Regenerative Endodontic Treatment as a Retreatment Option for a Tooth with Open Apex - A Case Report

Abstract: Treatment of non-vital immature teeth with apical periodontitis has always been a challenge in Endodontics. Regenerative endodontic treatment (RET) has been successfully used for the management of these cases. The aim of this study is to present a case of RET used for the retreatment of a previously endodontically treated permanent tooth with an open apex. A 14-year-old boy with a poor endodontic treatment done on his maxillary right central incisor developed symptomatic apical periodontitis. Radiographically, incomplete root development with thin dentinal walls and an open apex were evident. After accessing and removing previous filling materials, the canal was copiously irrigated with 2.5% sodium hypochlorite. A triple antibiotic paste was placed inside the canal and left for 15 days. After removal of the antibiotic mixture, bleeding was induced into the canal by passing a hand file out of the apex. A collagen membrane barrier was placed over the blood clot, followed by sealing with mineral trioxide aggregate. Access was sealed with permanent filling materials. Clinical examination at 12, 24 and 36 months revealed no symptoms. Radiographic examination showed resolution of the periapical lesion and apical closure. Sensitivity tests with cold and an electric pulp test elicited a negative response at all recall periods. On the basis of long-term results, RET may be an effective option for the retreatment of an immature permanent tooth with a failed previous treatment and periapical periodontitis.

Apical Barrier Formation After Incomplete Orthograde MTA Apical Plug Placement in Teeth with Open Apex - Report of Two Cases

Two cases are reported in which incomplete placement of 4 mm mineral trioxide aggregate (MTA) plug was performed unintentionally at the apical third of permanent immature teeth with open apex and apical periodontitis. As confirmed radiographically, there were gaps between MTA and dentinal walls along the MTA-dentin interface. After setting of MTA was confirmed, endodontic treatment was completed and access was sealed with composite resin. At 6 to 16 months follow-up examinations, formation of dentin in contact with the MTA surface, as well as apical closure and periapical healing were ideied radiographically for both cases. The results of these cases showed that apical barrier formation and complete periapical healing is possible despite the incomplete apical placement of the MTA plug. This might be due to the biological properties of the MTA. Even so, an incomplete three-dimensional placement of the filling material is not advocated.