Abstract
Trauma to the dentition during the period of root formation may cause incomplete development of root resulting in open apex. In order to eliminate infection from root canal endodontic treatment is a tooth-saving treatment modality. The absence of a natural apical constriction in a nonvital permanent tooth makes endodontic treatment a challenge. Therefore, it is necessary to induce or create an apical barrier against, which the obturating material can be condensed. Traditionally, calcium hydroxide is considered as the gold standard to induce apexification. Due to certain drawbacks such as very long treatment period, possibility of tooth fracture, and incomplete apical barrier formation, it is being replaced by materials, which have a more predictable outcome like mineral trioxide aggregate (MTA). One-step apexification with MTA reduces the treatment time when compared with traditional calcium hydroxide apexification, which requires an average time of 12–19 months. Also, MTA has various other superior properties compared to calcium hydroxide that are discussed below in detail along with successful treatment of an immature permanent tooth with open apex wherein MTA was used for one-step apexification.
Highlights
Dental trauma injuries are responsible for 30% of pulpal necrosis in an immature permanent tooth
Apexification is defined as ‘a method to induce a calcified barrier in a root with an open apex or the continued apical development of an incomplete root in teeth with necrotic pulp’ [3]
The use of calcium hydroxide was first introduced by Kaiser in 1964 who proposed that this material mixed with camphorated parachlorophenol (CMCP) would induce the formation of a calcified barrier across the apex. [4]
Summary
Dental trauma injuries are responsible for 30% of pulpal necrosis in an immature permanent tooth. Calcium hydroxide [Ca(OH)2] apexification may involve multiple monthly appointments to achieve elimination of the intracanal infection It has several disadvantages like alteration of the mechanical properties of dentin making the teeth more susceptible to root fracture. MTA has a pH of 12.5 after setting which is similar to the pH of calcium hydroxide and it has been suggested that this may impart some antimicrobial properties [10] It has been used in both surgical and non-surgical applications including root end fillings [8, 9, 11], direct pulp caps [12], perforation repairs in roots [13] or furcations [14, 15] and apexification [16, 17]. The present case report narrates a successful treatment of an immature permanent tooth with open apex wherein MTA was used for one-step apexification
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