Endodontics of the traumatised immature incisor Flashcards
what is the definition of an immature permanent incisor?
> one where the apex can be considered to be open
what is the sequence of root growth from the crown to the apex of a tooth?
divergent > Parallell > convergent
what are the challenges of a non-vital immature tooth?
> Compromised crown root ratio
> Thin root dentine walls
> Lack of dentinal stop against which root canal materials can be condensed
what is the name of Endodontics which is carried out in a non vital immature tooth to close the root?
> apexification
what is apexification?
> RCT of these non vital teeth requires a root end closure technique to form a barrier at apex to enable a root filling to be condensed without going through apex
> old - Calcium hydroxide therapy to induce barrier
> new - Artificial plug (MTA)
what is the difference between apexification and apexogenesis?
> apexogenesis aim is to maintain vitality and allow continued root growth (vital pulpotomy)
what is the diagnostic pathways for loss of vitality?
> Signs + Symptoms
- Pain, swelling, sinus, TTP, mobility, colour change
> Radiographic examination
- Periapical radiolucency (PAP), arrest of root development
> Sensibility tests
- Negative
> Any doubt of loss of vitality - delay endo Rx
Review 3 mths
Better prognosis if no acute abscess
how is an emergency treatment for an acute abscess carried out?
> Ideally full extirpation of pulp and dress with non-setting Calcium Hydroxide paste
> But if acutely tender
- Prescription
- Arrange appt 24 – 48 hrs
- Sedative dressing – e.g. odontopaste
what are the aims of CH apexification?
> Creation of a calcific barrier across the root apex
> Allows obturation of canal
what is the method of CH apexification?
> Achieved by repeated dressing of non-setting Calcium hydroxide at 3-6 monthly intervals
> Once barrier achieved remainder of canal obturated with thermoplastic GP
> Average 9 months to form up to 3 years
what is the plug made out of?
> coarse osteocementum material
what is the success of CH Apexification?
> 90% apical closure
> 85% success at 5 years for adequate root filling
what are the disadvantages of CH apexification ?
> Multiple visits
> Lengthy treatment - may take up to 30 mths for barrier
> Difficult technique
> Position and quality of barrier unpredictable
> Discolouration
> increase brittleness (risk of cervical #)
> Expensive in terms
1. Clinical time
2. Parent’s time off work
3. Missed school
what is the clinical technique of creating an MTA barrier? (consent - interim root canal dressing)
> Consent
> Isolation
> Access cavity
> Widen cervical constriction (Gates Glidden)
> Extirpation of the pulp
> Estimation of full working length (1mm short of radiographic apex
.> Preparation of root canal, sterile water / 0.5% Milton
> irrigation (must avoid extrusion through apex)
> Needle loose and 2-3mm short of working length
> Dry the root canal
> Interim Root canal dressing (CH) +RMGI
is the access cavity in an immature tooth larger or smaller than a mature tooth?
> Triangular shaped access (apex towards gingival margin
> Larger than access cavity for mature tooth
