Endodontic management of nonvital permanent teeth having immature roots with one step apexification, using mineral trioxide aggregate apical plug and autogenous platelet-rich fibrin membrane as an internal matrix: Case series

Abstract

A tooth with blunderbuss canal and open apex can be an endodontic challenge because of difficulty in obtaining an apical seal, and existing thin radicular walls which are susceptible to fracture. To overcome the limitations of traditional long-term calcium hydroxide apexification procedures, nonsurgical one step apexification using an array of materials such as mineral trioxide aggregate (MTA) has been suggested. However, adequate compaction of MTA in teeth with wide open apices can be an arduous task, and an internal matrix is required for controlled placement of MTA against which obturating material can be condensed. Platelet-rich fibrin (PRF), a second generation platelet concentrate containing several growth factors that promotes hard and soft-tissue healing, has been used as an internal matrix to create an apical plug of MTA and hence prevent extrusion of filling materials. This case series presents the endodontic management of immature permanent teeth with open apices using internal matrix of autologous PRF membrane and one step apical barrier placement of MTA.

Conservative management of discolored maxillary central incisor with open apex using Mineral Trioxide Aggregate (MTA) apical plug and walking bleach Method: A case report.

“…[14] Sharma et al conducted a case series and concluded that a combination of PRF (Platelet-rich fibrin) as a matrix and MTA as an apical plug or artificial apical barrier. [15] Now we can calibrate the diameter of open apex in cubic millimeter by CBCT (cone beam computed tomography), Spiral CT (computed tomography), and Ultrasound also confirmed the nature of the periapical tissues. [16] Novel bio regenerative and highly biocompatible material like MTA (calcium silicate) based single-visit apexification can be a better option for open apex cases to achieve a higher success rate in today's scenario.…”

Revascularization and vital pulp therapy in immature molars with necrotic pulp and irreversible pulpitis: A case report with two‐year follow‐up

“…24 However, since an immature permanent tooth has thin root dentin walls, this treatment plan is challenging. 25 In addition, there is increasing number of studies on vital pulp therapy of immature teeth with irreversible pulpitis that have demonstrated successful outcome. 9,10,26 Therefore, we selected pulpotomy as a vital pulp therapy procedure to treat the immature left molar.…”

“…Traditionally, it is regarded as an indication of root canal treatment (RCT) . However, since an immature permanent tooth has thin root dentin walls, this treatment plan is challenging . In addition, there is increasing number of studies on vital pulp therapy of immature teeth with irreversible pulpitis that have demonstrated successful outcome .…”

Interaction of backfilling techniques and MTA plugs with additives: Fracture strength and adaptation analyses

“…This treatment technique has been accomplished in several case reports by placing MTA plugs with a thickness of 3-5 mm and obturating the remaining root canal portion with cold lateral or warm vertical compaction techniques [16][17][18][19] . Both obturation techniques may create different stresses and wedging effects inside the root canal system 20,21) , thus may affect the marginal adaptation of apical plugs and also the fracture resistance of endodontically treated immature teeth.…”