Non‐vital immature permanent incisors: factors that may infIuence treatment outcome

Abstract

This study examines the treatment of non-vital immature permanent incisors using the calcium hydroxide apexification technique. The objectives of the present study were to determine the speed and location of barrier formation and those factors discernible at presentation and during treatment which may be related to it. Forty-four non-vital immature incisors undergoing calcium hydroxide apexification were reviewed in detail. All cases were reviewed every 8-12 weeks for up to 18 months, or until apexification occurred. Details of the time and nature of the injuries and treatment were recorded. The degree of apical development prior to treatment was assessed, and barrier formation, location and time were noted. Mean time to barrier formation was 34.2 weeks (range 13-67 weeks). The strongest predictor of rapid barrier formation was the rate of change of calcium hydroxide and a barrier also formed more rapidly in cases with narrower initial apical width. There was evidence of displacement and a higher mean time for barrier formation in half of the cases. The presence of an abscess was the weakest predictor of rapid barrier formation and the effect was not significant (P = 0.280). The barrier was located at the apex in 28 cases (63.6%) and the distance from the barrier to the apex for the remaining 16 (36.4%) varied from 1 mm to 5 mm. The number of placements of calcium hydroxide varied from 1 to 4 with a mean of 1.9, and there was a higher mean number of calcium hydroxide placements in the cases where the barrier was located at the apex.

Alkaline phosphatase activity assessment of two endodontic materials: a preliminary study

“…In conventional apexification, an osteoinductive material is placed into the canal and replaced periodically until a hard tissue barrier is formed. This process may take between 13-67weeks (2). The long duration needed for treatment and repeated replacement of canal Origina.l Article medicaments would have implications on strength of tooth (3).…”

Weakened anterior roots – intraradicular rehabilitation

“…Closure may not happen at all in cases that have suffered displacement injuries 7 or when a periapical abscess develops. 8 Undiagnosed horizontal or vertical root fractures may also prevent successful treatment. 6 One-visit apexification An alternative to apexification over multiple visits has been the placement of a biocompatible material into the apical part of the root canal.…”

“…The root canal must be completely filled with calcium hydroxide to ensure that the material is in contact with the periapical tissues otherwise a calcific barrier may not occur, or occur at a more coronal level. 8 This widely accepted technique has its disadvantages including the fact that the calcium hydroxide paste must be changed every three to six months until a calcific barrier can be detected. 6,8 The time taken for closure is variable, ranging from five to 19 months.…”

“…8 This widely accepted technique has its disadvantages including the fact that the calcium hydroxide paste must be changed every three to six months until a calcific barrier can be detected. 6,8 The time taken for closure is variable, ranging from five to 19 months. 9 This requires multiple visits over a long period of time, which some younger patients may find inconvenient.…”

“…Despite this, the success rate of apexification has been reported as 74-96%. [9][10][11] It has been suggested by some authors that an apical barrier will form quicker in cases where the calcium hydroxide is changed more often, 8 while others believe that this may in fact disturb the mineralisation process. 9 According to Ghose et al (1987) 9 and Kleier and Barr (1991) 6 the rate of closure does not appear to be related to the size of the apical opening.…”