Management of the Open Apex using New Biomaterials

Abstract

At the time of root development, trauma or caries results in tooth with immature and open root apices. The single most important factor that affects the success of endodontics is achievement of perfect apical seal. Apexification is done to achieve an apical barrier against which the obturating material can be condensed. Nowadays due to new advancements in materials and methods, single-visit apexification as compared with long and multiple visits (calcium hydroxide apexification) has gained popularity. With the new bioceramic materials like mineral trioxide aggregate (MTA) and Biodentine, perfect seal can be achieved much more easily and effectively. Various treatment modalities are present to treat immature open root apices. Retrograde root end filling by surgical intervention provides faster healing of the associated lesions. Both MTA and Biodentine promise to be quite reliable retrograde filling materials. In the following case reports, apexification using different treatment modalitiesnewer biomaterials-is explained.

Comparison of Mineral Trioxide Aggregate and Biodentine for Open Apex Management in Children with Nonvital Immature Permanent Teeth: A Systematic Review

“…3 The most common etiology for incomplete root formation would be pulp necrosis due to trauma or dental caries. 4 The challenges faced by the practitioner in open apex situations are difficulty in root canal debridement, lack of apical stop that threatens quality obturation, and thin root canals that have a high risk of fracture. 5 The herculean task during management of such case scenarios is forming an apical barrier which can provide a strong hermetic seal that can aid in a good obturation of the root canal.…”

“…[24][25][26] A vast diversity of materials have been used to induce apical barrier formation for the past two decades like calcium hydroxide, resorbable ceramic, freeze-dried cortical bone, freeze-dried dentin, dentinal shavings, mineral trioxide aggregate (MTA), bone morphogenetic protein, and biodentine. 4,27 Calcium hydroxide was first introduced by Kaiser for apical closure which was later popularized by Frank. But it had disadvantages of prolonged treatment duration, likelihood for reinfections, and susceptibility to tooth fracture.…”