Open Root Apex Research Articles

Evaluation of Microleakage of Orthograde Root-Filling Materials in Immature Permanent Teeth: An In Vitro Study.

Introduction: The absence of a barrier in an open root apex makes endodontic treatment challenging as root-filling material can easily reach the surrounding tissue. The aim of the study was to compare the apical microleakage associated with mineral trioxide aggregate (MTA), biodentine, custom-made gutta-percha with MTA plus and custom-made gutta-percha with Adseal in immature permanent teeth by dye penetration method. Methods: Apical 2 mm of 60 single-rooted mandibular premolar teeth was resected to create divergent open apices and 10 teeth each were filled with Biodentine plug, MTA plug, custom-made gutta-percha with MTA plus sealer and custom-made gutta-percha with Adseal sealer. Ten teeth each acted as positive and negative controls. All the samples were stored at 37°C at 100% humidity for 5 weeks and then immersed in 2% Rhodamine B dye for 24 h. Transverse sectioning was done apically at 1 mm and 3 mm to evaluate dye penetration under a fluorescence microscope using ImageJ software. Results: There was a significantly greater microleakage at 1 mm cross section compared to 3 mm (p < 0.0001). At 1 mm cross section, the apical microleakage was the highest for the MTA plug with a mean leakage percentage of 48.08 ± 16.38, a mean depth of leakage of 0.46 ± 0.10 mm and a mean area of leakage of 1.35 ± 0.74 mm2, compared to other groups, and the difference was statistically significant. However, at a 3 mm cross section, MTA plus sealer with gutta-percha demonstrated the highest mean leakage percentage (25.01 ± 7.77) compared to other groups and the difference was statistically significant (p = 0.03). Conclusion: It can be concluded that the 3-mm-thick apical plug provided better sealing of the open apex compared to the 1 mm apical plug and there was no significant difference in microleakage among the Biodentine plug, MTA plug and Adseal sealer with gutta-percha plug at 3 mm cross section.

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.

Biological parameters, discolouration and radiopacity of calcium silicate‐based materials in a simulated model of partial pulpotomy

To analyse the discolouration, radiopacity, pH and calcium ion release of Biodentine (BD), Bio-C repair (BCR) and Bio-C temp (BCT), as well as their biological effects on human dental pulp cells (hDPCs). Sixty-four extracted bovine incisors were prepared to simulate crown fractures with pulp exposure and open root apex. The roots were filled using a mixture of agar and blood (control), and BD, BCR or BCT were placed over this mixture. Colour assessment analyses of the samples were performed before and immediately after material insertion and repeated at 30 and 90days, using a spectrophotometer. The colour change of each specimen was evaluated at the crown and calculated based on the CIELab colour space. Digital radiographs were acquired for radiopacity analysis. hDPCs were placed in contact with different dilutions of culture media previously exposed to such materials and tested for cell viability using the MTT assay. The pH and calcium ion release of all materials were measured after 24h; the data were assessed using one-way analysis of variance (ANOVA). Cell viability was analysed by two-way ANOVA. Differences in colour parameters and wound-healing data were assessed by two-way repeated measures ANOVA (α=0.05). Tukey's and Dunnett's tests were used to compare the experimental groups with the control group. BCR had grater radiopacity and smaller colour alteration (ΔEab/ΔE00) than the other materials tested (p<.005; p<.001). No significant differences in pH were found amongst the tested materials (p>.05). BCT was associated with the largest release of calcium ions (p<.0001). BD had cell viability similar to that of the control at the lowest dilutions, and BCR was similar to that of the control, regardless of the dilution tested (p>.05). BCT had a lower percentage of viability than that of the control at all tested dilutions (p<.0001). Cell migration rates in BD and BCR were similar to those in the control group after 24h and 48h (p>.05), whilst BCT had larger voids than the control in both periods (p<.0001). BCR, BCT and BD were associated with tooth discolouration. BCR had the lowest staining values, the highest radiopacity and viability greater than 80% hDPCs.

Berberine mediates root remodeling in an immature tooth with apical periodontitis by regulating stem cells from apical papilla differentiation

Once pulp necrosis or apical periodontitis occurs on immature teeth, the weak root and open root apex are challenging to clinicians. Berberine (BBR) is a potential medicine for bone disorders, therefore, we proposed to apply BBR in root canals to enhance root repair in immature teeth. An in vivo model of immature teeth with apical periodontitis was established in rats, and root canals were filled with BBR, calcium hydroxide or sterilized saline for 3 weeks. The shape of the roots was analyzed by micro-computed tomography and histological staining. In vitro, BBR was introduced into stem cells from apical papilla (SCAPs). Osteogenic differentiation of stem cells from apical papilla was investigated by alkaline phosphatase activity, mineralization ability, and gene expression of osteogenic makers. The signaling pathway, which regulated the osteogenesis of SCAPs was evaluated by quantitative real time PCR, Western blot analysis, and immunofluorescence. In rats treated with BBR, more tissue was formed, with longer roots, thicker root walls, and smaller apex diameters. In addition, we found that BBR promoted SCAPs osteogenesis in a time-dependent and concentration-dependent manner. BBR induced the expression of β-catenin and enhanced β-catenin entering into the nucleus, to up-regulate more runt-related nuclear factor 2 downstream. BBR enhanced root repair in immature teeth with apical periodontitis by activating the canonical Wnt/β-catenin pathway in SCAPs.

Swinging Replantation: A Possible Protocol for the Management of Inverted Impacted Upper Central Incisor Tooth

Inverted tooth impaction is a rare occurrence. Third molar impaction is the most extensively studied, and only eight cases of inverted third molars have been reported in a literature search of 40 years from 1973 to 2013. In a study, 43.4% of the premaxillary supernumeraries were inverted and 21.1% were transversely oriented, while occasional inverted central incisors have been mentioned in the literature. Severe dilaceration makes the management of this case a big challenge. The case of an 8-year-old boy with an inverted, rotated, and impacted upper left central incisor obstructed by an odontome is presented here. Under local anesthesia, the odontome was excised; the inverted tooth was swung and repositioned. The patient experienced uneventful healing, and with 30 months follow-up, progressive tooth eruption has been observed. Vitality test is positive, while radiologically there was no sign of resorption. Swinging replantation is a protocol that has been used for the management of an inverted, rotated, and impacted central incisor. Open root apex is an important factor in the selection of the method. The minimal periodontal damage prevents inflammatory and replacement resorption. With some clear advantages over options like orthodontic and prosthetic replacement, it could be a method to be considered in the management of severely dilacerated central incisors. The clinical significance is that even though management of a severely malpositioned tooth has always been a big challenge in dental practice, requiring extraction and prosthodontic replacement, swinging replantation provides a possible protocol of tooth retention, i.e., less expensive and associated with fewer hospital visits.

Statistical analysis of teeth autotransplantation in Portugal's region of Chaves

Aim.The aim of this study was to evaluate the success rate of 33 transplanted teeth in a northern population of Portugal. Methods. The mean follow-up period was 7 years, ranging from 6 months to 20 years. Results. Six teeth (18%) were rated as unsuccessful, 52% of the donor teeth were transplanted to receptor alveolus after immediate exodontia and 24% were transplanted to receptor alveolus surgically prepared. From the total number of cases, 64% had open root apex at the time of the transplantation and, in the latest control, of all teeth root development was over in 55%. Teeth ankylosis was present in 38% of all cases and 58% of all 33 transplants presented pulpar vitality. Data shows that, in males, teeth transplanted into natural alveolus were non-ankylosed, with normal color and vital teeth with incomplete root development at the time of the surgery. All cumulative curves obtained showed no statistical significance, mainly due to the low number of unsuccessful teeth autotransplantations. Orthodontic treatment performed after tooth autotransplantation showed success in 15% of all cases. Conclusion. Data reconfirms that autotransplantation of teeth is, in selected patients, the best option to replace a missing tooth in young patients.

Mineral trioxide aggregate in management of immature teeth with open apices – A report of clinical cases

Injuries to immature permanent teeth due to trauma may eventually result in pulpal necrosis and the subsequent arrest of root development. These teeth are often difficult to treat as the associated open root apex hinders the placement of the root filling material. To overcome this drawback, various materials have been introduced to induce apex closure prior to endodontic treatment. One of the currently popular material for apexification is mineral trioxide aggregate due to its superior biocompatibility, good sealing ability & excellent marginal adaptability. The presented clinical cases justifies the successful nonsurgical management of traumatized upper anterior teeth with mineral trioxide aggregate (MTA).

Retreatment of a Mutilated Tooth with Open Apex by using PRF, MTA and Anatomic Post

ABSTRACT Apexification aims to induce apical closure of the open root apex with a hard-tissue barrier, against which a root filling can be compacted. Mineral trioxide aggregate (MTA) is a potential apical barrier material with good sealability and a high degree of biocompatibility. The main technical problem associated with placement is to prevent overfill and underfill. This paper demonstrates retreatment of an open apex tooth by placement of an apical barrier using MTA and PRF membrane as an internal matrix followed by application of anatomical post and core. This new technique is particularly advantageous in teeth which have open apex, root canals that are not round, wide canals and thin radicular dentin. How to cite this article Chande KP, Manwar NU, Chandak MG, Lokade J. Retreatment of a Mutilated Tooth with Open Apex by using PRF, MTA and Anatomic Post. Int J Prosthodont Restor Dent 2013;3(3):105-110.

An RCT on treatment of palatally displaced canines with RME and/or a transpalatal arch

To investigate the effect of rapid maxillary expansion (RME) and/or transpalatal arch (TPA) therapy in combination with deciduous canine extraction on the eruption of palatally displaced canines (PDCs). Hundred and twenty subjects were enrolled in an RCT based on PDCs diagnosed on panoramic radiographs and they were randomly assigned to one of four study groups. Three treatment groups (TGs) (RME followed by TPA therapy plus extraction of deciduous canines, RME/TPA/EC group, 40 subjects; TPA therapy plus extraction of deciduous canines, TPA/EC group, 25 subjects; extraction of deciduous canines, EC group, 25 subjects) were analyzed. A control group (CG, 30 subjects) received no orthodontic treatment. Prevalence rates of eruption of PDCs in the three TGs were compared with the CG at T2. Predictive features at T1 for successful canine eruption were tested in the three TGs. The prevalence of canine eruption was 80 per cent for the RME/TPA/EC group, 79 per cent for the TPA/EC group, 62.5 per cent for the EC group, versus 28 per cent in the CG, with statistically significant differences between all the groups, with the exception of the comparison between RME/TPA/EC and TPA/EC. Predictive pretreatment variables for the success of treatment were less severe sectors of canine displacement, prepubertal stages of skeletal maturity, and an open root apex of PDCs. The use of a TPA in absence of RME can be equally effective than the RME/TPA combination in PDC cases not requiring maxillary expansion, thus reducing the burden of treatment for the patient.

Dental stem cells and their potential role in apexogenesis and apexification

Injury to an immature permanent tooth may result in cessation of dentine deposition and root maturation leaving an open root apex and thin dentinal walls that are prone to fracture. Endodontic treatment is often complicated and protracted with an uncertain prognosis frequently resulting in premature tooth loss. Postnatal stem cells, which are capable of self-renewal, proliferation and differentiation into multiple specialized cell lineages have been isolated and identified within the dental pulp, apical papilla and periodontal ligament. The ability of these cells to produce pulp-dentine and cementum-periodontal ligament complexes in vivo suggest potential applications involving stem cells, growth factors and scaffolds for apexification or apexogenesis. Similar protein expression amongst dental stem cells possibly implicates a common origin; however, the dominant cells to repopulate an open apex will be directed by local environmental cues. A greater understanding of the structure and function of cells within their environment is necessary to regulate and facilitate cellular differentiation along a certain developmental path with subsequent tissue regeneration. This review focuses on development of the apical tissues, dental stem cells and their possible involvement clinically in closing the open root apex. MEDLINE and EMBASE computer databases were searched up to January 2009. Abstracts of all potentially relevant articles were scanned and their contents identified before retrieval of full articles. A manual search of article reference lists as well as a forward search on selected authors of these articles was undertaken. It appears that dental stem cells have the potential for continued cell division and regeneration to replace dental tissues lost through trauma or disease. Clinical applications using these cells for apexogenesis and apexification will be dependent on a greater understanding of the environment at the immature root end and what stimulates dental stem cells to begin dividing and then express a certain phenotype.

Endodontic Treatment of a Non-Vital Permanent Tooth with an Open Root Apex Using Mineral Trioxide Aggregate

A 2-year-old domestic feline patient was presented for evaluation of a complicated crown fracture of the right maxillary canine tooth. Clinical and radiographic examination revealed a non-vital immature permanent canine tooth with an open apex. This case report describes a two-visit technique using mineral trioxide aggregate in an apical barrier method for the treatment of a non-vital immature permanent canine tooth in a cat.