Apical Barrier Research Articles

Efficacy of Mineral Trioxide Aggregate Repair High Plasticity, Biodentine, and EndoSequence Root Repair Material Putty as Apical Barriers in Immature Permanent Teeth: An In Vitro Bacterial Leakage Study.

To assess the microleakage of mineral trioxide aggregate (MTA) repair high plasticity (HP), EndoSequence root repair material (ESRRM) putty, and Biodentine, when used as an apical plug in immature permanent teeth. In an in vitro model, 55 extracted maxillary incisors were decoronated and resected 3 mm apically to obtain standardized 15-mm root blocks, which were then cleaned and shaped. All samples had a 1.1-mm standardized, prepared artificial open apex. The teeth were arbitrarily designated into three experimental groups (n = 15) and two control (positive/negative) groups (n = 5). In the experimental groups, orthograde 4-mm thick apical plugs of Biodentine (group I), ESRRM putty (group II), and MTA repair HP (group III) were placed. Positive control samples were left vacant while negative control samples were filled with Biodentine. The bacterial leakage method was used to appraise the sealing efficiency of the cements. Statistical package for the social sciences (SPSS) software, version 21.0, was used for data analysis. Post hoc Tukey's test, one-way analysis of variance (ANOVA), and repeated measures of ANOVA were used for intergroup and intragroup comparisons. On day 1, there was a significant difference between the groups, with group II showing the least and group 1 showing the maximum microleakage. No significant difference among the groups was seen at other observational periods. There was a tendency for leakage to increase significantly from day 1 to 7, then decrease till the end of the experimental period. It was concluded that the three materials evaluated, with time, exhibited comparable apical microleakage when treating teeth with open apices. MTA repair HP can be used as an apical plug material in open apices with similar success as ESRRM putty and marginally better outcome than Biodentine.

Management of Non-Vital Teeth with open Apices using MTA as an Apical Plug: A Case Report

Dental professionals face a challenge in managing nonvital teeth with an open apex. In this situation, keeping the obturation material inside the boundaries of the root canal without extending into the periapical area is challenging. In order to allow root filling to be compacted, the apexification procedure attempts to close the open root apex with a hard tissue barrier. Therefore, the root canal obturation described in the current case report involved the use of a thermoplasticized gutta-percha after an MTA-made apical plug in an open apex tooth. Key Words Open apex, mineral trioxide aggregate, apexification, apical barrier.

Apexification of the mineral trioxide aggregate in nonvital immature anterior teeth with and without platelet-rich plasma: A preliminary clinical study

ABSTRACT Introduction: Treatment of permanent teeth with weak root dentin, exposed apex, necrotic pulp, periapical disease, and stunted root growth present a significant challenge to the practicing conservative dentistry. Necrotic immature permanent teeth with open apices are arduous to seal by thermo-plasticized or lateral condensation methods. Apexification methods have traditionally used a variety of materials including calcium hydroxide, biodentine, and mineral trioxide aggregate (MTA). Calcium hydroxide apexification takes a long time to develop an apical barrier and contains large pores, resulting in inadequate sealing ability and a bad outcome. MTA is a biomimetic and bio-inductive substance that has been employed to construct a single-step apical barrier in immature open apices with and without periapical pathology. Endodontic in this 21st century uses regenerative procedures in a nonvital, immature tooth with wide-open apices but it is also a very lengthy procedure and poor patient compliance due to slow biologic healing and long-term follow-up of the patients. Platelet-rich plasma (PRP) contains various growth factors such as platelet-derived growth factors and transforming growth factors and has been proposed as a potentially ideal scaffold for accelerated wound healing. Aims and Objectives: To evaluate and compare the clinical and radiographic outcome of MTA apexification with and without PRP in periapical healing kinetics in nonvital, immature teeth. Materials and Methods: An analysis was performed on patient with immature teeth, open-apex, maxillary front nonvital that were randomly divided into two groups of eighteen patients (eighteen roots permanent upper anterior) each: Group I in which MTA apexification was performed without PRP and Group II consisting of 18 roots where MTA apexification were carried out on a collagen sponge supplemented with PRP. Results: The cases were followed up at 6 months and 12 months after treatment, both clinically and radiographically, by two independent assessors. Periapical healing (PAH) was good in 6–18 roots, and in Group I-11 roots showed excellent healing. In Group II-17 roots showed excellent results. Case number 18 and case number 9 were lost to follow-up due to migration to groups I and II, respectively. Apical closure was 100% in Group II and 77% in Group I. Conclusions: Single-step MTA apexification with PRP is a conservative and effective method for inducing PAH and is time-saving in managing nonvital, immature teeth with an open apex.

NON-SURGICAL TREATMENT OF A TRAUMATIZED TOOTH WITH PERIAPICAL INJURY AND IMMATURE APICE USING MTA AS AN APICAL BARRIER: A CASE REPORT

A clinical case is described of a 17-year-old patient who suffered a trauma at the age of 8, compromising the upper right incisor, which prevented complete apical closure and the presence of a periapical lesion. The patient reports having interrupted the root canal treatment one year ago, in the diagnostic periapical radiograph the endodontic treatment already started is confirmed and temporary crown filling material is observed, the presence perhaps of calcium hydroxide inside the root canal, incomplete apical formation and a periapical radiolucent lesion. Root canal treatment was resumed using K-type manual files until reaching a #140 apical caliber, 5.25% sodium hypochlorite was used as irrigant, Ultrapex (Ca(OH)2 + Iodoform) was placed as intracanal medication for several months. Two years after resuming treatment, the patient was asymptomatic, and in the control periapical radiograph it was possible to observe the considerable decrease in the periapical lesion, therefore it was decided to obturate using the classic lateral condensation technique, AH Plus sealant and previous at this stage, 4mm of MTA was placed as an apical barrier. Conclusions The importance of using intracanal medication in situations of dental necrosis with a periapical lesion of considerable size is shown through this clinical case. This case was caused due to dental trauma which, as we know, can evolve in very different ways and in many situations the dental prognosis ends up being very unfavorable. In addition, because it is an immature apex, the use of an MTA apical barrier was essential for containing the filling materials to avoid their extrusion into the periapical tissues and ensuring a better sealing in the apical third.

Evaluating the radiographic results of apexification treatment in children

Aim: This retrospective study aimed to evaluate the radiographic success of apexification treatments applied with different materials and techniques. Methodology: Periapical radiographs of 224 maxillary incisors in patients between 6 and 12 years of age who had undergone apexification treatment at the Dicle University, Faculty of Dentistry, Department of Pediatric Dentistry were retrospectively examined. Each apex was scored using the periapical index (PAI) on X-rays obtained at 12 months of follow-up after treatment, and the presence or absence of the apical barrier was evaluated. The Kruskal–Wallis H, Mann–Whitney U, and chi-square tests were used for the statistical analysis (p < 0.05). Results: In the maxillary incisors, apexification was most commonly performed on the maxillary right central teeth (74.11%). The cause for this treatment was trauma in 97.77% of the patients. Enlargement in the periodontal space (95.98%), the presence of lesions (60.71%), loss of lamina dura (54.46%), and external resorption (43.75%) were observed. At 12 months of follow-up after treatment, apical closure (87.95%) was observed in all teeth with open apexes, and the ratio of patients with a PAI of < 2 was 89.35% for calcium hydroxide (CH) apexification and 92.73% for mineral trioxide aggregate (MTA) apexification. Conclusion: The radiographic success of apexification treatments with CH and MTA was found to be high in 224 immature upper incisors. How to cite this article: Akleyin E, Polat Y, Harman EB, Çelenk S. Evaluating the radiographic results of apexification treatment in children. Int Dent Res 2022;12(3):158-64. https://doi.org/10.5577/intdentres.2022.vol12.no3.8 Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Nursing cooperation of four-handed procedure for apical barrier technique under dental microscope combined with iRoot BP plus

Nursing cooperation of four-handed procedure for apical barrier technique under dental microscope combined with iRoot BP plus

Clinical study of combined application of iRoot-BP and collagen sponge in apical barrier surgery

This research aimed to observe the clinical effects of iRoot-BP along with collagen sponge applied in apical barrier surgery. 46 immature teeth were divided into traumatic group (n =25) and non-traumatic group (n =21) according to the etiology of necrotic pulps. While depending on whether collagen sponges are used during the apical barrier surgery, the 46 teeth were randomly divided into non-collagen group (n = 23) and collagen group (n = 23). Patients were scheduled for follow-up during 12 months to undergo clinical and radiological examination. The etiological analysis showed that the failure of both groups were caused by trauma, which indicated that there might be a negative correlation between trauma and success rate of periapical tissue healed (χ2 = 2.696, P = 0.10). Healing results of apical lesions indicated that 22 affected teeth in collagen group and 21 affected teeth in non-collagen healed well, without clinical and imaging manifestations of failure (χ2 = 0.357, P = 0.55). Assessment results of root sustainable growth suggested that the incomplete tooth roots in collagen group had different degrees of growth, with an average increase of about 2 mm (P <0.05). The combined application of iRoot-BP and collagen sponge in apical barrier surgery can promote immature roots formation, and make them more similar to normal roots formation.

PARTICULAR FEATURES OF ROOT CANAL FILLING IN TEETH WITH RESORBED APICAL OPENING NEAR THE MANDIBULAR CANAL

When filling root canals of teeth with apical resorption near the mandibular canal, there is a risk that the material will go beyond the apex into the region of mandibular canal, which can lead to serious damage to the innervation of this area. In most cases, modern approaches and technologies in endodontics allow to achieve the formation of dentinal plug in the resorption area, thus minimizing the risk of traumatization of the patient.
 Background. Improving efficiency of endodontic treatment of teeth with apical resorption in the region of mandibular canal.
 Materials and methods. 56 patients aged between 18 and 45 years were examined. All patients had clinical signs of mandibular endodontic treatment failure with a dark radiolucent focus in the region of the apex, which bordered the mandibular canal. Radiological indicators and quality of obturation were assessed on the basis of CBCT, the presence of dentinal bridge was assessed visually using a dental microscope and an apical hermetic test. The results were evaluated after 4, 6, 12, and 24 months.
 Results. After 16 weeks of treatment, more than 70% of apical barrier formation occurred in groups 1 and 2, which allowed us to perform a quality permanent obturation without excessive risks of complications.
 Conclusion. The use of a dental microscope in conjunction with modern endodontic techniques in the treatment of teeth with apical resorption can significantly reduce the treatment time, thereby improving the quality of treatment of patients with this pathology.

NON-SURGICAL MANAGEMENT OF FLOOR PERFORATION OF MAXILLARY FIRST MOLAR USING MTA: A CASE REPORT

In endodontic practice one of the most common iatrogenic errors is furcation perforation. The purpose of treating furcal perforation is to seal the articial communication between the endodontic space and the periradicular tissue to prevent alveolar bone resorption and damage to the periodontal ligament. Endodontic repair material should seal the pathways of communication between the root canal system and its surrounding tissues. In addition, it should be nontoxic, noncarcinogenic, nongenotoxic, biocompatible, insoluble in tissue uids, and dimensionally stable. Because existing materials did not have these ''ideal'' characteristics, mineral trioxide aggregate (MTA) was developed and recommended for pulp capping, pulpotomy, apical barrier formation in teeth with necrotic pulps and open apex, repair of root perforations, rootend lling, and root canal lling.

One Step Apexification in a Resorbed Tooth Using Autologous PRF as Internal Matrix and Biodentine Apical Plug

Apexification is defined as a method to induce a calcific barrier in a root with open apex or the continued apical development of an incompletely formed root in teeth with necrotic pulp tissue. The presented case was of a 26‑year‑old male patient with discoloured tooth associated with external resorption and periapical pathology in relation to the upper front right tooth. Teeth with open apex due to root end resorption pose difficulties during endodontic treatment because of the wide‑open root apex and thin dentin walls. This article describes the procedure of single‑visit apexification using a new calcium silicate‑based material (Biodentine) as an apical barrier along with platelet‑rich fibrin as internal matrix.

“BIODENTINE” THE DENTINE IN A CAPSULE AS AN APICAL BARRIER IN TRAUMATIZED MAXILLARY CENTRAL INCISOR WITH TWO YEARS FOLLOW UP.

Immature teeth are difcult to manage with conventional endodontic treatments and thus it becomes very challenging for clinicians. This case report describes an apexication with Biodentine in a maxillary left central incisor. The tooth became necrotic after the traumatic injury. According to the treatment procedure root canals were chemo-mechanically prepared, medicated with triple antibiotic paste followed by Biodentine plug to stimulate hard tissue apical barrier formation. Follow-up clinical and radiographic examinations were done after 1st quarter, 2nd quarter, 4th quarter and 2 years respectively. After two years follow-up the tooth was completely asymptomatic as well as resolution of periapical radiolucency was seen. Biodentine can be considered as basic, simple, biologically active, more limited setting time, improved mechanical properties and worthy cost. Therefore, it is a promising approach to other methods of an apexication.

Long-Term Outcome of Nonvital Immature Permanent Teeth Treated With Apexification and Corono-Radicular Adhesive Restoration: A Case Series

IntroductionThis study aimed to evaluate the long-term outcome of 16 permanent maxillary central incisors with nonvital pulps and open apices treated with apexification and corono-radicular adhesive restorations, within a follow-up span of 5 to 22 years. MethodsFourteen patients providing a total of 16 teeth treated with mineral trioxide aggregate (n = 12), Biodentine (n = 3), or β-tricalcium phosphate (n = 1) apical barrier and corono-radicular restoration, with or without fiberglass post, were included. Clinical and radiographic criteria were defined for assessment at recall. Restoration and periapical tissue status evaluation were performed according to FDI World Dental Federation's esthetic, functional, and biological criteria and Ørstavik Periapical Index (PAI). Outcome was dichotomized as “healed” (PAI ≤ 2, asymptomatic with absence of signs of infection) or “not healed” (PAI ≥ 3, presence of clinical signs and/or symptoms). ResultsFourteen of 24 patients were available for the present study (recall rate = 58%). Within a follow-up of 5 to 22 years, 10 (62.5%) teeth were considered “healed,” fulfilling both strict clinical and radiographic success criteria. Only 1 tooth was missing due to root resorption and 1 patient was presenting with clinical signs and symptoms at recall, resulting in a survival rate of 93.8%. ConclusionsAdhesive corono-radicular restoration in nonvital permanent immature teeth treated with apexification allows for favorable long-term outcomes, by ensuring structural reinforcement and coronal microleakage prevention. Teeth sustaining a substantial loss of coronal structure may require post/core placement. In the case of failure, this endodontic-restorative combination ensured teeth survival until growth phase conclusion, thus allowing for proper prosthetic rehabilitation approaches.

Won't You be My Neighbor: How Epithelial Cells Connect Together to Build Global Tissue Polarity.

Epithelial tissues form continuous barriers to protect against external environments. Within these tissues, epithelial cells build environment-facing apical membranes, junction complexes that anchor neighbors together, and basolateral surfaces that face other cells. Critically, to form a continuous apical barrier, neighboring epithelial cells must align their apico-basolateral axes to create global polarity along the entire tissue. Here, we will review mechanisms of global tissue-level polarity establishment, with a focus on how neighboring epithelial cells of different origins align their apical surfaces. Epithelial cells with different developmental origins and/or that polarize at different times and places must align their respective apico-basolateral axes. Connecting different epithelial tissues into continuous sheets or tubes, termed epithelial fusion, has been most extensively studied in cases where neighboring cells initially dock at an apical-to-apical interface. However, epithelial cells can also meet basal-to-basal, posing several challenges for apical continuity. Pre-existing basement membrane between the tissues must be remodeled and/or removed, the cells involved in docking are specialized, and new cell-cell adhesions are formed. Each of these challenges can involve changes to apico-basolateral polarity of epithelial cells. This minireview highlights several in vivo examples of basal docking and how apico-basolateral polarity changes during epithelial fusion. Understanding the specific molecular mechanisms of basal docking is an area ripe for further exploration that will shed light on complex morphogenetic events that sculpt developing organisms and on the cellular mechanisms that can go awry during diseases involving the formation of cysts, fistulas, atresias, and metastases.

Apexification of permanent immature teeth using MTA – a report of cases

Immature permanent teeth with necrotic pulp require endodontic treatment different than conventional procedure. Proper root canal treatment and correct filling of such teeth is hardly possible due to open wide apices. Apexification is a method that enables to create hard apical barrier. Until recently the most common material in this method was calcium hydroxide. It is highly effective, however using calcium hydroxide requires long time treatment up to 24 months with many appointments to create mineral apical barrier. This may lead to fracture of the root`s thin walls end tooth extraction. Currently, the MTA (Mineral Trioxide Aggregate) preparation is recommended in the apexification procedure to close open apex of immature teeth. It enables to carry out apexification procedure during one or two appointments. The aim of this study is to describe 5 cases of apexification in posttraumatic and due to caries non-vital immature teeth using MTA. In the following period of observation in all the presented cases a positive treatment result was obtained. In all the presented cases a positive treatment result was obtained.

EFFECT OF DIODE LASER DISINFECTION AND THE APICAL BARRIER TECHNIQUE IN AN ENDODONTIC RETREATMENT CASE WITH OPEN APEX: A CASE REPORTS

The primary reason for an endodontic treatment failure is the persistence or regrowth of different species of bacteria within the root canal system. The root development and closure of its apex in a permanent tooth occurs till 3 years after the eruption. Treatment of traumatic injury of teeth during the development period of root resulting in open apex poses an endodontic challenge. Various materials are used for induction of apical closure to produce favourable conditions and to conne the root canal lling within the canal space. This paper describes clinical case of retreatment on premolar with improperly treated root canal with open apex. Multiple visit endodontic retreatment of premolar was performed. Disinfection was performed using Intracanal diode laser irrigation activation followed by placing triple antibiotic paste (TAP) as intra-canal dressing. In the second appointment apical plug of Biodentine against a platelet-rich brin (matrix) was condensed. The present case showed successful periapical healing and resolution of symptoms with the use of calcium silicate based cement with platelet-rich brin as an apical barrier matrix. Procedure is followed carefully using recommended protocols.

Management of Ellis Class IV Fracture Using Two Different Materials: MTA vs Reverse Cone Technique: A Case Report

During root development, if tooth is subjected to trauma or caries, it results in tooth with immature and open root apices. The primary factor affecting the success of endodontics is achievement of perfect apical seal. Apexification is done to achieve an apical barrier against which the obturating material can be condensed. Various treatment modalities are used to treat immature open root apices. In the following case reports, apexification using different treatment modalities and both traditional and newer biomaterials have been explained.

MICROLEAKAGE IN MINERAL TRIOXIDE AGGREGATE AND BIODENTINE AS ORTHOGRADE APICAL PLUGS IN PERMANENT TEETH SIMULATED WITH OPEN APICES: AN IN-VITRO EVALUATION

Background: The divergent apical architecture makes complete debridement and holding of the obturating material within the root canal impossible as no apical barrier exists, which may result in a canal that is susceptible to leakage. The aim of the study was to evaluate the apical microleakage of MTA AngelusR and BiodentineTM when used as orthograde apical plugs. Methods: Sixty extracted sound human anterior teeth simulated with open apices were equally distributed in two groups viz group A [MTA AngelusR (Mfd by Angelus, Brazil)] and group B [BiodentineTM (Mfd by Septodont, France)]. Apical microleakage in both groups was evaluated using dye penetration method. Dye penetration data of two independent groups were summarized as Mean ± SE (standard error of the mean) and compared by independent Student’s t test. A two-tailed (α=2) p<0.05 was considered statistically significant. Results: Apical microleakage of MTA AngelusR [Group A] ranged from 1.30 to 3.10 mm with mean (± SE) 2.16 ± 0.10 mm and median 2.05 mm whereas in BiodentineTM [Group B] it ranged from 0.20 to 1.20 mm with mean (± SE) 0.68 ± 0.06 mm and median 0.60 mm. Sealing ability of Group B (BiodentineTM) was significantly better (p<0.001) and 68.5% higher than Group A (MTA AngelusR). Conclusions: Both the materials exhibited microleakage. There was a significant difference ( P˂ 0.001) between the two groups and BiodentineTM showed to have less apical microleakage than MTA AngelusR.

The unresolved contest between MTA and IRM as apical barrier material in apicoectomies. A retrospective cohort study

When endodontic treatment of periapical infection does not suffice, apicoectomy might be the next treatment of choice. Years of treatment development have optimised it as far as possible, but the optimal apical barrier material has still not been indicated. Does MTA as an apical barrier material in apicoectomies effectuate a higher success rate than IRM? A retrospective cohort study analysed all patients who underwent an apicoectomy between 2015 and 2020. Patients for whom the apical barrier material had not been registered, or who were treated by a resident, were excluded. Patients were retrospectively allocated to either the MTA or IRM group. A total of 1,347 treatments were analysed, with an overall success rate of 71%. The MTA group had a success rate of 71%, and the IRM group had a success rate of 70% (p = 0.794). The study revealed that the success rate of apicoectomies was 71%, regardless of the type of material used as the apical barrier. Hence, the use of either material is justified.

Fracture resistance of simulated human immature teeth reinforced with anatomic post and MTA as apical barrier

Background: The development of immature teeth can be arrested because of various harmful stimuli such as trauma, caries, and anatomic variations such as dens evaginatus. The present study was conducted to compare fracture the resistance of simulated human immature teeth treated with anatomic post and MTA as apical barrier. Materials & Methods: 32 permanent mandibular incisors were randomly divided into two groups of 16 each. Group I—apical barrier using Biodentine and Group II—apical barrier using MTA (MTA Plus). Fracture resistance was compared. Results: Fracture resistance of control was 640.4 and in group II was 613.5. Everstick showed value of 1476.3 MPa in group I and 1290.5 MPa in group II. Inter- group comparison was significant (P

SINGLE VISIT- APEXIFICATION USING MTA AND AUTOLOGOUS PRF AS AN INTERNAL MATRIX. A CASE SERIES.

Endodontic treatment is challenging in teeth with a blunderbuss canal and an open apex due to difculties in attaining an apical seal. Nonsurgical one-step apexication using materials such as mineral trioxide aggregate has been proposed to overcome the shortcomings of the traditional longterm calcium hydroxide apexication technique. In order to create an apical plug, there has to be some matrix against which MTA can be placed. Platelet-rich brin (PRF), a second-generation platelet concentrate, can be employed as a matrix material against which MTA can be condensed. This case series aims to present the treatment of an immature tooth with an open apex using a one-step apexication using autologous PRF membrane as an interior matrix and MTA as an apical barrier.