An innovative technique to safely perform active cleaning in teeth with open apices: CAB technique

Abstract

The current study aims to evaluate in vitro the extrusion of NaOCl, using an artificial root canal with an open apex, using different canal irrigation protocols. For this study, a transparent artificial root canal was used. The apex was shaped to be oversized and irregular in form. After root canal mechanical shaping, the artificial cylindrical chamber, which was made below the large apical foramen, was filled with fuchsine-stained bovine pulp tissue. Afterward, irrigation protocols were carried out and compared regarding their safety with regards to irrigant extrusion. Subsequently, the examiner created two groups, Group A: internal heating associated with ultrasonic activation and Group B: internal heating associated with ultrasonic activation, using the CAB technique. In both the groups, 5.25% sodium hypochlorite solution was used as the irrigant. Regarding assessing the presence or absence of the extrusion, photographs at ×20 were taken and analyzed. For the statistical analysis, a t -test for paired samples was used. Extrusion of irrigant beyond the apex was present only in Group A. The main objective of endodontic treatment is the removal of damaged tissues and bacteria. For this reason, active cleaning is crucial in all endodontic treatment cases. Internal heating followed with ultrasonic activation while using the CAB technique was an effective and safe technique to ensure no irrigant extrusion beyond the open apex.

Pulp regeneration treatment using different bioactive materials in permanent teeth of pediatric subjects

“…[ 21 ] Irrigant activation can consist of several methods, such as subsonic, sonic, and ultrasonic activation and preheating of the irrigant. [ 85 ]…”

“…[ 86 87 ] For this reason, the application of negative apical pressure has been proposed as a safer method for immature or open apices. [ 85 ] Even though applying negative pressure can minimize extrusion through the apical foramen,[ 24 ] this technique is not as powerful as the others in accessing the lateral anatomies. [ 85 ] In the case of immature teeth with open apices and periapical lesions, such as those found in this study in 86 teeth, one possibility could be the application of the CAB technique, which consists of the application of a collagen apical barrier, to ensure irrigant activation without risks of extrusion.…”

“…[ 85 ] Even though applying negative pressure can minimize extrusion through the apical foramen,[ 24 ] this technique is not as powerful as the others in accessing the lateral anatomies. [ 85 ] In the case of immature teeth with open apices and periapical lesions, such as those found in this study in 86 teeth, one possibility could be the application of the CAB technique, which consists of the application of a collagen apical barrier, to ensure irrigant activation without risks of extrusion. [ 85 ] It has also been demonstrated that including the diode laser in the AAE regenerative guidelines improved disinfection and periapical healing.…”

Cytotoxicity and Efficacy in Debris and Smear Layer Removal of HOCl-Based Irrigating Solution: An In Vitro Study

“…It has been reported that nearly half of endodontists experience an accidental irrigant extrusion into the periapical tissues at least once, and open root apices, either iatrogenic or anatomic, may impel the occurrence of irrigant extrusion [ 7 ]. Even though various irrigation and irrigant activation techniques have been proposed to avoid inadvertent irrigant extrusion [ 8 ], some limitations in terms of safety or cleaning effectiveness usually remain [ 9 ]. Therefore, the irrigating solution should be selected appropriately in these clinical cases and should exhibit a high efficacy in root canal disinfection and debridement, along with the absence of toxicity towards the periodontal tissues.…”

Revascularization of an Immature Permanent Tooth with Periapical Periodontitis Using Concentrated Growth Factor Assisted by Erbium Laser (2940 nm) Irrigation: A Case Report

“…Periapical periodontitis of immature permanent teeth is commonly caused by caries, trauma, or dens evaginatus. The cleaning, shaping, and obturating of the root canal system are challenging when treating infected pulp in immature permanent teeth [1]. Meanwhile, nonvital immature teeth have fragile dentinal walls, which are susceptible to fracture resulting in tooth extraction [2].…”