Bioceramics are materials which include Alumina,
Zirconia, Bioactive glass, Glass ceramics, Hydroxyapatite,
resorbable Calcium phosphates, among others. They have
been used in dentistry for filling up bony defects, root
repair materials, apical fill materials, perforation sealing,
as endodontic sealers and as aids in regeneration. They
have certain advantages like biocompatibility, non toxicity,
dimensional stability and most importantly in endodontic
applications, being bio-inert. They have a similarity to
Hydroxyapatite, an intrinsic osteo conductive activity and
have an ability to induce regenerative responses in the
human body. In Endodontics, they can be broadly classified
into Calcium Phosphate/ Tricalcium/ Hydroxyapatite based,
Calcium Silicate based or mixtures of Calcium Silicate
and Phosphates. This review focuses on an overview of
Bioceramics, classification and their advantages. It also
gives a detailed insight into individual bioceramic materials
currently used in the fields of Endodontics along with their
properties and applications.
Loss of pulp vitality in an immature permanent tooth arrests root development. This leads to tooth with open apex and weak lateral dentinal walls. Management of such necrotic teeth with immature roots poses several treatment challenges. The documented study was performed to evaluate and compare apexogenesis induced by revascularization, with and without platelet rich plasma (PRP) in non-vital, immature anterior teeth. Three patients having bilateral, non-vital, immature maxillary central incisors with apical periodontitis were recruited after institutional ethical clearance. Subsequent to chemo-mechanical preparation, revascularization with and without PRP was randomly induced in either of the tooth. The cases were followed-up clinically and radiographically at 6 and 12 months. There was a marked difference in periapical healing, apical closure and dentinal wall thickening of teeth treated by revascularization with PRP.
The present case report is the first of its kind that documents the successful outcome of “revascularization,” a regeneration-based treatment protocol in a mature adult patient. It belies the myth that “revascularization” should only be done in children and young, adolescent patients. The misconception that stem cells number as well as viability in older age group patients will not allow revascularization to be successful is also contradicted by this case. The paper highlights all the mechanisms that come into play and the enhancing of regenerative response by supplementation with platelet-rich plasma (PRP).
Caries or trauma induced non-vital immature permanent tooth with blunderbuss, thin root which are very common among childrens are corrected using regenerative endodontic (revascularization) procedures. In the presented case, a 16-year-old boy reported with chief complaint of pain in maxillary left central incisor (Tooth #21). Tooth #21 showed grade III mobility, draining labial sinus, and short blunderbuss root with diffuse periapical radiolucency. Patient was explained the treatment plan and written informed consent was taken. Platelet rich fibrin (PRF) was prepared according to standard protocol. Autologous PRF was carried to the apical portion of the root canal after inducing revascularization. Access opening was double sealed with MTA and resin modified glass ionomer cement (RMGI). Baseline, 12 month and 18 month follow-up intraoral radiographs were taken. Clinically case was asymptomatic with complete resolution of intraoral sinus. Periapical healing, apical closure, root lengthening and dentinal wall thickening were uneventful. Thus PRF supplementation hastens the predictability and rate of revascularization in non-vital immature permanent teeth.
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