Apical closure of mature molar roots with the use of calcium hydroxide

Treatment of immature teeth with nonvital pulps in adults: a prospective comparative clinical study comparing MTA with Ca(OH)2

AIM

To evaluate and compare the influence of various predictors on outcomes of apexification using either mineral trioxide aggregate (MTA) or calcium hydroxide (CH) in permanent immature anterior teeth with necrotic pulps and periapical lesions of adults.

METHODOLOGY

Ninety immature teeth with necrotic pulps and periapical lesions on adult patients (aged 18-40 years) were treated with MTA (45 teeth) or CH (45 teeth) between 2015 and 2018. Patients of both groups were recalled for follow-up examinations after the first intervention at 1,3,6 and 12 months for the first year, every 6 months for the second year and every year thereafter until the end of the study (median 32.3 months). The treatment outcome based on clinical and radiographic criteria was assessed by calibrated examiners and dichotomized as 'healed+healing' or 'not healed'. The age, gender, stage of root development, preoperative signs and symptoms of apical periodontitis and size of periapical lesion were recorded. The cumulative success proportion and mean time were analysed with the Kaplan-Meier test. The generalized logrank statistic was used to describe prognostic clinical variables. Fisher's exact test was applied for the evaluation of the healing rates.

RESULTS

Thirty-nine of the 45 teeth treated with MTA were available for recall. Of these, 29 teeth (74%) revealed calcific apical barrier formation with complete resolution of periapical lesions, 7 teeth (18%) were healing, and 3 teeth (8%) had persistent disease. Thirty-four of the 45 teeth in the CH group were available for recall. Of these, 27 teeth (79%) had complete healing of periapical lesions and had calcific barrier formation, 4 teeth (12%) were healing, and the remaining 3 teeth (9%) had not healed. The survival rate of teeth treated with MTA was similar to the survival rates observed in teeth treated with CH (90% and 91%, respectively, P > 0.05). The generalized logrank statistic revealed that the cumulative success rate of both materials was not significantly different (P > 0.05). None of the tested predictors had an influence on the treatment outcomes of teeth in both groups (P > 0.05).

CONCLUSIONS

Apexification with both MTA and CH was associated with similar treatment outcomes. MTA may be proposed as a material for apexification treatment in immature teeth of adult patients due to the shorter treatment time associated with its use.

Endodontic management of nonvital permanent teeth having immature roots with one step apexification, using mineral trioxide aggregate apical plug and autogenous platelet-rich fibrin membrane as an internal matrix: Case series

A tooth with blunderbuss canal and open apex can be an endodontic challenge because of difficulty in obtaining an apical seal, and existing thin radicular walls which are susceptible to fracture. To overcome the limitations of traditional long-term calcium hydroxide apexification procedures, nonsurgical one step apexification using an array of materials such as mineral trioxide aggregate (MTA) has been suggested. However, adequate compaction of MTA in teeth with wide open apices can be an arduous task, and an internal matrix is required for controlled placement of MTA against which obturating material can be condensed. Platelet-rich fibrin (PRF), a second generation platelet concentrate containing several growth factors that promotes hard and soft-tissue healing, has been used as an internal matrix to create an apical plug of MTA and hence prevent extrusion of filling materials. This case series presents the endodontic management of immature permanent teeth with open apices using internal matrix of autologous PRF membrane and one step apical barrier placement of MTA.

Mineral trioxide aggregate apical plug method for the treatment of nonvital immature permanent maxillary incisors: Three case reports

Treatment of nonvital immature permanent teeth with calcium-hydroxide is associated with some difficulties such as weakened tooth fracture, root canal reinfection and long treatment time. Mineral trioxide aggregate (MTA) apical plug method is an alternative treatment option for open apices, and has gained popularity in the recent times. In this case report, we have attempted to present successful treatment of three maxillary incisors with open apices and periapical lesions with MTA. After preparing the access cavity, the working length was determined. The root canals were irrigated with 2.5% Sodium hypochlorite (NaOCl) and disinfected with calcium-hydroxide for two weeks. MTA was then placed in the apical 3 millimeters of the root canal. The remaining part of the root canal was filled with gutta-percha and the coronal restoration was finished with composite resin. After six months the radiographic examination showed a decrease of periapical lesions. At a 1-year and 18-months follow up, radiological and clinical successful healing of the incisor teeth was seen. MTA seems as an effective material for the apical plug method for the treatment of nonvital immature permanent teeth with open apices.

Nonsurgical management of periapical lesions

Periapical lesions develop as sequelae to pulp disease. They often occur without any episode of acute pain and are discovered on routine radiographic examination. The incidence of cysts within periapical lesions varies between 6 and 55%. The occurrence of periapical granulomas ranges between 9.3 and 87.1%, and of abscesses between 28.7 and 70.07%. It is accepted that all inflammatory periapical lesions should be initially treated with conservative nonsurgical procedures. Studies have reported a success rate of up to 85% after endodontic treatment of teeth with periapical lesions. A review of literature was performed by using electronic and hand searching methods for the nonsurgical management of periapical lesions. Various methods can be used in the nonsurgical management of periapical lesions: the conservative root canal treatment, decompression technique, active nonsurgical decompression technique, aspiration-irrigation technique, method using calcium hydroxide, Lesion Sterilization and Repair Therapy, and the Apexum procedure. Monitoring the healing of periapical lesions is essential through periodic follow-up examinations.

Endodontic treatment of bilateral dens evaginatus premolars with large periapical lesions

Dens evaginatus is a developmental anomaly characterized by the presence of an accessory cusp composed of enamel and dentine, usually containing pulp tissue. This condition is clinically important because of fracture or wear of the tubercle, which can frequently lead to the major complication of pulp necrosis and periapical infection. Treatment varies according to pulp condition, tubercle integrity, and stage of root development. Here we report a case of bilateral dens evaginatus with large periapical lesions. Non-surgical root canal treatment using calcium hydroxide medication was performed for both mandibular second premolars. At the 3-year postoperative recall examination, the teeth were asymptomatic and radiographically showed healing of the periapical lesions.

Apical closure of immature molar roots: a rare case report

This is a rare case report of apexification in an immature permanent mandibular first molar. Calcium hydroxide was used for apical root closure of both the mesial and distal canals. Root closure occurred after 13 months following which obturation of the tooth was completed.

Periapical lesions accidentally filled with calcium hydroxide

AIM

To evaluate the effect of accidental and voluminous calcium hydroxide overextensions into periradicular lesions and tissues on the prognosis of periapical healing.

SUMMARY

Eleven cases with periapical lesions and voluminous calcium hydroxide overextension are presented. Despite literature reports on the deleterious effects of calcium hydroxide extension in the periapical area, none of the endodontic treatments failed and surgical intervention was not indicated.

KEY LEARNING POINTS

Extensive extrusion of calcium hydroxide into the periapical tissues does not appear to comprise periapical healing. Despite this finding, the deliberate extrusion of dental materials into the apical tissues is not advocated.

Calcium hydroxide pastes: classification and clinical indications

REVIEW ARTICLE: Calcium hydroxide has been used in endodontology for many years. The aim of this paper is to review the various formulations of calcium hydroxide that have been described, with specific reference to the vehicle used to carry the compound. The requirements for a vehicle are described, and ex vivo and in vivo studies reviewed. Vehicles can be classified into aqueous, viscous and oily, the clinical properties of calcium hydroxide changing depending on the vehicle. The review also describes the use of various active components that have been added to calcium hydroxide, including antimicrobial and anti-inflammatory agents. This review will help clinicians to make informed judgements about which formulations of calcium hydroxide should be used for specific endodontic procedures.

Formation of crystals on the surface of calcium hydroxide-containing materials in vitro

The purpose of the present study was to examine the surface of calcium hydroxide-containing materials when treated in different in vitro conditions. Five calcium hydroxide-containing materials (Dycal, Nu-Cap, Life, Sealapex, and Apexit) and two control calcium hydroxide-free materials (Roth 811 and AH26) were tested. The materials were placed onto Teflon discs or root dentin samples; maintained in distilled water or phosphate-buffered saline, or culture medium supplemented or not supplemented with fetal calf serum; incubated at 37 degrees C in humidified atmosphere containing or not containing 5% CO2; and examined by scanning electron microscope. The results demonstrated precipitation of simple crystal units or organized crystalline structures in the calcium hydroxide-containing specimens treated in all experimental conditions, except those maintained in distilled water without 5% CO2. X-ray elemental microanalysis of the different crystalline structures showed one or two peaks corresponding to calcium or calcium and phosphorus. These data indicate that the crystals formed by reactions of calcium ions released from the calcium hydroxide-containing materials with the environmental ions might modify the material surface, especially in the presence of substrate adhesion molecules, such as fibronectin. This modification might play an important role in the regulation of cell adhesion and the initiation of new matrix synthesis.

Periapical repair and apical closure of a pulpless tooth using calcium hydroxide

A case with a wide-open apex and a large cystlike periapical lesion in an adult is presented. The lesion formed as a result of necrosis from trauma to a maxillary central incisor 12 years ago. After nonsurgical endodontic treatment with calcium hydroxide paste and a calcium hydroxide-containing root canal sealer, apical closure and significant healing of the periapical lesion within 15 months were observed. This report suggests that even large periapical lesions (likely cystic) could respond favorably to nonsurgical treatment.

Endodontic treatment of teeth with apical periodontitis using calcium hydroxide: a long-term study

The aim of this study was to evaluate clinically and radiographically the long-term results of endodontic therapy. A total of 172 mature teeth with periapical radiolucencies with and without symptoms were treated endodontically using calcium hydroxide paste as the intracanal medicament and a calcium hydroxide containing root canal sealer. In 58 teeth, the dressing was accidentally or intentionally extruded into the lesions. All cases were followed up for a period of 2-5 years. The teeth in which the dressing was extruded did not show a different healing pattern from the ones treated conventionally. The complete healing rate for all cases was 80.8% while incomplete healing had taken place in 7.6% of the cases.