Abstract
This study aims to evaluate fracture resistance of simulated immature teeth after treatment with regenerative endodontic procedure (REP) using tricalcium silicate cements (TSCs) as cervical plugs. Bovine incisors were sectioned to standard crown/root ratio. Pulp tissue was removed and canals were enlarged to a standardized diameter. Teeth were then treated with a REP protocol consisting of NaOCl and EDTA irrigation, intracanal medication with triple-antibiotic paste for 14 days followed by a TSC cervical seal and composite restoration. Teeth were divided into groups according to the material used; Mineral-Trioxide-Aggregate (MTA), Biodentine, TotalFill. Teeth filled with guttapercha (GP) and intact teeth served as controls. All teeth subjected to an increasing compressive force (rate of 0.05 mm/s at a 45° angle to the long axis of the tooth) until fracture. All treated teeth exhibited significantly lower resistance to fracture compared to the intact teeth but no difference was found between the TSC groups (Kruskal-Wallis, Dunn’s multiple comparison, p < .05). TSCs applied at the cervical area of simulated immature teeth treated with REP did not reinforce fracture resistance.
Highlights
Endodontic treatment of non-vital immature permanent teeth presents quite a challenge in dental clinics due to wide open apices and thin dentinal walls
In the interest of experimental standardization, there were no differences between the simulated immature teeth in terms of crown/root ratio, intra-canal diameter at cementoenamel junction (CEJ) and dentin thickness (Table 2)
There were no differences between the tricalcium silicate cements (TSCs) groups (1–3) in terms of the TSC cervical plug length (MTA: 3.9 ± 0.193 mm; Biodentine: 4.015 ± 0.1228 mm and TotalFill: 3.481 ± 0.125 mm) (Table 2)
Summary
Endodontic treatment of non-vital immature permanent teeth presents quite a challenge in dental clinics due to wide open apices and thin dentinal walls. A relatively high incidence of cervical root fracture (>60%) has been reported in such teeth teeth after a long-term intra-canal treatment with calcium hydroxide (CH) in order to achieve a hard-tissue barrier at the apical area (apexification) [1,2]. These fractures may occur with minor impacts or spontaneously over time [1,3]. The use of TSC materials to achieve a root-end closure at the apical area of necrotic immature teeth (direct apexification) has replaced the traditional treatment with CH With this method the dentinal walls remain thin, and the risk of fracture is still present [5,6]
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