JOVD 2008: Endodontic Tx of a Non-Vital permanent Tooth with Open Root Apex Using MTA Flashcards

1
Q

Authors?

A

S. Juriga

S. Manfra

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2
Q

Difference between Apexogenesis and Apexification?

Goal of apexification?

A
  • Apexogenesis: Physiological formation of the apex of a vital tooth
  • Apexification (APN): Procedure to promote apical closure of a nonvital tooth
    • Goal: to provide a hard tissue barrier that will provide an apical stop for effective obturation of the canal allowing the patient to retain the tooth
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3
Q

What was the initial patient condition in this case report?

What were the steps of the APN procedure in this case report?

A

Young cat with traumatic immature permanent 104 with pulp necrosis and chronic periradicular periodontitis

Procedure: 2 visits-tx

  • 1st visit:
    • Determined WL (15 K-File)
    • Gentle circumferential filing of canal (C-prep); flush NaOCl 2.5 % warm between files (blunt tip needle, 1.5mm short of apex, in-and-out motion)
    • Canal soak NaOCl 5% x 5 min; 17% EDTA should have been used to remove smear layer; rinse sterile water
    • Plugger selection (1.5mm short of apex)
    • 5mm MTA placement (1mm increment with plugger; x-ray confirm); ppt moistened place over MTA then removed
    • Temporary restoration with GI cement
  • 2nd visit (4 hours or more after MTA; here 4 days)
    • Remove coronal restoration with round bur
    • Flush canal 2.5% NaOCl
    • Determined WL (15 K-file)
    • Flush sterile saline; dried with ppt
    • Obturation: Thermoplasticized GP vertial compaction
    • Coronal restoration
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4
Q

At what level should the MTA plug be placed?

A
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5
Q

Can this procedure be done as a 1-visit Tx?

A

Yes

Can do a 1 visit technique by adding a barrier of self curing GI over the top of the MTA and then obturating immediately

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6
Q

What could have been done differently to improve the procedure?

A
  • Warm (37C) irrigant
  • Removal of smeal layer with 17% EDTA
  • Placement of MTA with Ultrasonic (should place resorbable barrier collagen foam to prevent extrusion of MTA)
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7
Q

What was the follow-up?

A

Radiographic reevaluation 6 months post-tx

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8
Q

Disadvantages of Calcium hydroxide?

A
  • unpredictability of apical closure (success rates 74-100%)
  • variability in treatment time (5-20 months in human)
  • number of appointments/patient (owner) compliance/difficulty in patient follow-up
  • weakened root dentin with long-term calcium hydroxide
  • delayed treatment/leakage of temporary restoration/recurrence of infection
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9
Q

Advantages of MTA?

A
  • biocompatible
  • non-cytotoxic
  • set in the presence of moisture or blood (hydrophylic)
  • bacteriocidal effects
  • adequate seal of root canal (prevent bact. leakage)
  • allows undifferentiated cells to transform into fibroblast, cementoblast and osteoblast to regenerate the original periradicular tissues (cementum and bone)
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10
Q

What is the composition of MTA?

A

tricalcium silicate, tricalcium aluminate, tricalcium oxide, and silicate oxide

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11
Q

What irrigation agents can be used?

A

Ideal agent: debride; disinfect with sustained antimicrobial effect; lubricant, dissolve tissues left in canal, non-toxic, non-antigenic, non-carcinogenic

Use endo needle 1-2mm from apex; passive pressure

  • NaOCl (0.5-5.25%): best antibacterial and dissolve tissues; 2.5% large and frequent flush; do not dissolved smear layer so need EDTA flush
  • Chlorhexidine gluconate (0.2-2%): Less effective disinfectant and no dissolving properties but les cytotoxic than NaOCl; absorb into dentin and release for prolong effect
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