root Canal Obturation using Bioceramic Sealer
Keywords:
Calcium hydroxide apexification, Immature tooth, Bioceramic sealerAbstract
One of the most common causes of an immature necrotic permanent tooth is a fractured dens evaginatus. Incomplete root formation can be challenging for high-quality root canal treatment outcomes. There are several techniques to induce hard tissue formation at the apex (apexification), and calcium hydroxide is one of the most commonly used materials due to its high success rate and cost effectiveness. This case report describes a root canal treatment of the immature non-vital mandibular second premolar by using calcium hydroxide and obturating with bioceramic sealer.
This study investigated a 12-year-old Thai female patient with worn dens evaginatus with abscess on a right mandibular second premolar. Radiographic examination revealed an apparent periapical lesion covering its open apex, which was diagnosed as pulp necrosis with chronic apical abscess. The tooth was endodontically treated by calcium hydroxide apexification for 4 months, followed by root canal obturation with gutta percha and bioceramic sealer. At the 3-month postoperative recall examination, the tooth was clinically asymptomatic with normal periodontal conditions. Its radiograph displayed a slightly more radiopacity of the periapical lesion.
Root canal treatment of non-vital open-apex teeth needs an accurate evaluation of root formation. This is necessary for proper treatment planning, as well as its prognosis and success rate. Compliance from patients and their guardians is also a key for a favourable treatment result. Moreover, dentists must have knowledge and skills to provide appropriate treatment which is another inevitably essential factor for success of this treatment procedure.
Downloads
References
Levitan ME, Himel VT. Dens evaginatus: literature review, pathophysiology, and comprehensive treatment regimen. J Endod. 2006;32(1):1-9.
Chen JW, Huang GT, Bakland LK. Dens evaginatus: Current treatment options. J Am Dent Assoc. 2020;151(5):358-67.
Lin J, Zeng Q, Wei X, Zhao W, Cui M, Gu J, et al. Regenerative Endodontics Versus Apexification in Immature Permanent Teeth with Apical Periodontitis: A Prospective Randomized Controlled Study. J Endod. 2017;43(11):1821-7.
Kratunova E, Silva D. Pulp therapy for primary and immature permanent teeth: an overview. Gen Dent. 2018;66(6):30-8.
Shaik I, Dasari B, Kolichala R, Doos M, Qadri F, Arokiyasamy JL, et al. Comparison of the Success Rate of Mineral Trioxide Aggregate, Endosequence Bioceramic Root Repair Material, and Calcium Hydroxide for Apexification of Immature Permanent Teeth: Systematic Review and Meta-Analysis. J Pharm Bioallied Sci. 2021;13(Suppl 1):S43-s7.
Guide to clinical endodontics [Internet]. 2019 [cited December 17, 2023]. Available from: https://www.aae.org/specialty/clinical-resources/guide-clinical-endodontics/.
Jirathanyanatt T. New trends in endodontics therapy: Regenerative Endodontics. M Dent J. 2016;16(3):403-13.
Erdem AP, Sepet E. Mineral trioxide aggregate for obturation of maxillary central incisors with necrotic pulp and open apices. Dent Traumatol. 2008;24(5):e38-41.
Saulius Drukteinis JC. Bioceramic Materials in Clinical Endodontics. 1 ed. Switzerland: Springer Cham; 2021.
Mohammadi Z, Dummer PM. Properties and applications of calcium hydroxide in endodontics and dental traumatology. Int Endod J. 2011;44(8):697-730.
Plascencia H, Díaz M, Gascón G, Garduño S, Guerrero Bobadilla C, Márquez-De Alba S, et al. Management of permanent teeth with necrotic pulps and open apices according to the stage of root development. J Clin Exp Dent. 2017;9(11):e1329-39.
Sheehy EC, Roberts GJ. Use of calcium hydroxide for apical barrier formation and healing in non-vital immature permanent teeth: a review. Br Dent J. 1997;183(7):241-6.
Nosrat A, Seifi A, Asgary S. Regenerative endodontic treatment (revascularization) for necrotic immature permanent molars: a review and report of two cases with a new biomaterial. J Endod. 2011;37(4):562-7.
Metzger Z, Solomonov M, Mass E. Calcium hydroxide retention in wide root canals with flaring apices. Dent Traumatol. 2001;17(2):86-92.
ละอองทอง วัชราภัย. คลองรากฟัน:วิธีการรักษาและการแก้ปัญหา. พิมพ์ครั้งที่ 3. กรุงเทพฯ: ซันต้าการพิมพ์; 2562.ed. กรุงเทพฯ: ซันต้าการพิมพ์; 2562.
Tanomaru Filho M, Leonardo MR, Silva LA, Utrilla LS. Effect of different root canal sealers on periapical repair of teeth with chronic periradicular periodontitis. Int Endod J. 1998;31(2):85-9.
Khandelwal A, Janani K, Teja K, Jose J, Battineni G, Riccitiello F, et al. Periapical Healing following Root Canal Treatment Using Different Endodontic Sealers: A Systematic Review. Biomed Res Int. 2022;2022:3569281.
Whitworth J. Methods of filling root canals: principles and practices. Endodontic Topics. 2005;12(1):2-24.
Debelian G, Trope M. The use of premixed bioceramic materials in endodontics. Giornale Italiano di Endodonzia. 2016;30(2):70-80.
Lerdrungroj K, Banomyong D, Songtrakul K, Porkaew P, Nakornchai S. Current Management of Dens Evaginatus Teeth Based on Pulpal Diagnosis. J Endod. 2023;49(10):1230-7.
Wei X, Yang M, Yue L, Huang D, Zhou X, Wang X, et al. Expert consensus on regenerative endodontic procedures. Int J Oral Sci. 2022;14(1):55.
Tarcin B, Gumru B, Iriboz E, Turkaydin DE, Ovecoglu HS. Radiologic Assessment of Periapical Health: Comparison of 3 Different Index Systems. J Endod. 2015;41(11):1834-8.
Ong TK, Lim GS, Singh M, Fial AV. Quantitative Assessment of Root Development after Regenerative Endodontic Therapy: A Systematic Review and Meta-Analysis. J Endod. 2020;46(12):1856-66.e2.
Tong HJ, Rajan S, Bhujel N, Kang J, Duggal M, Nazzal H. Regenerative Endodontic Therapy in the Management of Nonvital Immature Permanent Teeth: A Systematic Review Outcome Evaluation and Meta-analysis. J Endod. 2017;43(9):1453-64.
Ballesio I, Marchetti E, Mummolo S, Marzo G. Radiographic appearance of apical closure in apexification: follow-up after 7-13 years. Eur J Paediatr Dent. 2006;7(1):29-34.
Guerrero F, Mendoza A, Ribas D, Aspiazu K. Apexification: A systematic review. J Conserv Dent. 2018;21(5):462-5.
Kim YJ, Chandler NP. Determination of working length for teeth with wide or immature apices: a review. Int Endod J. 2013;46(6):483-91.
Rosenberg DB. The paper point technique. Part 1. Dent Today. 2003;22(2):80-6.
Gawthaman M, Vinodh S, Mathian VM, Vijayaraghavan R, Karunakaran R. Apexification with calcium hydroxide and mineral trioxide aggregate: Report of two cases. J Pharm Bioallied Sci. 2013;5(Suppl 2):S131-4.
Minamisako M, Kinoshita J-I, Grando L, Jafarzadeh H. Apexification of a dens evaginated premolar with open apex. Cumhuriyet Dental Journal. 2015;18.
Chen CM, Lee KT, Chuang FH, Hong YY, Chen HC, Hsu KR, et al. Facial cellulitis arising from dens evaginatus: a case report. Kaohsiung J Med Sci. 2005;21(7):333-6.
CHO SY. Dental abscess in a tooth with intact dens evaginatus. International Journal of Paediatric Dentistry. 2006;16(2):135-8.
Ng YL, Mann V, Rahbaran S, Lewsey J, Gulabivala K. Outcome of primary root canal treatment: systematic review of the literature -- Part 2. Influence of clinical factors. Int Endod J. 2008;41(1):6-31.
Drukteinis S, Peciuliene V, Shemesh H, Tusas P, Bendinskaite R. Porosity Distribution in Apically Perforated Curved Root Canals Filled with Two Different Calcium Silicate Based Materials and Techniques: A Micro-Computed Tomography Study. Materials (Basel). 2019;12(11).
Chybowski EA, Glickman GN, Patel Y, Fleury A, Solomon E, He J. Clinical Outcome of Non-Surgical Root Canal Treatment Using a Single-cone Technique with Endosequence Bioceramic Sealer: A Retrospective Analysis. J Endod. 2018;44(6):941-5.
Palma PJ, Marques JA, Antunes M, Falacho RI, Sequeira D, Roseiro L, et al. Effect of restorative timing on shear bond strength of composite resin/calcium silicate-based cements adhesive interfaces. Clin Oral Investig. 2021;25(5):3131-9.
Palma PJ, Marques JA, Falacho RI, Vinagre A, Santos JM, Ramos JC. Does Delayed Restoration Improve Shear Bond Strength of Different Restorative Protocols to Calcium Silicate-Based Cements? Materials (Basel). 2018;11(11).
Vilas-Boas DA, Grazziotin-Soares R, Ardenghi DM, Bauer J, de Souza PO, de Miranda Candeiro GT, et al. Effect of different endodontic sealers and time of cementation on push-out bond strength of fiber posts. Clin Oral Investig. 2018;22(3):1403-9.
Lee JY, Shin SJ, Park JW. Influence of Phosphoric Acid Etching on Bond Strength for Calcium Silicate-Based Sealers. J Endod. 2023;49(5):514-20.
Upanisakorn M. Treatment of Endodontic-Periodontic Lesion: a Case Study of patient with Primary Endodontic Lesion. Singburi Hospital Journal. 2023;31(3):172-185
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Singburi Hospital Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The published articles are copyrighted by Singburi Hospital.
The statements appearing in each article in this academic journal are the personal opinions of each author and are not related in any way to Singburi Hospital or other hospital personnel. Each author is solely responsible for all contents of their article. If there are any errors, each author alone will be responsible for their own article.
