Conservative approach of a symptomatic carious immature permanent tooth using a tricalcium silicate cement (Biodentine): a case report

The restorative management of deep carious lesions and the preservation of pulp vitality of immature teeth present real challenges for dental practitioners. New tricalcium silicate cements are of interest in the treatment of such cases. This case describes the immediate management and the follow-up of an extensive carious lesion on an immature second right mandibular premolar. Following anesthesia and rubber dam isolation, the carious lesion was removed and a partial pulpotomy was performed. After obtaining hemostasis, the exposed pulp was covered with a tricalcium silicate cement (Biodentine, Septodont) and a glass ionomer cement (Fuji IX extra, GC Corp.) restoration was placed over the tricalcium silicate cement. A review appointment was arranged after seven days, where the tooth was asymptomatic with the patient reporting no pain during the intervening period. At both 3 and 6 mon follow up, it was noted that the tooth was vital, with normal responses to thermal tests. Radiographic examination of the tooth indicated dentin-bridge formation in the pulp chamber and the continuous root formation. This case report demonstrates a fast tissue response both at the pulpal and root dentin level. The use of tricalcium silicate cement should be considered as a conservative intervention in the treatment of symptomatic immature teeth.

Revascularización pulpar de un incisivo central permanente con ápice inmaduro / Pulp revascularization of a permanent central incisor with immature apices

Se presenta el reporte de un caso de un incisivo central superior inmaduro con necrosis pulpar y periodontitis apical crónica, al cual se le instauró la técnica de revascularización descrita por Trope, mediante la estimulación de un coágulo a partir de los tejidos periapicales, previa desinfección del conducto con una mezcla de tres antibióticos, y finalmente la colocación de MTA coronal a este; para obtener así una matriz estéril, que permitiera el crecimiento de nuevo tejido. Esta alternativa de tratamiento se presenta con gran auge en los últimos días pues puede ayudar a mejorar el pronóstico de dientes inmaduros necróticos mediante el reforzamiento de sus paredes dentinales. Después de 7 meses se observó radiográficamente una barrera calcificada bajo el MTA y un engrosamiento delas paredes laterales del conducto, lo que sugiere la obtención de un proceso biológico de desarrolloactivo con un resultado favorable, lo cual puede ayudar a disminuir por ahora la posibilidad de fractura radicular.

The article presents the report of a case of an immature maxillary central incisor with pulp necrosis and chronic apical periodontitis, which was established revascularization technique described by Trope, stimulated by a blood clot from the periapical tissues after disinfecting the canal with a mixture of three antibiotics, and finally the placement of MTA coronal this; order to obtain a sterile matrix, which allowed the growth of new tissue. This treatment option is presented with great success in recent days as it can help improve the prognosis of necrotic immature teeth by strengthening dentinal walls. After seven months was observed radiographically calcified barrier under the MTA and a thickening of the side walls of the duct, suggesting the collection of a biological process of active development with a favorable outcome, which can help reduce the possibility for now of root fracture.

Influence of post types and sizes on fracture resistance in the immature tooth model / 대한치과보존학회지

The purpose of this study was to determine the effect of post types and sizes on fracture resistance in immature tooth model with various restorative techniques. Bovine incisors were sectioned 8 mm above and 12 mm below the cementoenamel junction to simulate immature tooth model. To compare various post-and-core restorations, canals were restored with gutta-percha and resin core, or reinforced dentin wall with dual-cured resin composite, followed by placement of D.T. LIGHT-POST, ParaPost XT, and various sizes of EverStick Post individually. All of specimens were stored in the distilled water for 72 hours and underwent 6,000 thermal cycles. After simulation of periodontal ligament structure with polyether impression material, compressive load was applied at 45 degrees to the long axis of the specimen until fracture was occurred. Experimental groups reinforced with post and composite resin were shown significantly higher fracture strength than gutta-percha group without post placement (p < 0.05). Most specimens fractured limited to cervical third of roots. Post types did not influence on fracture resistance and fracture level significantly when cement space was filled with dual-cured resin composite. In addition, no statistically significant differences were seen between customized and standardized glass fiber posts, which cement spaces were filled with resin cement or composite resin individually. Therefore, root reinforcement procedures as above in immature teeth improved fracture resistance regardless of post types and sizes.

Cases report of autotransplantation of immature teeth