Abstract
Besides the risk of filling material extrusion throughout the apex, a satisfactory apical seal can be difficult to achieve in canals with open apices or iatrogenic enlargements of the apical constriction. These situations pose a challenge to root canal filling. This paper describes the root canal filling of a maxillary right canine with an overinstrumented apex, complete loss of the apical stop, extensive canal transportation and apical periodontitis. A 5 mm calcium hydroxide apical plug was placed before root canal filling. The plug was made by soaking paper points with saline, dipping the points in calcium hydroxide powder and then applying it to the apex several times, until a consistent apical plug was obtained. The canal was then irrigated with saline in order to remove any residual calcium hydroxide from the root canal walls, dried with paper points and obturated with an inverted #80 gutta-percha cone and zinc oxide-eugenol based sealer by the lateral condensation technique. An 8-year radiographic follow-up showed formation of mineralized tissue sealing the apical foramen, apical remodeling and no signs of apical periodontitis.
Highlights
Teeth displaying canals with open apices or iatrogenic enlargements of the apical constriction pose a challenge to endodontic treatment [1] and a satisfactory apical seal can be hard to achieve in these clinical situations
The implementation of a mineral trioxide aggregate (MTA) apical plug has been proposed for cases of open apex or overinstrumentation [7]
This paper demonstrates the use of calcium hydroxide (CH) as an apical plug in a maxillary right canine with necrotic pulp, apical periodontitis and enlarged apex with lack of apical stop due to overinstrumentation
Summary
Teeth displaying canals with open apices or iatrogenic enlargements of the apical constriction pose a challenge to endodontic treatment [1] and a satisfactory apical seal can be hard to achieve in these clinical situations. Closing of the apex with a mineralized tissue barrier with long-term calcium hydroxide (CH) use, as in apexification treatment [4,5], has been an alternative for cases of overinstrumented apices This procedure may raise some problems, such as the longer chairside time [2] and the increase of the risk of dental fracture [6]. The implementation of a mineral trioxide aggregate (MTA) apical plug has been proposed for cases of open apex or overinstrumentation [7] This material has a high cost and presents difficulties in its application to the apical region, including the risk of extrusion to the periapical tissues, which could cause. This paper demonstrates the use of CH as an apical plug in a maxillary right canine with necrotic pulp, apical periodontitis and enlarged apex with lack of apical stop due to overinstrumentation
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