Revascularization in Immature and Mature Teeth with Necrotic Pulp: A Clinical Study

AIM

The aim of this in vivo study was to evaluate the revascularization procedure both in immature and mature teeth with necrotic pulp and open apices, disinfected with triple antibiotic paste followed by inducing blood clot in the root canal.

MATERIALS AND METHODS

Fifteen patients were selected who presented with immature and mature permanent teeth with pulpal necrosis and open apices. In the first visit, the root canal was accessed with LA and rubber dam isolation; then the canal was disinfected using triple antibiotic paste containing ciprofloxacin, metronidazole, and clindamycin in the ratio of 1:1:1 and closed with IRM. In the second visit, after administering local anesthesia and isolating with a rubber dam, the triple antibiotic paste was washed out by saline irrigation, and apical papilla beyond the confines of the root canal was stimulated with sterile H file to produce a blood clot. Finally, the access was closed using a double seal with mineral trioxide aggregate (MTA) placed apical to cementoenamel junction and resin bonded cement over the MTA. Radiographic examination and pulp sensibility test was done during the follow-up period of 2,4,6,8 and 10 months.

RESULT

After 10 months follow-up, 10 out of 13 patients showed root development and apical closure. The eight patients out of 13 showed root development, apical closure and lateral thickening of radicular dentin and 2 out of 13 patients showed a positive response to electric sensibility test.

CONCLUSION

Within the limitation of this study, it can be concluded that there is evidence of root development, increase in lateral wall thickness, apical closure and positive response to pulp sensibility test in both mature and immature teeth with necrotic pulp.

CLINICAL SIGNIFICANCE

The conventional approach for management of teeth with necrotic pulp and the open apex is altered with the possibility of tissue regeneration within the pulp space and continued root development through revascularization procedures. It also re-establishes the vitality in a previously nonvital and necrosed tooth.

A comparative evaluation on the cleaning and shaping ability of three nickel titanium rotary instruments using computerized tomography - An ex vivo study

Introduction:

Successful root canal treatment depends primarily on the removal of micro-organisms through chemo-mechanical instrumentation of the root canal system. This encompasses shaping by mechanical removal of the dentine and cleaning by chemical disinfection of microorganisms and dissolution of organic tissues from the root canal. While root canal shaping can be predictably and efficiently attained with advanced instrumentation technology, effective cleaning of the entire root canal system remains a challenge. Rotary nickel titanium instruments are known for their efficient preparation of root canal. This is mainly because of the super elasticity of the nickel titanium alloy which gives an increased flexibility and allows the instrument to efficiently follow the original path of root canal. The purpose of this study is to compare the cleaning efficiency and shaping ability of M two, K3, Race ni-ti rotary instruments during the preparation of curved canals in extracted molars.

Materials and Methods:

Thirty teeth with 18 mm as their working length were selected and divided into three groups of 10 teeth each Angle of curvature, Radius of curvature, was determined using computerized tomography. A Pre and Post-operative measurement of canal width and volume was recorded and compared using CT. The teeth was then sectioned into two halves and subjected to scanning electron microscope. Images were taken at the level of apical third, middle third and coronal third for debris and smear layer. Scoring was done separately for both debris and smear layer.

Results:

Results were tabulated and statistically analyzed to evaluate the shaping ability and cleaning efficiency. Instruments were examined for any deformation or fracture during canal preparation.

Conclusion:

M two showed greater enlargements in all the three levels, when compared its width and volume, with other two instruments. K3 was better than Race when compared among them. In the scanning electron microscope study for debris and smear layer M Two performed better followed by K3 and Race.