One-visit Apexification Research Articles

Comparison of the microleakage of mineral trioxide aggregate, calcium-enriched mixture cement, and Biodentine orthograde apical plug

One-visit apexification is a treatment of choice in necrotic immature open apex teeth. Calcium silicate base materials are suitable for this method. The purpose of this study was to investigate and compare the sealing efficiency of Biodentine, mineral trioxide aggregate (MTA) ProRoot, and calcium-enriched mixture (CEM) cement orthograde apical plug using bacterial leakage method. In this in vitro study a total of 70 extracted maxillary incisors were cleaned and shaped. A 1.1-mm standardized artificially open apex was created in all samples. The teeth were randomly divided into three experimental groups of 20, and two negative and positive control groups of 5. In experimental groups, 4-mm thick apical plugs of ProRoot MTA, CEM cement, or Biodentine were placed in an orthograde manner. Negative control samples were completely filled with MTA while positive control samples were left unfilled. Sealing efficiency was measured by bacterial leakage method, and results were analyzed by Kaplan-Meier and Chi-square tests. The level of significance was set at 0.05. The highest number of turbidity was recorded for ProRoot MTA samples, while the lowest for Biodentine. There was a significant difference in the number of turbidity between ProRoot MTA and Biodentine groups (P < 0.001), but there was no significant difference between CEM cement and Biodentine (P = 0.133) and ProRoot MTA (P = 0.055). Within the limitation of this in vitro study, Biodentine showed promising results as a substance with good-sealing efficiency.

Evaluation of one-visit apexification with MTA apical plug versus traditional Calcium hydroxide apexification with the help of Platelet Rich Fibrin apical matrix

This study aimed to evaluate one-visit apexification with MTA apical plug versus traditional calcium hydroxide apexification with the help of platelet rich fibrin (PRF) apical matrix. Methods: 18 immature permanent maxillary anterior teeth with non-vital pulp were chosen from 14 children ranging from 9 to15 years old, and were divided randomly into two main groups with 9 teeth in each group [Group I MTA, and Group 2 Ca(OH)2]. Platelet Rich Fibrin was used for both groups as internal apical matrix. In group 1 MTA approximately 4-5 mm thickness of mixed MTA apical plug was placed at the apical end of the root, then the canal was obturated by Obtura II system after 24 hours, while in group 2 Ca(OH)2 ; the apexification was done by Ca(OH)2 and renewed at 3,6 months and after 12 months the canal was obturated by Obtura II system. The radiographs were taken for all cases at preoperatively, post operatively and at 3, 6 and 12 months follow up. Data were subjected to statistically analyze. Results: At 12 months follow up period 100% of teeth with calcific apical barrier were detected in Group 1 MTA, and 88% of teeth with calcific apical barrier were detected in Group 2 Ca (OH)2. However, there was no difference in statistically point of view between the groups. Conclusions: One-visit apexification provides an alternative treatment option over the traditional calcium hydroxide apexification in treating the non-vital cases with open apices.

Antibacterial effects of new endodontic materials based on calcium silicates

Background/Aim. The main task of endodontic treatment is to eliminate pathologically altered tissue, to disinfect root canal space and to obtain its three-dimensional hermetic obturation. The main purpose of this study was to evaluate antimicrobial activity of new endodontic nano-structured highly active calcium silicates based materials albo-mineral plyoxide carbonate aggregate (ALBO-MPCA) and calcium silicates (CS) in comparison to mineral trioxide aggregate (MTA+) and UltraCal XS (CH). Methods. The antimicrobial activity of materials was tested against Staphylococcus aureus (ATCC 25923) and Enterococcus faecalis (ATCC 14506) strains, and following clinical isolates: Rothia dentocariosa, Enterococcus faecalis, Staphylococcus aureus, Streptococcus anginosus and Streptococcus vestibularis using a double layer agar diffusion test. The pH measurements were performed using the pH meter. Total amount of released ions was determined by inductively coupled plasma optical emission spectrometry (ICP-OES). Results. All tested materials showed the best antibacterial potential after 1 h of incubation. After 3h and 24h of the incubation period, the antibacterial potential of all tested materials were similar. The Agar diffusion test showed that ALBO-MPCA, CS and MTA+ had similar inhibition zones (p &gt; 0.05), except in the activity against Staphylococcus aureus where ALBO-MPCA showed better antimicrobial properties than MTA+ in 3h and 24h of the incubation period (p &lt; 0.05). Following 24h of the incubation, the inhibition zones were the strongest with CH against Staphylococcus aureus (16.67 ? 2.34 mm) followed by ALBO-MPCA (14.67 ? 1.21 mm) and the weakest with CS against Enterococcus faecalis (6.50 ? 1.76 mm). CH showed the highest pH, followed by ALBO-MPCA, CS and MTA+. Conclusion. The expressed antibacterial effects indicate that materials based on nano-structured highly active calcium silicates represent effective therapeutic agents for root canal obturation in one-visit apexification treatment, therefore they are recommend for further examination and clinical trials as they are proposed for MTA substitution.

One-visit Apexification Using MTA and Reattachment of a Crown-root Fractured Tooth with Severe Coronal Damage: A Case Report

치아의 외상에서 íŒŒì ˆíŽ¸ì˜ 재부착은 본래 치아의 형태, 질감, 색, ë°©ì‚¬ì„ íˆ¬ê³¼ì„±ì„ 재현하여 우수한 심미성을 ì œê³µí•œë‹¤.9세의 남자 환자가 ìƒì• ìš°ì¸¡ ì¤‘ì ˆì¹˜ì˜ 복잡 치관-치근 íŒŒì ˆë¡œ 내원하였다. 심한 치관 손상과 골 연하로 연장된 íŒŒì ˆë¡œ 인해 예후가 불량했지만 환자의 나이를 ê³ ë ¤í•˜ì—¬ 치아 íŒŒì ˆíŽ¸ì„ 재부착하기로 ê²°ì •í•˜ì˜€ë‹¤. Mineral trioxide aggregate(MTA)를 이용한 일회 ë‚´ì›ì¹˜ê·¼ê´€í˜•ì„±ìˆ í›„ì— ê³¨ì ˆì œìˆ ê³¼ 포스트 식립을 동반하여 치아 íŒŒì ˆíŽ¸ì„ 재부착하였다.ì •ê¸°ì ì¸ 관찰결과 임상 및 ë°©ì‚¬ì„ í•™ì ìœ¼ë¡œ 양호한 결과를 나타냈기에 ë³´ê³ í•˜ê³ ìž 한다.

The management of non-vital immature permanent incisors

The management of pulp necrosis in an immature permanent incisor can pose a significant challenge with regards to both operator technique and patient management. The main aim of this paper is to outline techniques described in the endodontic management of the immature incisor: calcium hydroxide apexification; one-visit apexification; and root revascularization. Clinical Relevance: With 5% of 8-year-olds in the UK reported to have evidence of trauma to the permanent incisors, 1 an awareness of the challenges posed and techniques available for management is essential for general dental practitioners, should these teeth subsequently become non-vital.

Apexification of Immature Teeth Using Novel Apical Matrices and MTA Barrier: Report of Two Cases

There are a number protocols to manage non-vital open-apex teeth such as apexification, apical barrier technique (one-visit apexification), orthograde root filling using MTA, triple antibiotic paste, and tissue engineering concept. Aim of this paper is to highlight the use of the novel materials such as PRF and DFDBA to be used as apical matrix in management of non vital open apex cases.

Induced Apical Closure of Nonvital Immature Root Apices with MTA

Endodontics is a specialty which is very receptive to new ideas and concepts. Management of open apex is a challenge to the endodontist. The treatment of choice for necrotic teeth is apexification, which is induction of apical closure to produce more favorable conditions for conventional root canal filling. The most commonlyadvocated medicament is calcium hydroxide, althoughrecently considerable interest has been expressed in the use of mineral trioxide aggregate. Introduction of techniques for one-visit apexification provide an alternative treatment option in these cases. Research, published studies, and clinical results support this material, and have served to increase the expectation that nonsurgical treatment success is both possible and attainable. This paper highlights a case reports for apexification using mineral trioxide aggregate.

Chemical characteristics of mineral trioxide aggregate and its hydration reaction

Mineral trioxide aggregate (MTA) was developed in early 1990s and has been successfully used for root perforation repair, root end filling, and one-visit apexification. MTA is composed mainly of tricalcium silicate and dicalcium silicate. When MTA is hydrated, calcium silicate hydrate (CSH) and calcium hydroxide is formed. Formed calcium hydroxide interacts with the phosphate ion in body fluid and form amorphous calcium phosphate (ACP) which finally transforms into calcium deficient hydroxyapatite (CDHA). These mineral precipitate were reported to form the MTA-dentin interfacial layer which enhances the sealing ability of MTA. Clinically, the use of zinc oxide euginol (ZOE) based materials may retard the setting of MTA. Also, the use of acids or contact with excessive blood should be avoided before complete set of MTA, because these conditions could adversely affect the hydration reaction of MTA. Further studies on the chemical nature of MTA hydration reaction are needed.

Strategies to manage permanent non-vital teeth with open apices: a clinical update

If dental pulp injury occurs prior to complete root formation and apical closure, normal root development is halted. This condition produces several complications. Firstly, the apical diameter of the canal is often larger than the coronal diameter, so debridement is difficult. Secondly, the lack of an apical stop makes the obturation in all dimensions virtually impossible. And finally, the thin walls of the root canal are prone to fracture, so that surgical treatment is generally not a viable option. There are a number protocols to manage non-vital open-apex teeth such as apexification, apical barrier technique (one-visit apexification), orthograde root filling using MTA, triple antibiotic paste, and tissue engineering concept. The aim of this paper is to review these treatment protocols.

Sealing Ability of ProRoot MTA and MTA-Angelus Simulating a One-Step Apical Barrier Technique- An in vitro Study

Endodontic treatment of the pulpless tooth with an immature root apex poses a special challenge for the clinician due to lack of an apical stop against which to compact an interim dressing of calcium hydroxide, or the final obturation material. A one-visit apexification protocol with MTA (Mineral Trioxide Aggregate) has be seen as an alternative to the traditional treatment practices with calcium hydroxide [Ca(OH)2]. The aim of this study was to investigate the use of MTA as a 5mm apical barrier by comparing sealing ability of ProRoot MTA to that of MTA-Angelus. 50 freshly extracted Maxillary and Mandibular single canal sound human incisor teeth were used in this study, which were decoronated to standardized 10mm root lengths. The root segments were prepared to simulate the clinical situation of an open apex with Gates Glidden burs # 51 and randomly assigned into 2 experimental groups of 20 samples each (Group A: ProRoot MTA, Group B: MTA-Angelus) and 10 root segments were used as control (Group C) where no apical barrier was used. After obturation the coronal portion of all samples were sealed with Glass Ionomer and stored at 37 degrees C and 100% humidity for 4 weeks. The root segments were then double coated with nail varnish except for the apical 1mm and apical ends of all root segments were suspended vertically in methylene blue dye for 48 hours at room temperature. After removal from the dye, the samples were sectioned longitudinally and linear dye penetration was measured using a Grid and stereomicroscope. The measurements were tabulated and statistically analyzed. The mean percentage of dye leakage for Group A was 55.5% and for Group B was 53.25%. The results showed no statistically significant difference in the sealing ability of ProRoot MTA and MTA-Angelus when used as apical barriers.

Repairing traumatic injuries in immature non-vital teeth

Mineral Trioxide Aggregate (MTA) is a dental material which allows a one-visit apexification and is considered an effective alternative to calcium hydroxide. It is important for the whole dental team to understand the clinical techniques used and the materials involved.

Comparative in vitro study of the sealing efficiency of white vs grey ProRoot mineral trioxide aggregate formulas as apical barriers

Mineral trioxide aggregate (MTA) has been proposed as one of the materials which can be used in a one-visit apexification technique. Recently conventional grey MTA has been replaced by a new white MTA formula. The aim of this study was to compare the root canal adaptation of white MTA to that of grey MTA when used as an apical barrier in teeth with open apices. We also examined whether a previous calcium hydroxide intracanal medication affects MTA's sealing ability and investigated the ability to remove calcium hydroxide from the root canal walls. Forty-nine teeth were prepared in a manner to simulate a divergent open apex of immature teeth. Four teeth were used in a preliminary experiment to demonstrate the inefficacy of calcium hydroxide removal from the canal walls in teeth with open apices. Four groups of 10 teeth each were created: groups A and B were treated with calcium hydroxide intracanal medication and then received an apical plug of grey and white MTA respectively. Groups C and D received an apical plug of grey and white MTA respectively without previous intracanal medication. Four teeth served as negative and one as a positive control. The marginal adaptation and sealing ability of the apical barrier were tested by means of a dye tracer (basic fuchsine) after longitudinal sectioning. It was found that MTA apical barrier resisted displacement during gutta-percha condensation. Calcium hydroxide pretreatment, adversely affected white MTA sealing ability (P < 0.05).

Microleakage of Accelerated Mineral Trioxide Aggregate and Portland Cement in an In Vitro Apexification Model

The purpose of this study was to evaluate the microleakage of accelerated mineral trioxide aggregate (MTA) and Portland cement by flow porometry analysis in an in vitro apexification model. Sixty-four single-rooted, extracted teeth were divided into 4 groups (group 1, MTA; group 2, MTA with accelerator; group 3, Portland cement; and group 4, Portland cement with accelerator). In an in vitro apexification model, MTA or Portland cement mixed with or without 10% CaCl 2 was condensed to 2-mm thickness. The negative control group (n = 4) had the apical foramen sealed with epoxy resin. The maximum and mean flow pore diameters of the samples were tested by capillary flow porometry at 90 minutes and 48 hours after obturation. The addition of accelerator significantly reduced the maximum pore diameters of MTA and Portland cement at the initial setting phase. After 48 hours of obturation, the maximum and mean flow pore diameters of the accelerated samples were significantly reduced compared with the normal samples. There was no statistically significant difference in the maximum pore diameter of MTA and Portland cement between the measurements at 90 minutes and 48 hours. The results imply that the addition of accelerator into MTA or Portland cement can be useful in a one-visit apexification by reducing microleakage even in an early setting time.

Apexification: a review

This paper reviews the rationale and techniques for treatment of the non-vital immature tooth. The importance of careful case assessment and accurate pulpal diagnosis in the treatment of immature teeth with pulpal injury cannot be overemphasized. The treatment of choice for necrotic teeth is apexification, which is induction of apical closure to produce more favorable conditions for conventional root canal filling. The most commonly advocated medicament is calcium hydroxide, although recently considerable interest has been expressed in the use of mineral trioxide aggregate. Introduction of techniques for one-visit apexification provide an alternative treatment option in these cases. Success rates for calcium hydroxide apexification are high although risks such as reinfection and tooth fracture exist. Prospective clinical trials comparing this and one-visit apexification techniques are required.

The use and predictable placement of Mineral Trioxide Aggregate in one-visit apexification cases.

Endodontic treatment of the pulpless tooth with an immature root apex poses a special challenge for the clinician. The main difficulty encountered is the lack of an apical stop against which to compact an interim dressing of calcium hydroxide (Ca(OH)2), or the final obturation material. In these situations the unpredictability of the result, the difficulty in creating a leak-proof temporary restoration for the duration of treatment, and the difficulty in protecting the thin root from fracture may lead to complications when using traditional (Ca(OH)2-based) apexification techniques. Furthermore, given the increased mobility of today's society, lengthy treatment protocols are fraught with problems, and may not be followed through to completion. This may lead to ultimate failure of the case. Mineral Trioxide Aggregate (MTA) has recently been introduced for use in endodontics. Current literature supports its efficacy in a multitude of procedures including apexification. The focus of this paper is to propose a one-visit apexification protocol with MTA as an alternative to the traditional treatment practices with Ca(OH)2. One-visit apexification may shorten the treatment time between the patient's first appointment and the final restoration. The importance of this approach lies in the expedient cleaning and shaping of the root canal system, followed by its apical seal with a material that favours regeneration. Furthermore, the potential for fractures of immature teeth with thin roots is reduced, as a bonded core can be placed immediately within the root canal.