Open Apex Research Articles

An innovative technique to safely perform active cleaning in teeth with open apices: CAB technique.

The current study aims to evaluate in vitro the extrusion of NaOCl, using an artificial root canal with an open apex, using different canal irrigation protocols. For this study, a transparent artificial root canal was used. The apex was shaped to be oversized and irregular in form. After root canal mechanical shaping, the artificial cylindrical chamber, which was made below the large apical foramen, was filled with fuchsine-stained bovine pulp tissue. Afterward, irrigation protocols were carried out and compared regarding their safety with regards to irrigant extrusion. Subsequently, the examiner created two groups, Group A: internal heating associated with ultrasonic activation and Group B: internal heating associated with ultrasonic activation, using the CAB technique. In both the groups, 5.25% sodium hypochlorite solution was used as the irrigant. Regarding assessing the presence or absence of the extrusion, photographs at ×20 were taken and analyzed. For the statistical analysis, a t-test for paired samples was used. Extrusion of irrigant beyond the apex was present only in Group A. The main objective of endodontic treatment is the removal of damaged tissues and bacteria. For this reason, active cleaning is crucial in all endodontic treatment cases. Internal heating followed with ultrasonic activation while using the CAB technique was an effective and safe technique to ensure no irrigant extrusion beyond the open apex.

Management of Open Apex - A Case Report

Introduction: Endodontic management of immature permanent teeth is a challenge for both clinicians and researchers. Open apex is an unusual wide apical foramen that results due to multiple reasons such as incomplete development, extensive apical resorption, caries leading to pulpal necrosis or trauma before complete root formation, root-end resection, or due to over instrumentation. Aims: To prevent the risk of subsequent microbial contamination. Case Report: This article is a case report showing the management of open apex with MTA plug and a thermoplasticized Gutta Percha technique for obturation. Discussion: Traditionally, calcium hydroxide was used for inducing the formation of an apical barrier. Conclusion: Currently, biomimetic materials like mineral trioxide aggregate (MTA) and biodentin have shown promising results for apexification procedures.

Diagnosis and treatment of dens invaginatus with open apex in a young adult patient by using cone-beam computed tomography and operative microscope.

Dens invaginatus is a developmental anomaly that can affect both deciduous and permanent dentition. The anomaly is caused by the invagination of the enamel organ into the dental papilla prior to the calcification of the dental tissues. The treatment option changes according to the classification, from the simple filling of the invaginated enamel area to root canal treatment with or without retrograde surgery, intentional re-implantation, or the extraction of the affected tooth. In this study we report a case of a maxillary lateral incisor invaginatus in a young adult patient. The periapical endoral X-ray showed the presence of a periapical radiolucency in tooth 22, that had a structure similar to a tooth inside it and an immature apex. Cold thermal testing showed that it was not a vital tooth. CBCT confirmed the diagnosis of Oehler Class II dens invaginatus. The treatment plan involved root canal treatment of both the "true" and the "invaginated" canal using calcium hydroxide-based intermediate medication. Then, after removing the hard internal structure with the aid of an operative microscope, MTA was used to close the immature apex. Finally, the large endodontic space was filled with self-etching, self-adhesive, dual curing resin cement. The patient was included in a follow-up programme to monitor and verify the complete healing of the periapical bone of the affected tooth. The use of technology and of special materials allowed an adequate management and resolution of the case reported.

Inverted Cone Guttapercha Obturation in Open Apex: A Case Report and Review

Inverted Cone Guttapercha Obturation in Open Apex: A Case Report and Review

Management of non-vital anterior teeth with open apex: A report of two cases

Management of non-vital anterior teeth with open apex: A report of two cases

Push-out bond strength and marginal adaptation of apical plugs with bioactive endodontic cements in simulated immature teeth.

ObjectivesThis study evaluates the bond strength and marginal adaptation of mineral trioxide aggregate (MTA) Repair HP and Biodentine used as apical plugs; MTA was used as reference material for comparison.Materials and MethodsA total of 30 single-rooted teeth with standardized, artificially created open apices were randomly divided into 3 groups (n = 10 per group), according to the material used to form 6-mm-thick apical plugs: group 1 (MTA Repair HP); group 2 (Biodentine); and group 3 (white MTA). Subsequently, the specimens were transversely sectioned to obtain 2 (cervical and apical) 2.5-mm-thick slices per root. Epoxy resin replicas were observed under a scanning electron microscope to measure the gap size at the material/dentin interface (the largest and smaller gaps were recorded for each replica). The bond strength of the investigated materials to dentin was determined using the push-out test. The variable bond strengths and gap sizes were evaluated independently at the apical and cervical root dentin slices. Data were analyzed using descriptive and analytic statistics.ResultsThe comparison between the groups regarding the variables' bond strengths and gap sizes showed no statistical difference (p > 0.05) except for a single difference in the smallest gap at the cervical root dentin slice, which was higher in group 3 than in group 1 (p < 0.05).ConclusionsThe bond strength and marginal adaptation to root canal walls of MTA HP and Biodentine cement were comparable to white MTA.

Interdsiciplinary management of co-existent mucosal fenestration and dehiscence in a maxillary central incisor with immature apex : A case report

Mucosal fenestration is a clinical condition wherein the root apex of an affected tooth is visible in the oral cavity due to loss of overlying alveolar bone and mucosa, while dehiscence results in denudation of the root surface due to loss of overlying alveolar bone including the marginal bone. A 25-year-old male patient reported with primary concern of defect in gums and discoloration in an upper central incisor. Examination revealed an intricate case of combined mucosal fenestration and dehiscence occurring concomitantly with an endodontic lesion in an open apex anterior tooth. Cone-beam computed tomographic scan, in addition to routine diagnostic aids, supplemented the diagnosis and facilitated meticulous treatment planning. Both conventional and surgical endodontic procedures were carried out. This was followed by periodontal plastic surgery and prosthodontic rehabilitation of the discolored tooth. Complete healing of soft tissue defect was seen in 6 months, while complete bony healing was seen at 12 months. The treatment thus aimed at correcting the pathology, handling the psychological concerns, and restoring physiologic function and aesthetics by reconstruction of the lost periodontium around the involved tooth.

Knowledge of Emergency Management of Avulsed Tooth Among Dental Surgeons of Chitwan

Introduction: Prognosis of an avulsed tooth depends on timely and correct management. Therefore, knowledge about the emergency management of an avulsed tooth among dentists is very important. The study was aimed to access the knowledge of emergency management of avulsed tooth among the dental surgeons of Chitwan. Methods: A descriptive cross-sectional study was conducted among the dental surgeons in Chitwan using a questionnaire containing 12 items. Only 105 dental surgeons participated in the study. Data was entered into Statistical Package of Social Science (SPSS) version 16 and was analyzed using descriptive statistics. Results: Most of the dentist 71.4% were familiar with the correct management of the avulsed tooth before replantation. Regarding storage medium, most of the dentist 44.4% correctly choose Hank’s balanced salt solution, while 21.9% choose saliva as the best storage medium for an avulsed tooth. Similarly, 47.6% of the dentist rightly choose that less than 30 minutes was the extra alveolar critical time, while 35.2 % suggested it to be within an hour. More than half of the dentists 51.4% preferred stainless-steel wire to be the method of splinting after replantation. However, most of the dentists 75.2% correctly recommended splinting for a duration of 15 days. Almost half of the dentist 49.5% agreed that the tooth with open apex had better prognosis. Conclusions: The results of this study indicate that the dental surgeons do have knowledge regarding emergency management of an avulsed tooth. However, with time they need to update themselves their knowledge of dental traumatology.

A Comparative Study of Surface Hardness between Two Bioceramic Materials in an Experimental Apexification Model under Wet and Dry Conditions

Background:The placement of a wet cotton pellet against Mineral Trioxide Aggregate (MTA) is often recommended to ensure the completion of its setting reaction.Objective:This study aimed to evaluate the setting behaviour of MTA Angelus and NeoMTA by comparing their hardness after placing them in dry and moist conditions.Methodology:A simulated open apex was created on 40 polyvinyl tubes. The apical 4 mm of the tubes was filled with the two materials, NeoMTA Plus (Avalon Biomed Inc. Bradenton, FL, USA) and MTA Angelus (Angelus, Londrina, PR, Brazil) (n=20 per group). Both groups were subdivided into two subgroups based on the dry and wet conditions (n=10 per group). A wet cotton pellet was placed above the two materials in the wet group, and the coronal segment was sealed using Type II Glass ionomer cement (GC corporation Tokyo, Japan). Gutta-percha was placed against the test materials in the dry group with the coronal segment sealed with amalgam. Samples were placed in an oasis soaked in phosphate-buffered saline for seven days in 100% humidity and at 37°C. Microhardness was measured independently at 4 and 2 mm from the apex. Hardness was compared between materials and conditions, applying analysis of variance (a = .05).Results:The presence of dry or wet conditions had no significant effect on material hardness. MTA Angelus showed significantly higher hardness values compared with NeoMTA Plus.Conclusion:The moisture of the periapical environment can compensate for the absence of a wet cotton pellet and is adequate for the setting of the materials.

Measurement of the open apices of mandibular first and second premolars to test the chronological age over 14 years: Study on a sample of south Indian children

Abstract Age estimation is an integral part of forensic medical and dental practice. In many countries, the age threshold of 14 years is set to determine the minimum age for criminal responsibility. In the present study, the authors studied the final maturation of the first (IPM1) and second mandibular premolars (IPM2) by Cameriere maturity index and determined cut-offs at the age threshold of 14 years, and validate on the test sample. Orthopantomograms of 960 healthy south Indian children and sub-adults (480 boys and 480 girls) aged between 10 and 18 were analysed, 640 as training sample and 320 as a test sample. The results of logistic regression analysis with age (

MODERN APPROACHES TO DIAGNOSTICS AND TREATMENT OF DENTAL TRAUMA

Relevance of the topic. Disruption of the anatomical integrity of the dentition, occurring as a result of dental trauma, not only impairs the patient’s appearance, but can also affect the functional properties of the entire maxillofacial area. Therefore, the choice of optimal methods for treatment of dental traumas remains an urgent problem of dentistry and requires further development.&#x0D; The aim of this study was to offer the most effective methods for treatment of dental traumas, with a view to preserve and restore the damaged structures of teeth and provide positive long-term outcomes.&#x0D; Materials and methods. The research relied on the study and generalization of modern scientific literature.&#x0D; Results and discussion. To diagnose dental traumas and, accordingly, to determine the ways to eliminate their consequences, its classification is of great importance. In this context, the classification by Andreason gained the strongest support in the world dental community. The approaches to the diagnostics and treatment of dental traumas, which have become established in the world of dentistry, largely rely on this classification.&#x0D; In modern conditions, computed tomography provides the opportunity to obtain maximum information about the condition of the injured tooth and bone damage. Cone-beam computer devices are used to study the maxillofacial area, providing high image quality at low radiation exposure. Essential diagnostic methods also include pulp vitality tests (cold test and electroodontodiagnostics). In this case, to exclude the diagnosis of pulp necrosis, it is recommended to check its vitality repeatedly.&#x0D; Currently, as an alternative to classical restoration in case of fracture of the tooth crown, specialists consider the fixation of the proper fragment of the tooth. Recently, this method of eliminating the effects of fractures of the dental crown is becoming increasingly popular due to the significant improvement in quality and enhanced technological properties of adhesive systems and materials.&#x0D; The search for ways to improve medical care in cases of tooth avulsion is mainly associated with the introduction of replantation and autotransplantation of teeth in the clinical practice. It is recommended to replant a tooth with an open apex without its depulpation due to the high ability of the germinal zone and periodontium to revascularize. Immediately after returning the tooth to the alveolus, a flexible splint is applied for a period of 3-4 weeks. Further endodontic treatment is performed only in cases when revascularization does not occur and signs of apical periodontitis appear. When the root apex is formed, the tooth is replanted in the alveolus, splinted for up to 2 weeks. Endodontic treatment should begin before the splint is removed, 7-10 days after replantation.&#x0D; Experts suggest replanting permanent teeth with both open and closed root apices, even in cases where the tooth has been in a dry environment for more than 60 minutes. However, not always after the injury the tooth can be found or it can be destroyed so that replantation becomes impossible. Nevertheless, in modern conditions, having received an in-depth biological justification of the process of engraftment of the transplanted tooth, it becomes possible to widely use the method of autotransplantation in the clinical practice.&#x0D; Conclusions. Thus, based on the study of a significant array of scientific publications, we can conclude that the problems of dental trauma are increasingly attracting the attention of researchers due to the prevalence of this pathology, the complexity of its diagnostics and treatment. The current approach to the treatment of dental trauma is focused on less invasive and more biologically oriented methods of treatment of hard dental tissues, pulp, periodontal ligament and alveolar bone.&#x0D; Research prospects. It is important to develop the best conditions for tooth storage before replantation in order to improve the periodontal regeneration, the quality of the revascularization process, offer better types of splinting, which will ensure the regeneration of periodontal and pulp tissues, prevent inflammatory complications.

Immediate management of rotated young permanent incisor by surgical approach - A case report

Tooth rotation is displacement of tooth around its long axis. Fixed and removable orthodontics are the conventional methods for management of rotation. But in case of single tooth rotation especially for teeth with single conical root with open apex another option is surgical approach. The procedure is called surgical derotation. It is the repositioning of a rotated tooth in normal alignment along with adjacent tooth in the dental arch, by surgical method. The procedure is simple and gives patient aesthetic result immediately without relapse. This is a case report of successful management of almost 120 degree mesiopalatally rotated maxillary right central incisor with open apex of a 9 year old girl. Keywords: Tooth rotation, Derotation, Splint, Maxillary central incisor, Young permanent tooth.

A four year journey to success MTA repair

Aim: This case report presents the healing potential of MTA along with its properties of bone formation and apexification. A cystic lesion was successfully resolved with the use of MTA and the follow up proves success. In cases of combined issues of resorption, abscess, cystic lesion and open apices, MTA seems to be the material of choice. Summary: Access was prepared, biomechanical preparation was done and medicament was placed. Thereafter an MTA plug was made and the canals were obturated. MTA discovery has provided the clinicians with a wonder material which can help to manage multi problem related cases efficiently and successfully. Keywords: Apexification, Mineral Trioxide Aggregate, Non Surgical Healing, Obtura, Periapical Cyst.

Polyethylene fiber post modification with vital pulp therapy in a traumatized immature incisor using Biodentine: A four year follow-up case report

In this case, it was aimed to restore a traumatized permanent incisor with open apex using a modified polyethylene fiber post after amputation as well as to present a four-year long term follow-up. A healthy 10-year-old boy was referred with a complaint of pain caused by tooth number 11. The patient fell and broke his upper incisor ten days ago and no treatment was done before. Total amputation was carried out after clinical and radiological examination. The exposed root pulp was covered with BiodentineTM (Septodent, Saint-Maur-Fosses Codex, France). Glass-ionomer cement (Fuji IX extra, GC Corp., Tokyo, Japan) was placed on the BiodentineTM, and after a 3-month follow-up, polyethylene fiber post (Ribbond, Seattle, WA, USA) was placed in the crown since healing was observed in the relevant tooth. The restoration was completed with composite resin (Clearfil Majesty Esthetic Kuraray, Osaka, Japan). Four years later, radiographic examination revealed completed root formation and complete root obliteration. Clinical examination revealed favorable esthetic and functional outcome. Traditional treatments can be modified in order to obtain long term clinical success. Polyethylene fiber post can be used as an alternative method to root canal therapy in complicated crown fractures in teeth with immature root formation due to the advantages such as the possibility of modification according to the crown, aesthetics, easy application, and supporting the vitality of the tooth.

Single-Visit Apexification with Biodentine and Platelet-Rich Fibrin

An open apex in a nonvital permanent tooth makes endodontic treatment a challenge. There is a necessity to induce or create an apical barrier against which the obturating material can be compacted. The present article reports the effective closure of root apex in a pulpless permanent upper incisor tooth with wide-open apex utilizing Biodentine in blend with platelet-rich fibrin in the form of a matrix showing excellent healing potential at a 12-month follow-up.

Dental Pathology of the Domestic Pig (Sus Scrofa Domesticus).

Antemortem domestic pig (Sus scrofa domesticus) dental pathology literature is sparse. This observational descriptive study evaluated 23 client-owned pigs that while sedated/anesthetized for routine annual care had intraoral dental radiographs and an oral examination performed. Age, gender, weight, and breed for each pig were recorded. Oral examination and radiographic findings were reviewed to create a comprehensive list of dental abnormalities identified. Descriptive statistics were performed to summarize the data. The study population included 14 castrated males and 20 Vietnamese pot-bellied mini-pigs. The median age was 3 years (range 2-12 years), and the median weight was 39 kg (range 11-140 kg). The most common finding was missing teeth (21/23 pigs); the first premolar tooth was the most likely to be absent (64/106 missing teeth). Periodontal disease was common (20/23 pigs). Advanced stages primarily affected the first molar teeth frequently in the form of a mucogingival defect. Supernumerary roots were discovered on the maxillary canine teeth in female pigs only (10/25 teeth with supernumerary roots). The most common persistent deciduous tooth was the maxillary second incisor (15/19 persistent deciduous teeth). Non-age or gender related open apices were most likely associated with mandibular first and second incisor teeth (26/96 teeth with open apices). Tooth resorption was also identified (7/23 pigs). The study findings prove that pet pigs commonly have dental pathology; therefore, thorough oral examinations with intraoral radiographs should be included in porcine routine health care regimens.

Comparative Evaluation of the Efficacy of Stepwise Caries Excavation vs Indirect Pulp Capping in Preserving the Vitality of Deep Carious Lesions in Permanent Teeth of Pediatric Patients: An In Vivo Study.

Aims and objectivesTo comparatively evaluate the clinical efficacy of stepwise caries excavation with indirect pulp capping (IPC) in managing the young permanent teeth in pediatric patients who have deep carious lesions.Materials and methodsEighty-eight teeth (first/second permanent molars) were included and randomly divided into two groups: group I (stepwise caries excavation) and group II (IPC). For group I, i.e., stepwise caries excavation, in the initial visit, bulk caries removal was done from walls of the cavity, however, soft and infected dentin was left untouched on the pulpal floor. The final excavation was performed after 2 months. The dentin parameters like the color, the consistency, and the humidity of dentin were noted at the first and second visits. A final follow-up to assess the primary outcome, i.e., sustained pulp vitality, was done after 1 year.ResultsWhen both the groups were compared with each other using the Chi-squared test, a highly significant difference was found (p < 0.05) between them. The success rate of stepwise caries excavation (97.3%) was found to be significantly greater than IPC (82.4%). After doing statistical analysis, a significant difference between stepwise excavation at baseline and at re-entry for parameters like the color, the consistency, and the humidity (p < 0.05), where dentin was observed to be darker in color, harder in consistency, and drier to touch at re-entry was found.ConclusionStepwise caries excavation was considered a safer technique than IPC for preserving the vitality of young permanent teeth. Also, the clinical changes recorded during the re-entry in the case of stepwise caries excavation technique indicated the arrest of the carious process.Clinical significancePulp preservation is of utmost importance especially in the case of young permanent teeth which have open apex to aid in apexogenesis. Failure to do so in maintaining the vitality of pulp before root completion may lead to the unfavorable crown to root ratio resulting in thin dentinal walls which are prone to fracture.How to cite this articleManhas S, Pandit IK, Gugnani N, et al. Comparative Evaluation of the Efficacy of Stepwise Caries Excavation vs Indirect Pulp Capping in Preserving the Vitality of Deep Carious Lesions in Permanent Teeth of Pediatric Patients: An In Vivo Study. Int J Clin Pediatr Dent 2020;13(S-1):S92–S97.

Regenerative endodontic therapy: a follow-up of 47 anterior traumatised teeth.

To collect long-term survival data in anterior traumatised teeth on the outcome of Regenerative Endodontic Treatments (RET) with a network of dentists working in different clinics to overcome the problem of anecdotical evidence. The seven dentists from Paediatric REsearch Project (PREP) performed RET treatments following the same protocol in five different secondary dental care clinics in the Netherlands. Treatment resulting in pain, apical problems, sinus tracts, resorption or fracture were considered as failure of treatment. 47 teeth in 38 children were treated between January 2009 and September 2017 and had at least 6month follow-up (mean 35months). Apical closure was seen in 27 teeth (25 cases) and root length growth in 6 teeth (6 cases). Thickening of the root walls was seen in 20 teeth (20 cases) and obliteration of the root canal in 30 teeth (25 cases). Of 38 teeth with apical inflammation at the start of treatment, no radiographic sign of apical inflammation was visible at 3months in 13 of 28 teeth; taking up to 42months for radiographic signs of apical inflammation to be not visible. Nineteen of 35 teeth showed discoloration at the beginning of treatment. After 18months two teeth showed signs of ankylosis, but were still functional. After 36months one more tooth showed signs of new apical inflammation and 2months later it was extracted. With three failures in 47 treated teeth, RET seems to be a promising treatment for difficult to treat anterior traumatised teeth with an open apex.

Endodontic management and follow-up of two rooted maxillary lateral incisor with open apex – A case report

Anatomical variations in the root are quite possible, if such teeth are infected, it is challenging to treat them. A patient with two rooted maxillary lateral incisor having open apex with periapical lesion reported to the department. Non-surgical endodontic treatment was initiated under magnification, open apex was sealed with MTA plug and root canal treatment completed. The case was followed up for one year and there was radiographic healing of periapical lesion.

Assessment of knowledge, attitude and practice on different treatment modalities for management of open apex among dentist

Assessment of knowledge, attitude and practice on different treatment modalities for management of open apex among dentist