The success rate of apexification is primarily determined by multiple factors,including the material used,the size of the open apex compared to the length of the root,and the technique used in each case.The main objec...The success rate of apexification is primarily determined by multiple factors,including the material used,the size of the open apex compared to the length of the root,and the technique used in each case.The main objective of this review was to provide an update on the present management of open apex to identify factors and circumstances that may influence the success of apexification using different materials and techniques.Future research on apexification should focus on how to treat open apices with wide periapical lesions without surgery.Previously,the predictability of these parameters with non-surgical procedures was uncertain,but now,with the use of a dental operating microscope,it has become more predictable.Another reason could be that extra visits are no longer required due to major advances in the armamentarium and materials used for apexification.展开更多
BACKGROUND Advanced materials and techniques are used to successfully manage the apexification of immature teeth with open apices.The use of mineral trioxide aggregate(MTA),bioceramic sealers,and sodium hypochlorite(N...BACKGROUND Advanced materials and techniques are used to successfully manage the apexification of immature teeth with open apices.The use of mineral trioxide aggregate(MTA),bioceramic sealers,and sodium hypochlorite(NaOCl),combined with internal heating and ultrasonic activation,ensures that canals are cleaned,disinfected,and sealed properly.Magnification devices,such as dental operating microscopes(DOM),provide precise visualization for accurate material placement,while the micro apical placement system ensures void-free MTA delivery.This modern approach improves procedural outcomes,lowers iatrogenic errors,and increases long-term success in apexification,making it a dependable and predictable treatment option for immature teeth.CASE SUMMARY Apexification is a regenerative endodontic procedure that involves creating a calcified barrier at the apex of a nonvital tooth with an open apex.This technique is commonly used in immature teeth with necrotic pulps to ensure proper root canal sealing.Traditionally,calcium hydroxide was the preferred material,but advances have introduced bioceramic cements like MTA or Biodentine,which provide superior results with less treatment time.Apexification not only helps to maintain the tooth's structural integrity but also prevents further complications,making it an important procedure in such cases.CONCLUSION This case demonstrates the effectiveness of integrating advanced materials,precise irrigation protocols,and magnification tools in the apexification of immature teeth with open apices.The use of MTA created a stable apical barrier,while bioceramic sealers enhanced the seal and promoted long-term healing.NaOCl with internal heating,ultrasonic activation,and double-sided vented needles ensured thorough irrigation and disinfection,especially in complex canal anatomy.展开更多
BACKGROUND The management of immature permanent teeth with open apices in pediatric patients presents unique challenges,particularly in cases of nonvital pulp.Modern advancements in materials and techniques have signi...BACKGROUND The management of immature permanent teeth with open apices in pediatric patients presents unique challenges,particularly in cases of nonvital pulp.Modern advancements in materials and techniques have significantly improved the predictability and success of apexification procedures.In this case,a 16-yearold patient presented with an immature necrotic tooth requiring apexification.Contemporary approaches incorporate calcium silicate-based materials such as mineral trioxide aggregate(MTA),Biodentine,and bioceramic putty,along with bioceramic sealers and enhanced canal cleaning including internal heating and ultrasonic activation with sodium hypochlorite(NaOCl)for disinfection,and sealing.Additionally,magnification tools such as dental operating microscopes ensure precise visualization for accurate material placement,while a micro-apical placement(MAP)system guarantees void-free MTA delivery.These advancements improve procedural outcomes and minimize the risk of iatrogenic errors,making apexification a more predictable and reliable treatment option in pediatric patients with immature teeth.CASE SUMMARY A 16-year-old patient presented with a nonvital maxillary central incisor with an open apex,secondary to trauma.Due to the lack of apical closure,traditional root canal obturation was not feasible.Apexification was chosen as the treatment modality to induce the formation of a calcified apical barrier,allowing for proper root canal sealing.Historically,calcium hydroxide was the material of choice for apexification,requiring multiple visits and prolonged treatment duration.However,the introduction of bioceramic materials such as MTA has revolutionized the procedure,offering superior outcomes with reduced treatment time.In this case,the apexification procedure involved thorough canal disinfection using NaOCl,enhanced by internal heating,ultrasonic activation,and double-sided vented needle irrigation.Under the dental operating microscope,MTA was precisely placed at the apex using a MAP system,ensuring a dense,void-free apical barrier.The remaining canal space was subsequently sealed with a bioceramic sealer to promote long-term stability and healing.CONCLUSION This case highlights the effectiveness of a modern approach for apexification in a pediatric patient.The use of advanced materials and techniques facilitated the formation of a stable apical barrier,ensuring long-term tooth retention and function.By incorporating precise irrigation protocols,internal heating,ultrasonic activation,and magnification tools,the treatment achieved thorough disinfection and optimal material placement.These advancements make apexification a predictable and reliable treatment option for young patients with immature necrotic teeth,preserving their natural dentition and preventing future complications.展开更多
One-step apexification using mineral trioxide aggregate(MTA) has been reported as an alternative treatment modality with more benefits than the use of long-term calcium hydroxide for teeth with open apex.However,ortho...One-step apexification using mineral trioxide aggregate(MTA) has been reported as an alternative treatment modality with more benefits than the use of long-term calcium hydroxide for teeth with open apex.However,orthograde placement of MTA is a challenging procedure in terms of length control.This case series describes the sequence of events following apical extrusion of MTA into the periapical area during a one-step apexification procedure for maxillary central incisor with an infected immature apex.Detailed long-term observation revealed complete resolution of the periapical radiolucent lesion around the extruded MTA.These cases revealed that direct contact with MTA had no negative effects on healing of the periapical tissues.However,intentional MTA overfilling into the periapical lesion is not to be recommended.展开更多
Introduction: The endodontic management of necrotic permanent immature teeth is a challenge for the practitioner. These teeth are treated by apexification. However, because of the complications associated with this tr...Introduction: The endodontic management of necrotic permanent immature teeth is a challenge for the practitioner. These teeth are treated by apexification. However, because of the complications associated with this treatment, researchers have developed other therapies. Currently, a new technique called pulp revascularization has emerged. This technique allows the continuation of root completion thanks to a healthy tissue newly formed at the intra root canal level. Material and method: A literature search of articles dealing with pulp revascularization of immature permanent teeth was conducted using two types of search strategy, a literature search using keywords on databases and then a manual “bottom-up” search of references of previously identified articles. Results: 112 articles were identified based on inclusion and exclusion criteria. Discussion: This work showed that pulp revascularization is a new therapy that aims to restart root development on an immature permanent tooth. It is based on the principle of tissue engineering and uses the differentiation potential of stem cells. Conclusion: Currently, the literature values revascularization as it allows root development, sidewall thickening, apical closure and a decrease in periapical lesion and ensures a good sealing. Clinical and radiographic success rates appear to be encouraging, except that factors influencing treatment must be taken into consideration.展开更多
文摘The success rate of apexification is primarily determined by multiple factors,including the material used,the size of the open apex compared to the length of the root,and the technique used in each case.The main objective of this review was to provide an update on the present management of open apex to identify factors and circumstances that may influence the success of apexification using different materials and techniques.Future research on apexification should focus on how to treat open apices with wide periapical lesions without surgery.Previously,the predictability of these parameters with non-surgical procedures was uncertain,but now,with the use of a dental operating microscope,it has become more predictable.Another reason could be that extra visits are no longer required due to major advances in the armamentarium and materials used for apexification.
文摘BACKGROUND Advanced materials and techniques are used to successfully manage the apexification of immature teeth with open apices.The use of mineral trioxide aggregate(MTA),bioceramic sealers,and sodium hypochlorite(NaOCl),combined with internal heating and ultrasonic activation,ensures that canals are cleaned,disinfected,and sealed properly.Magnification devices,such as dental operating microscopes(DOM),provide precise visualization for accurate material placement,while the micro apical placement system ensures void-free MTA delivery.This modern approach improves procedural outcomes,lowers iatrogenic errors,and increases long-term success in apexification,making it a dependable and predictable treatment option for immature teeth.CASE SUMMARY Apexification is a regenerative endodontic procedure that involves creating a calcified barrier at the apex of a nonvital tooth with an open apex.This technique is commonly used in immature teeth with necrotic pulps to ensure proper root canal sealing.Traditionally,calcium hydroxide was the preferred material,but advances have introduced bioceramic cements like MTA or Biodentine,which provide superior results with less treatment time.Apexification not only helps to maintain the tooth's structural integrity but also prevents further complications,making it an important procedure in such cases.CONCLUSION This case demonstrates the effectiveness of integrating advanced materials,precise irrigation protocols,and magnification tools in the apexification of immature teeth with open apices.The use of MTA created a stable apical barrier,while bioceramic sealers enhanced the seal and promoted long-term healing.NaOCl with internal heating,ultrasonic activation,and double-sided vented needles ensured thorough irrigation and disinfection,especially in complex canal anatomy.
文摘BACKGROUND The management of immature permanent teeth with open apices in pediatric patients presents unique challenges,particularly in cases of nonvital pulp.Modern advancements in materials and techniques have significantly improved the predictability and success of apexification procedures.In this case,a 16-yearold patient presented with an immature necrotic tooth requiring apexification.Contemporary approaches incorporate calcium silicate-based materials such as mineral trioxide aggregate(MTA),Biodentine,and bioceramic putty,along with bioceramic sealers and enhanced canal cleaning including internal heating and ultrasonic activation with sodium hypochlorite(NaOCl)for disinfection,and sealing.Additionally,magnification tools such as dental operating microscopes ensure precise visualization for accurate material placement,while a micro-apical placement(MAP)system guarantees void-free MTA delivery.These advancements improve procedural outcomes and minimize the risk of iatrogenic errors,making apexification a more predictable and reliable treatment option in pediatric patients with immature teeth.CASE SUMMARY A 16-year-old patient presented with a nonvital maxillary central incisor with an open apex,secondary to trauma.Due to the lack of apical closure,traditional root canal obturation was not feasible.Apexification was chosen as the treatment modality to induce the formation of a calcified apical barrier,allowing for proper root canal sealing.Historically,calcium hydroxide was the material of choice for apexification,requiring multiple visits and prolonged treatment duration.However,the introduction of bioceramic materials such as MTA has revolutionized the procedure,offering superior outcomes with reduced treatment time.In this case,the apexification procedure involved thorough canal disinfection using NaOCl,enhanced by internal heating,ultrasonic activation,and double-sided vented needle irrigation.Under the dental operating microscope,MTA was precisely placed at the apex using a MAP system,ensuring a dense,void-free apical barrier.The remaining canal space was subsequently sealed with a bioceramic sealer to promote long-term stability and healing.CONCLUSION This case highlights the effectiveness of a modern approach for apexification in a pediatric patient.The use of advanced materials and techniques facilitated the formation of a stable apical barrier,ensuring long-term tooth retention and function.By incorporating precise irrigation protocols,internal heating,ultrasonic activation,and magnification tools,the treatment achieved thorough disinfection and optimal material placement.These advancements make apexification a predictable and reliable treatment option for young patients with immature necrotic teeth,preserving their natural dentition and preventing future complications.
基金supported by the National Research Foundation(NRF) of Koreafunded by the Ministry of Education,Science and Technology(MEST) (No.2011-0014231,Dr.Seok-Wood Chang),Korea
文摘One-step apexification using mineral trioxide aggregate(MTA) has been reported as an alternative treatment modality with more benefits than the use of long-term calcium hydroxide for teeth with open apex.However,orthograde placement of MTA is a challenging procedure in terms of length control.This case series describes the sequence of events following apical extrusion of MTA into the periapical area during a one-step apexification procedure for maxillary central incisor with an infected immature apex.Detailed long-term observation revealed complete resolution of the periapical radiolucent lesion around the extruded MTA.These cases revealed that direct contact with MTA had no negative effects on healing of the periapical tissues.However,intentional MTA overfilling into the periapical lesion is not to be recommended.
文摘Introduction: The endodontic management of necrotic permanent immature teeth is a challenge for the practitioner. These teeth are treated by apexification. However, because of the complications associated with this treatment, researchers have developed other therapies. Currently, a new technique called pulp revascularization has emerged. This technique allows the continuation of root completion thanks to a healthy tissue newly formed at the intra root canal level. Material and method: A literature search of articles dealing with pulp revascularization of immature permanent teeth was conducted using two types of search strategy, a literature search using keywords on databases and then a manual “bottom-up” search of references of previously identified articles. Results: 112 articles were identified based on inclusion and exclusion criteria. Discussion: This work showed that pulp revascularization is a new therapy that aims to restart root development on an immature permanent tooth. It is based on the principle of tissue engineering and uses the differentiation potential of stem cells. Conclusion: Currently, the literature values revascularization as it allows root development, sidewall thickening, apical closure and a decrease in periapical lesion and ensures a good sealing. Clinical and radiographic success rates appear to be encouraging, except that factors influencing treatment must be taken into consideration.
