Cytotoxicity of intracanal dressings on apical papilla cells differ upon activation with E. faecalis LTA

Abstract Objective The aim of this study was to investigate the cytotoxic effects of modified triple antibiotic paste and an experimental composition using calcium hydroxide on lipoteichoic acid (LTA)-primed apical papilla cells (APC). Material and Methods Human APC were tested for in vitro cytotoxicity of modified Triple Antibiotic Paste (mTAP - Ciprofloxacin, Metronidazole and Cefaclor at 1:1:1) and of a paste of Ciprofloxacin, Metronidazole and Calcium hydroxide (CMC - 1:1:2) and modified CMC (mCMC - 2:2:1) by using MTT assay. The substances were reconstituted in DMEM at 1,000 µg/mL and » serially diluted before being kept in contact with cells for 1, 3, 5 and 7 days. Further, cells were primed with 1 µg/mL of Enterococcus faecalis LTA for 7 days prior to the viability test with 1,000 µg/mL of each substance. Statistical analysis was performed using one-way analysis of variance (ANOVA) and two-way ANOVA respectively followed by Tukey's post-test. Significance levels were set at p<0.05. Results In the first assay, the higher cytotoxic rates were reached by mTAP for all experimental periods. CMC was found toxic for APC at 5 and 7 days, whereas mCMC did not affect the cell viability. Only CMC and mCMC were able to induce some cellular proliferation. In the second assay, when considering the condition with medium only, LTA-primed cells significantly proliferated in comparison to LTA-untreated ones. At this context, mTAP and CMC showed similar cytotoxicity than the observed for LTA-untreated cells, while mCMC was shown cytotoxic at 7 days only for LTA-primed APC. Comparing the medications, mTAP was more cytotoxic than CMC and mCMC. Conclusion mTAP showed higher cytotoxicity than CMC and mCMC and the effect of topic antimicrobials might differ when tested against apical papilla cells under physiological or activated conditions.

Light curing resin cements containing iodonium salts promote suitable apical bonding of posts to radicular dentin

Abstract The aim of this study was to analyze the efficiency of experimental light-curing resin cements (ERCs) with a ternary photo-initiator system containing diphenyliodonium hexafluorphosphate (DPI) and different amines on retention of glass-fiber posts to dentin (GFP). ERCs formulations: a 1:1 mass ratio of 2,2-bis[4-(2-hydroxy-3-methacryloxypropoxy)phenylpropane and triethyleneglycol dimethacrylate. Camphorquinone was used as initiator. Six experimental groups were established according to the amine used: [ethyl-4-(dimethylamino)benzoate-EDMAB or 2-(dimethylamino)ethyl methacrylate-DMAEMA] and the concentration of DPI (0, 0.5 mol%, 1 mol%). The resin cements Variolink II (dual- and light-cured versions) were used as commercial reference. Eighty recently extracted bovine incisors (n = 10) were selected for this study. The roots were prepared and the fiber posts were cemented with the resin cement specified for each experimental group. Specimens from coronal, middle, and apical thirds of the root were subjected to push-out bond strength test 24 hours after bonding. Data were subjected to split-plot ANOVA and the Tukey test (p = 0.05). ERCs containing DPI showed statistically significant higher bond strengths compared with ERCs without DPI. ERCs containing DPI were statistically similar to VARIOLINK II - dual-cured and superior to VARIOLINK II - light-cured (except for EDMAB - 1DPI in the medium third and DMAEMA - 1DPI in the coronal third). Different amines did not influence post retention. The apical root region showed the lowest bond strength for the groups EDAB-0DPI, DMAEMA-0DPI and VARIOLINK II light-cured. Light-cured ERCs containing DPI were efficient for GFP retention to radicular dentin, with similar behaviour to that of dual-curing commercial resin cement.

Tissue characterization following revascularization of immature dog teeth using different disinfection pastes

Abstract Revascularization of immature teeth with necrotic pulps traditionally involves the use of triple antibiotic paste, which may sometimes lead to undesirable complications. The objective of this study was to assess tissue repair in immature dog teeth with apical periodontitis subjected to revascularization, comparing two different pastes used for root canal disinfection. Apical periodontitis was induced in 30 dog premolars. Teeth were randomly divided into three experimental groups: root canals filled with triple antibiotic paste (n = 10); root canals filled with 1% propolis paste (n = 10); and no medication (n = 10). An additional group (n = 10, no intervention) was used as control. After 7 months, the jaws were histologically evaluated for the following variables: newly formed mineralized tissue (present/absent); vital tissue in the canal space (absent/periodontal ligament-like/pulp-like); apical extension of root (present/absent); and severity of inflammatory process (absent/mild/moderate/severe). There were no statistically significant differences among the experimental groups in new mineralized tissue formation and apical root development. The formation of vital tissue in the canal space, in turn, was statistically different between the triple paste and propolis groups: vital tissues were present in all revascularized teeth disinfected with propolis paste (100%), compared to 71% of those disinfected with the triple paste. Severity of inflammatory process was different between the triple paste and no medication groups. The new tissues formed onto canal walls and in the root canal space showed characteristics of cementum and periodontal ligament, respectively. Propolis may have some advantages over the triple paste for the revascularization of immature teeth.

Endodontic management of open apex using Biodentine as a novel apical matrix.

Aim: Endodontic management of open apex using Biodentine as an apical matrix. Summary: An immature tooth with pulpal necrosis and periapical pathology imposes a great difficulty to the endodontist. Endodontic treatment options for such teeth consist of conventional apexification procedure with and without apical barriers. Biodentine™ is new calcium silicate based cement that exhibits physical and chemical properties similar to those described for certain Portland cement derivatives. This article demonstrates the use of the newer material, Biodentine as an apical matrix barrier in root end apexification procedure. This case reports present apexification and successful healing with the use of Biodentine as an apical barrier matrix. Conclusion: Apexification in one step using an apical plug of Biodentine can be considered a predictable treatment and may be an alternative to mineral trioxide aggregate apexification.

Autotransplantation of a Mandibular Third Molar: A Case Report with 5 Years of Follow-up

This paper describes the autologous transplantation of a mandibular right third molar to replace the residual roots of the second molar in the same quadrant, preserving function and aesthetics. A 5-year clinical and radiographic follow-up was undertaken. After transplantation, the donor tooth received endodontic treatment and placement of calcium hydroxide, which was periodically replaced every 3 months until the filling of the root canals, totalizing a period of 1-year, when apical closure was confirmed. The tooth was in perfect functional and aesthetic conditions 5 years after beginning of treatment. Autotransplantation is a feasible option for replacing missing teeth when a donor tooth is available. The autotransplantation of a right mandibular third molar with compromised function and aesthetics to replace the residual roots resulting from coronal destruction due to extensive carious lesion of the second molar in the same quadrant was a viable treatment alternative.

O objetivo deste trabalho foi descrever o transplante autógeno de um terceiro molar inferior direito para substituir as raízes residuais do segundo molar no mesmo quadrante, preservando a função e a estética. Foi realizado acompanhamento clínico e radiográfico por 5 anos. Após o transplante, o dente doador recebeu tratamento endodôntico e colocação de hidróxido de cálcio, o qual foi substituído periodicamente a cada 3 meses, até a obturação dos canais radiculares, totalizando período de 1 ano quando então, o fechamento apical foi confirmado. O dente encontra-se em perfeitas condições funcionais e estéticas após 5 anos do início do tratamento. O autotransplante é uma opção viável para a substituição de dentes perdidos quando um dente doador está disponível. O autotransplante de um terceiro molar inferior direito com comprometimento estético e funcional afim de substituir raízes residuais (resultado de um processo cariogênio extenso) de um segundo molar do mesmo quadrante foi um tratamento alternativo viável.

Sealability of MTA and calcium hydroxidecontaining sealers

OBJECTIVES: The aim of this study was to evaluate the apical sealability of Fillapex®, endo-CPM-Sealer® and Sealapex®. Material and Methods: Ninety-four freshly extracted single-rooted teeth were selected and decoronated. All teeth were radiographed to confirm the existence of a single and straight root canal, which was prepared using Protaper Universal and 2.5% sodium hypochlorite. The teeth were randomly divided in groups of 10 specimens each according to the sealer, and the canals were filled using the single cone technique and one of the sealers. Four additional teeth were used as controls. The teeth were submitted to dye leakage with Rhodamine B for 24 h but using vacuum on the initial 15 min. Thereafter, they were cut longitudinally and the leakage was measured in a linear fashion from apex to crown. Data were analyzed by ANOVA and Tukey's tests at 5% significance level. Results: Fillapex® and Sealapex® showed significantly less dye leakage than endo-CPM-Sealer® (p<0.05). Conclusions: It was concluded that Fillapex® and Sealapex® were able to prevent apical dye leakage differently from endo-CPM-Sealer®.

Carisolv as an endodontic irrigant in deciduous teeth: An SEM study.

Aim: Root canal irrigation plays an important role in the debridement and disinfection of the root canal system. "The purpose of this study was to evaluate the efficacy of Carisolv TM , 1% sodium hypochlorite (NaOCl) gel, and 1% NaOCl solution as root canal irrigants in deciduous anterior teeth." Materials and Methods: Thirty-six extracted deciduous anterior teeth were used. Root canals were flooded with NaOCl solution in Group A, NaOCl gel in Group B and Carisolv TM in Group C and incubated for 30 min. Scanning electron microscope photomicrographs of canal wall debris in the apical, middle and coronal thirds were scored. Results: The results showed that regardless of irrigation regime, canals were consistently cleaner in the coronal and middle thirds than in the apical thirds. NaOCl solution, NaOCl gel, and Carisolv TM had comparable activity at coronal third and middle third of root canals. At the apical third, NaOCl solution cleaned canals better than NaOCl gel and Carisolv TM . Carisolv TM cleaned debris better than NaOCl gel at the apical third. Conclusion: Carisolv TM can be used as an adjunct to root canal preparation.

Tissue reaction to Endométhasone sealer in root canal fillings short of or beyond the apical foramen

OBJECTIVE: This study evaluated the response of periapical tissues to the endodontic sealer Endométhasone in root canal fillings short of or beyond the apical foramen. MATERIAL AND METHODS: Twenty root canals of premolars and incisors of 2 mongrel dogs were used. After coronal access and pulp extirpation, the canals were instrumented up to a size 55 K-file and the apical cemental barrier was penetrated with a size 15 K-file to obtain a main apical foramen, which was widened to a size 25 K-file. The canals were irrigated with saline at each change of file. The root canals were obturated either short of or beyond the apical foramen by the lateral condensation of gutta-percha and Endométhasone, originating 2 experimental groups: G1: Endométhasone/short of the apical foramen; G2: Endométhasone/beyond the apical foramen. The animals were killed by anesthetic overdose 90 days after endodontic treatment. The individual roots were obtained and serial histological sections were prepared for histomorphological analysis (H&E and Brown & Brenn techniques) under light microscopy. The following parameters were examined: closure of the apical foramen of the main root canal and apical opening of accessory canals, apical cementum resorption, intensity of the inflammatory infiltrate, presence of giant cells and thickness and organization of the apical periodontal ligament. Each parameter was scored 1 to 4, 1 being the best result and 4 the worst. Data were analyzed statistically by the Wilcoxon nonparametric tests (p=0.05). RESULTS: Comparing the 2 groups, the best result (p<0.05) was obtained with root canal filling with Endométhasone short of the apical foramen but a chronic inflammatory infiltrate was present in all specimens. CONCLUSIONS: Limiting the filling material to the root canal space apically is important to determine the best treatment outcome when Endométhasone is used as sealer.

Effect of calcium hydroxide-based dressing on apical sealing in immature teeth filled with MTA / Efeito da medicação à base de hidróxido de cálcio no selamento apical de dentes imaturos obturados com MTA

OBJECTIVES: To evaluate the effects of a calcium hydroxide-based intracanal dressing on the initialapical adaptation and leakage of fillings performed with mineral trioxide aggregate (MTA) in teeth withopen apices. STUDY DESIGN: A total of 24 canals were manually prepared and randomly divided intotwo groups (n = 12). In the experimental group, root canals were dressed with calcium hydroxide-basedpaste for 21 days; in the control group, no medication was applied prior to the filling of root canalswith mineral trioxide aggregate. Apical sealing was evaluated on the basis of rhodamine B penetrationand the detection of microscopic apical defects at the filling interface (SEM). The data obtained werecompared by means of t- and Fisher’s Exact tests (á = 0.05). RESULT S: The difference in mean dyeleakage between the experimental (5.03±1.97 mm) and control (4.14±1.13 mm) groups was not statisticallysignificant (ñ < 0.05). The number of microscopic fissures at the experimental group interface (2/12)was significantly lower than that observed for the control group (9/12) (ñ < 0.05). CONCLUSIONS:The use of a calcium hydroxide-based intracanal dressing did not interfere with the initial apical sealingof immature teeth filled with MTA.

OBJETIVOS: Avaliar os efeitos da medicação intracanal à base de hidróxido de cálcio sobre a adaptação apical inicial e selamento de obturações realizadas com agregado de trióxido mineral (MTA) em dentes com ápice aberto. PLANEJAMENTO DO ESTUDO: Um total de 24 canais foram manualmente preparados e aleatoriamente divididosem dois grupos (n = 12). No grupo experimental, canais radiculares foram preenchidos com pasta à base de hidróxido de cálcio por 21 dias; no grupo controle, nenhuma medicação foi aplicada antes da obturação dos canais com agregado de trióxido mineral. O selamento apical foi avaliado com base na penetração de rodamina B e na detecção microscópica de defeitos apicais na interface das obturações (MEV). Os dados obtidos foram comparados por intermédio dos testes “t” e Exato de Fisher (α = 0,05). RESULTADOS: A diferença nos níveis médios de infiltraçãoentre os grupos experimental (5.03±1.97 mm) e controle (4.14±1.13 mm) não se mostrou estatisticamente significante (ρ < 0,05). O número de fendas microscópicas na interface das obturações do grupo experimental (2/12) apresentou-se estatisticamente inferior ao detectado para o grupo controle (9/12) (ρ < 0,05). CONCLUSÕES: O uso de medicação intracanal à base de hidróxido de cálcio não interferiu no selamento apical inicial de dentes imaturos obturados com MTA.

Histopathological evaluation of root canal filling materials for primary teeth

This study aimed to assess the response of apical and periapical tissues of dogs' teeth after root canal filling with different materials. Forty roots from dogs' premolars were prepared biomechanically and assigned to 4 groups filled with: Group I: commercial calcium hydroxide and polyethylene glycol-based paste (Calen®) thickened with zinc oxide; Group II: paste composed of iodoform, Rifocort® and camphorated paramonochlorophenol; Group III: zinc oxide-eugenol cement; Group IV: sterile saline. After 30 days, the samples were subjected to histological processing. The histopathological findings revealed that in Groups I and IV the apical and periapical regions exhibited normal appearance, with large number of fibers and cells and no resorption of mineralized tissues. In Group II, mild inflammatory infiltrate and mild edema were observed, with discrete fibrogenesis and bone resorption. Group III showed altered periapical region and thickened periodontal ligament with presence of inflammatory cells and edema. It may be concluded that the Calen paste thickened with zinc oxide yielded the best tissue response, being the most indicated material for root canal filling of primary teeth with pulp vitality.

O objetivo deste estudo foi avaliar a resposta dos tecidos apicais e periapicais de dentes de cães, após obturação dos canais radiculares com diferentes materiais indicados para dentes decíduos. Foram utilizados pré-molares de cães, totalizando 40 raízes que, após pulpectomia e preparo biomecânico, foram divididas em 4 grupos, nos quais os canais radiculares foram obturados com os seguintes materiais: Grupo I - pasta comercial composta de hidróxido de cálcio e polietileno glicol 400 (Calen®) espessada com óxido de zinco; Grupo II - pasta composta de iodofórmio, Rifocort® e paramonoclorofenol canforado; Grupo III - cimento de óxido de zinco e eugenol; e Grupo IV - solução salina. Decorridos 30 dias, as peças foram submetidas ao processamento histológico. De acordo com os resultados da análise histopatológica observou-se que nos Grupos I e IV as regiões apical e periapical apresentaram aspecto de normalidade, com grande número de fibras e células e ausência de reabsorção dos tecidos mineralizados. No Grupo II observou-se infiltrado inflamatório e edema leves, com discreta fibrogênese e reabsorção óssea. O Grupo III apresentou alteração na região periapical e ligamento periodontal ampliado, com presença de células inflamatórias e edema. Os resultados obtidos permitiram concluir que a pasta Calen espessada com óxido de zinco apresentou a melhor resposta tecidual, sendo a mais indicada para a obturação de canais radiculares de dentes decíduos com vitalidade pulpar.

Comparative sem evaluation by of three solvents used in endodontic retreatment: an ex vivo study

This study compared, by scanning electron microscopy (SEM), the efficacy of three solvents on the removal of filling materials from dentinal tubules during endodontic retreatment. Forty human maxillary canines with straight canals were prepared according to a crown-down technique and enlarged to a#30 apical file size, before obturation with gutta-percha and a zinc-oxide-eugenol based sealer. The samples were stored for 3 months before being randomly assigned to four groups: chloroform (n=10), orange oil (n=10), eucalyptol (n=10) and control (n=10). Solvents were applied to a reservoir created on the coronal root third using Gates Glidden drills. The total time for retreatment using the solvents was 5 minutes per tooth. Following retreatment the roots were split longitudinally for SEM evaluation. SEM images were digitized, analyzed using Image ProPlus 4.5 software, and the number of dentinal tubules free of filling material from the middle and apical thirds was recorded. No significant difference was found among the solvent groups regarding the number of dentinal tubules free of root filling remnants in the middle and apical root thirds (p>0.05). However, the control group had fewer dentinal tubules free of filling material (p<0.05). Under the tested conditions, it may be concluded that there was no significant difference among the solvents used to obtain dentinal tubules free of filling material remnants.

Cyclosporin a-induced new cementum formation: a morphometric evaluation in the periapical region of rats

Cyclosporin A (CsA) is a potent immunosuppressor used in organ transplantation and in the management of various autoimmune diseases. Recent studies have shown that CsA stimulates deposition of cementum on root surfaces. The aim of this study was to evaluate the periapical cementum thickness and the apical foramen width in CsA-treated rats. Rats weighing 50 g were treated with a daily injection of 10 mg/kg body weight of CsA in the chow for 60 days. The cementum of the mandibular 1st molars was histologically and morphometricaly examined by analysis of 5-æm-thick serial buccolingual paraffin sections stained with hematoxylin and eosin. Histometric and stereologic analyses revealed the presence of large amounts of cementum in all root surfaces, particularly abundant in the periapical region and obliterating the foramen. The volume density of cementoblasts did not increase. Five to 90 days after the termination of CsA therapy, there was no reduction of cementum thickness. These results suggest that cementum deposition is not reversible after cessation of CsA treatment.

Ciclosporina A (CsA) é um potente imunossupressor usado no transplante de órgãos e no tratamento de várias doenças auto-imunes. Recentes estudos têm demonstrado que a CsA estimula a deposição de cemento na superfície radicular. O objetivo deste estudo foi de avaliar a espessura do cemento periapical e largura do forame apical em ratos tratados com CsA. Os ratos pesavam 50 g e foram tratados com doses diárias de 10 mg/kg de peso corporal de CsA no período de 60 dias. O cemento do primeiro molar inferior foi examinado histologicamente e morfometricamente por análises de cortes em parafina com 5æm de espessura no sentido vestíbulo-lingual e corados com hematoxilina e eosina. As análises histométricas e estereológicas revelaram a presença de largos depósitos de cemento em todas as superfícies radiculares, particularmente maior na região periapical e obliterando o forame. A densidade volumétrica dos cementoblastos não foi aumentada. No período de 5 a 90 dias após o término da terapia com CsA, não houve redução na espessura do cemento. Estes resultados sugerem que o depósito de cemento não é reversível após o tratamento com CsA ser cessado.

Ex vivo analysis of the debris remaining in flattened root canals of vital and nonvital teeth after biomechanical preparation with Ni-Ti rotary instruments

The purpose of this study was to assess the presence of apical debris remaining in the apical third of flattened root canals of vital and nonvital teeth after biomechanical preparation with Ni-Ti rotary instruments. Fresh-extracted human mandibular incisors were used in this study. The teeth had clinical indication for extraction and were submitted to cold pulp vitality testing and radiographic examination. Eighteen teeth were selected and randomly assigned to two groups (n=9), according to the clinical diagnosis, i.e., pulp vitality or pulp necrosis. The canals were instrumented with the ProTaper NiTi rotary system in the following sequence: S1 - up to the middle third; SX - at the cervical third; S2- up to the apical third; and S1, F1, F2, F3 - at the working length. The canals were irrigated with 1 percent sodium hypochlorite, dried and were submitted to the histological processing. Sections from the apical third were analyzed by an optical microscope (X40) that was coupled to a computer where the images were captured and analyzed using specific softwares. A grid was placed over these images to assess the total canal area and the areas with debris. Mann-Whitney U-test showed no statistically significant difference (p>0.05) between the teeth with pulp vitality (6.49 ± 3.39) and those with pulp necrosis (5.95 ± 2.22). It may be concluded that the clinical condition of pulp tissue did not interfere with the amount of debris remaining in the apical third of flattened root canals prepared with Ni-Ti rotary instruments.

O objetivo deste estudo foi avaliar a presença de debris no terço apical de canais radiculares achatados de dentes com polpa vital ou não-vital após preparo biomecânico com instrumentos rotatórios de níquel-titânio. Incisivos humanos inferiores recentemente extraídos for usados neste estudo. Os dentes tinham indicação para exodontia e o diagnóstico clínico do estado pulpar foi realizado mediante teste de vitalidade com frio e exame radiográfico. Dezoito incisivos inferiores humanos foram selecionados e distribuídos em dois grupos (n=9), de acordo com o diagnóstico clínico: dentes com a polpa viva ou dentes com a polpa necrosada. Os canais radiculares foram instrumentados com o sistema rotatório ProTaper com instrumentos de NiTi na seguinte seqüência: S1- até o terço médio; SX - no terço cervical; S2 - até no terço apical; e S1, F1, F2, F3 - no comprimento de trabalho. Os canais foram irrigados com hipoclorito de sódio a 1 por cento, secos e submetidos ao processamento histológico. Cortes do terço apical foram analisados em microscópio ótico (40X) acoplado a um computador onde as imagens resultantes foram capturadas e analisadas utilizando programas específicos. Uma grade foi colocada sobre estas imagens para avaliar a área total do canal e as áreas com debris. O teste de Mann-Whitney mostrou não haver diferença estatisticamente significante (p>0,05) entre os dentes com vitalidade pulpar (6,49 ± 3,39) e aqueles com necrose pulpar (5,95 ± 2,22). Concluiu-se que o estado clínico pulpar não interferiu na quantidade de debris remanescentes no terço apical de canais radiculares achatados preparados com instrumentos rotatórios de NiTi.

[In vitro comparison of the apical microleakage of laterally condensed gutta percha after using calcium hydroxide or cold ceramic as apical plug in open apex teeth]

The treatment of immature teeth with open apex by Gutta percha in one visit apexification requires an optimum material as apical barrier. One of the desirable properties of the apical barrier material is its sealing ability. This study was performed to compare the sealing ability of calcium hydroxide and a new experimental material [cold ceramic] when used as an apical barrier. Fifty extracted single canal human teeth were collected and stored in saline solution. The crowns were resected and by conventional step back method, canals were instrumented and then extended by Piso Reamer, so that, root ends were formed divergently. Samples were divided into two group including 23 teeth as study and 4 teeth as positive and negative control groups and then all teeth were mounted in a plaster cast. The two experimental materials [Cold ceramic and calcium hydroxide] were placed in the root ends for producing apical barrier, and canals were obturated with Gutta percha. The teeth in the positive and negative groups were obturated with Gutta percha, and in the negative group, cavit was placed at the end of root. In the 3 groups [calcium hydroxide, cold ceramic and positive group], all surfaces of the teeth were covered by two layers of the nail polish except 2 to 3 mm of the roots end and in the negative control group, samples were covered completely by two layers of the nail polish. Then, photographs of teeth were scanned and amount of leakage was calculated with the Photoshop software. The data were analyzed by t-test. Amount of cold ceramic leakage was less than calcium hydroxide and this difference was statistically significant [p=0.0001]. showed that apical plug with cold ceramic was more resistant than the apical plug with calcium hydroxide. The results of this study confirmed optimum sealing ability of the new experimental material for creating of apical barrier in one appointment apexification

Management of teeth with open apices and necrotic pulps with single visit apexification: 3 representative cases.

Apexification is the most widely accepted procedure for the treatment of nonvital immature teeth. Single visit apexification is less time consuming, more economical and an easily acceptable technique with the aim of inducing the formation of a hard tissue barrier, thus allowing proper condensation of gutta percha in the root canal. Factors considered during this procedure are: i. Debridement of root canal minimizing the infection and filling the root canal space with resorbable calcification inducing material i.e. Ca(OH)2. ii. Minimal mechanical intervention to maintain the integrity and vascularity of apical region. Once filled, Ca(OH)2 was not changed again and the treated tooth was examined only radiographically till the desired apical closure was achieved. Three representative cases treated with this single visit apexification technique are discussed here. In all the cases successful apical closure of different types was achieved. Treatment was then concluded with gutta percha obturation in all the cases with successful follow up.