Apicificação, apicogênese e revascularização, conceitos e conduta clínica: uma revisão de literatura / Apexification, apexogenesis and revascularization, concepts and clinical management: a literature review

O tratamento endodôntico de dentes com rizogênese incompleta requer uma atenção especial, uma vez que o tratamento convencional é inviável e devemos evitar a perda dos dentes permanentes. Na maioria das vezes, as causas que interrompem a formação radicular são os traumatismos dentários e as cáries extensas, que podem atingir a polpa coronária, podendo levar, inclusive, à necrose pulpar. Atualmente, esses casos têm sido tratados por meio da apicificação, apicogênese e da revascularização pulpar, com uso de medicações a base de hidróxido de cálcio, antibiótico e MTA (Agregado trióxido mineral). Nessas técnicas, a intenção é induzir o desenvolvimento radicular completo ou o fechamento apical por tecido duro calcificado. O objetivo deste trabalho foi realizar uma breve revisão de literatura, utilizando artigos científicos disponíveis nas plataformas Café (UFF), Scielo e PubMed, a fim de descrevermos os conceitos de apicificação, apicogênese e revascularização, expondo as suas indicações e condutas clínicas ideais para a realização destes tratamentos. Pode-se concluir que são procedimentos clínicos simples e de conhecimento extremamente importantes para qualquer cirurgião-dentista, uma vez que são tratamentos emergenciais bastante comuns no dia a dia. Além disso, sabe-se da necessidade de manter um dente permanente sadio na boca, que pode evitar grandes problemas no futuro.

Endodontic treatment on teeths with incomplete rhizogenesis requires special attention, since conventional treatment is infeasible and we must avoid the loss of permanent teeth. Most often, the causes that interrupt root formation are dental trauma and extensive caries, which can reach the coronary pulp and may even lead to pulpal necrosis. Currently, these cases have been treated through apexification, apexogenesis and pulpal revascularization, with the use of calcium hydroxide, antibiotic and MTA (Aggregate mineral trioxide) base medications. In these techniques, the intent is to induce complete root development or apical closure by calcified hard tissue. The objective of this work was to carry out a review of literature, using scientific articles available on the Café platform (UFF), Scielo and PubMed, in order to describe the concepts of apexification, apexogenesis and revascularization, exposing their indications and ideal clinical procedures for the realization of these treatments. It can be concluded that they are simple clinical procedures and of knowledge extremely important for any dentist, since they are emergency treatments that are quite common day by day. In addition, it is known that one needs to maintain a permanent healthy tooth in the mouth, which can avoid major problems in the future.

Tratamento endodôntico em dente permanente traumatizado com rizogênese incompleta: relato de caso / Endodontic treatment in permanent traumatised tooth with incomplete rhizoganis: case report / Tratamiento endodóntico en diente permanente traumatizado con rizoganis incompleta: presentación de un caso

Os traumatismos dentários representam um problema de saúde pública devido à alta prevalência e impacto psicossocial, sendo muito frequentes em crianças podendo resultar em necrose pulpar e culminar na rizogênese incompleta de dentes permanentes. Nestes casos de traumatismos em dentes permanentes com rizogênese incompleta e necrose pulpar, o tratamento mais indicado pela literatura é a apicificação, sendo um tratamento complexo e longo. Considerando a importância deste tema, o objetivo deste trabalho é relatar o caso de um paciente com traumatismo dental e necrose pulpar, que acarretou a interrupção do desenvolvimento completo e adequado do ápice dentário, sendo necessária a intervenção por meio da técnica de apicificação e o acompanhamento a longo prazo. O caso trata-se de uma menina em que um traumatismo dentário acarretou fratura de um incisivo central superior com formação radicular incompleta, comprometendo tanto a estética quanto a vitalidade do dente. Foi realizado o tratamento endodôntico com apicificação e posteriormente ao plug apical de MTA. O dente foi restaurado definitivamente com resina composta e realizado acompanhamento do paciente. Nas consultas de acompanhamento houve ausência de sintomatologia dolorosa e satisfação da paciente com a aparência atual. Sendo assim, a apicificação apresenta-se como uma ótima alternativa para dentes com rizogênese incompleta e necrose pulpar, embora longo houve uma melhora estética e satisfação do paciente.

Dental trauma represents a public health problem due to its high prevalence and psychosocial impact, being very frequent in children and can result in pulp necrosis and culminate in incomplete root formation of permanent teeth. In these cases of trauma to permanent teeth with incomplete root formation and pulp necrosis, the most indicated treatment in the literature is apexification, which is a complex and long treatment. Considering the importance of this topic, the objective of this work is to report the case of a patient with dental trauma and pulp necrosis, which caused the interruption of the complete and adequate development of the dental apex, requiring intervention through the apexification technique and follow-up. long-term. The case is about a girl in which a dental trauma resulted in a fracture of a maxillary central incisor with incomplete root formation, compromising both the esthetics and the vitality of the tooth. Endodontic treatment was performed with apexification and then apical MTA plug. The tooth was definitively restored with composite resin and the patient was followed up. In the follow- up consultations, there was no painful symptomatology and the patient was satisfied with her current appearance. Thus, the apexification presents itself as a great alternative for teeth with incomplete root formation and pulp necrosis, although in the long run there was an aesthetic improvement and patient satisfaction.

Los traumatismos dentales representan un problema de salud pública debido a su alta prevalencia e impacto psicosocial, siendo muy frecuentes en niños y pudiendo dar lugar a necrosis pulpar y culminar en la formación incompleta de la raíz de los dientes permanentes. En estos casos de traumatismos en dientes permanentes con formación radicular incompleta y necrosis pulpar, el tratamiento más indicado en la literatura es la apexificación, que es un tratamiento complejo y largo. Considerando la importancia de este tema, el objetivo de este trabajo es relatar el caso de una paciente con traumatismo dentario y necrosis pulpar, que causó la interrupción del desarrollo completo y adecuado del ápice dentario, requiriendo intervención a través de la técnica de apexificación y seguimiento. a largo plazo. Se trata de una niña en la que un traumatismo dental provocó la fractura de un incisivo central maxilar con formación radicular incompleta, comprometiendo tanto la estética como la vitalidad del diente. Se realizó tratamiento endodóntico con apexificación y posterior taponamiento apical con MTA. El diente fue restaurado definitivamente con resina compuesta y el paciente fue sometido a seguimiento. En las consultas de seguimiento, no había sintomatología dolorosa y la paciente estaba satisfecha con su aspecto actual. Así, la apexificación se presenta como una gran alternativa para dientes con formación radicular incompleta y necrosis pulpar, aunque a la larga se produjo una mejoría estética y satisfacción de la paciente.

Revascularização pulpar, uma nova opção na terapêutica endodôntica: revisão da literatura e caso clínico em paciente adulto / Pulpar revascularization, a new option in endodontc therapy: literature review and case report in adult patient

Introdução: A revascularização pulpar é uma terapêutica que visa regenerar parte do complexo dentino pulpar, proporcionando a continuidade do desenvolvimento radicular, sanando a fragilidade e propensão a fratura que a apicificação apresentava. É um tratamento direcionado a dentes diagnosticados com rizogênese incompleta. Entretanto, a possibilidade de realização da técnica em dentes maduros tem sido alvo de pesquisas e estudo. Objetivo: O objetivo deste estudo, é apresentar através da revisão de literatura e caso clínico, os benefícios dos procedimentos endodônticos regenerativos (REPs), em dentes jovens e maduros, em relação à apicificação. Metodologia: O estudo é uma revisão de literatura, desenvolvida através de pesquisa exploratória e realizada uma abordagem qualitativa. Para a coleta de dados, foi aplicada a técnica de análise documental e revisão bibliográfica consultando PUBMED, Scielo, Google Acadêmico e monografias acadêmicas. O caso clínico foi realizado de acordo com o protocolo atualizado pela AAE em 2016. Discussão: A revascularização pulpar tem mostrado ser um tratamento promissor na endodontia, é preconizada a desinfecção e medicação intracanal, já que não pode haver instrumentação mecânica. Os agentes irrigadores devem ser bactericidas, bacteriostáticos e devem ter baixo teor de toxicidade, já a medicação intracanal deve ter papel inibidor em bactérias gram positivas e gram negativas. Conclusão: A apicificação mesmo com o uso de MTA, que não exige trocas excessivas de medicações, não sana as necessidades que um dente com rizogênese incompleta requer. Sendo assim, a revascularização foi eleita o tratamento de melhor prognóstico para dentes jovens e necrosados. O caso clínico demonstrou qualidade moderada, no tratamento regenerativo em um dente maduro com reabsorção externa, abrindo novas perspectivas para os (REPs)(AU)

Introduction: Pulp revascularization is a therapy that aims to regenerate part of the pulp dentin complex, providing continuity of root development, remedying the fragility and propensity to fracture that apexification presented. It is a treatment aimed at teeth diagnosed with incomplete rhizogenesis. However, the possibility of performing the technique on mature teeth has been the subject of research and study. Objective: The aim of this study is to present, through literature review and clinical case, the benefits of regenerative endodontic procedures (REPs), in young and mature teeth, in relation to apexification. Methodology: The study is a literature review, developed through exploratory research and carried out a qualitative approach. For data collection, the technique of document analysis and bibliographic review was applied, consulting PUBMED, Scielo, Academic Google and academic monographs. The clinical case was performed according to the protocol updated by the SEA in 2016. Discussion: Pulp revascularization has shown to be a promising treatment in endodontics, intracanal disinfection and medication is recommended, as there can be no mechanical instrumentation. Irrigating agents must be bactericidal, bacteriostatic and must have a low level of toxicity, whereas intracanal medication must have an inhibiting role in gram positive and gram negative bacteria. Conclusion: Apexification, even with the use of MTA, which does not require excessive medication changes, does not meet the needs that a tooth with incomplete rhizogenesis requires. Therefore, revascularization was chosen as the treatment with the best prognosis for young and necrotic teeth. The clinical case demonstrated moderate quality in regenerative treatment in a mature tooth with external resorption, opening new perspectives for (REPs)(AU)

Protección pulpar directa y posterior apexogénesis: informe de un caso clínico / Direct pulp capping followed by apexogenesis: a clinical case report

Objetivo: Describir el tratamiento de un paciente que pre- sentó un incisivo superior permanente con exposición pulpar y desarrollo radicular incompleto utilizando Biodentine como material para la protección pulpar directa. Caso clínico: Un paciente de 9 años fue derivado para la evaluación y el tratamiento del diente 11. El examen clínico y radiográfico reveló la presencia de una fractura amelodentinaria, con exposición pulpar y desarrollo radicular incompleto. Luego de lavar y desinfectar el área de la fractura, se protegió la pulpa expuesta con Biodentine y se restauró la cavidad. El paciente fue citado para control a los 18 y 25 meses. En los controles se comprobó que el diente se mantuvo asintomático y funcional. Luego de 25 meses, el examen clínico y radiográfico confirmó la presencia de pulpa vital y el completo desarrollo del remanente radicular. Los resultados obtenidos en el presente caso clínico sugieren que el empleo de Biodentine puede ser considerado como una valiosa alternativa para la protección de la pulpa ex- puesta en dientes con desarrollo radicular incompleto (AU)

Aim: To describe the treatment of a patient that presented a permanent maxillary central incisor with pulp exposure and incomplete root formation, using Biodoentine as the material for direct pulp protection. Clinical case A 9-year-old male patient was referred for evaluation and treatment of tooth 11. The clinical and radio-graphic examination revealed the presence of a dentinoe- namel fracture, with pulp exposure and incomplete root for- mation. After cleaning and disinfecting the area, the exposed pulp was protected with Biodentine and the cavity was re- stored. The patient was scheduled for control after 18 and 25 months. In these evaluations, it was confirmed that the tooth remained asymptomatic and functional. After 25 months, the clinical and radiographic examination showed the presence of vital pulp and a completed development of the root. The obtained results of this clinical case suggest that Biodentine can be considered a valuable alternative for pulp capping in teeth with incomplete root formation (AU)

Application of cold flowable gutta-percha in root canal obturation after apexification / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the clinical effect of root canal obturation therapy using cold flowable gutta-percha on young permanent teeth after apexification.@*METHODS@#Ninety cases of young permanent teeth with pulp necrosis or periapical periodontitis treated by apexification were randomly divided into two groups. The cases in each group were divided into single root canal and multiple root canal according to the number of the root canal, and divided into classifications Ⅰ, and Ⅱ/Ⅲ/Ⅳ according to Frank's classification of root development after apexification. Cold flowable gutta-percha and warm gutta-percha obturation techniques were used for root canal obturation of the two groups. The operation time was recorded, and the patients' therapy pain degree was evaluated by visual analog scale (VAS) immediately after operation. Periapical X-ray was performed after operation to evaluate the effect of the root canal filling. The total length of the root was divided into equal three parts on the X-ray film, and three-dimensional tightness of the apical, middle, and coronal region of the root canals were statistically analyzed respectively. Clinical examinations and X-ray examination were performed 6 and 12 months after the operation to evaluate the treatment success rate.@*RESULTS@#The operation time of cold flowable gutta-percha group was significantly lower than that of the control group, which were 51 s and 74 s (P < 0.05); The percentages of pain and discomfort in the two groups were 26.67% and 40.00%, respectively. There were two cases of underfilling and no overfilling in both groups. The percentages of proper filling and tight three-dimensional obturation in the experimental and control groups were 71.11% and 60.00% respectively; and the percentages of tight three-dimensional obturation in the apical third areas were 86.67% and 66.67%, the difference was significant (P < 0.05). There was no significant difference in the three-dimensional tightness between the two groups in the middle and coronal third areas. The percentages of tight three-dimensional obturation in classification Ⅰ groups were 86.67%, 83.33%, 93.33% and 76.67%, 90.00%, 96.67% in experimental and control group, respectively; The percentages of classification Ⅱ/Ⅲ/Ⅳ groups were 86.67%, 86.67%, 100.00% and 46.67%, 86.67%, 100.00%, respectively, and the difference was significant (P < 0.05). There were no apical lesions that occurred in either group during the one-year review period.@*CONCLUSION@#The application of cold flowable gutta-percha on young permanent teeth root canal obturation after apexification can achieve good obturation effect. The root obturation effect in the apical third area is significantly better than that of warm gutta-percha obturation techniques. Cold flowable gutta-percha can shorten the clinical treatment time and ameliorate the patients' therapy comfort.

Different techniques for the treatment of teeth with an incomplete root development and pulp necrosis: a systematic review / Diferentes técnicas para o tratamento de dentes com rizogênese incompleta e necrose pulpar: uma revisão sistemática

Introduction: The objective of this systematic review was to compare the apexification techniques of calcium hydroxide (Ca(OH)2), or mineral trioxide aggregate (MTA), with the pulp regeneration technique, using cohort studies, and non-randomized and randomized clinical trials. Methods: The methodology was based on electronic research in the following databases: PubMed, MEDLINE, Google Scholar, SciELO, and LILACS. In addition, a manual search was carried out using the references that were listed in the articles found. Results: A total of 403 potentially eligible studies were found, with seven being included in the inclusion criteria of this systematic review. The seven studies involved a total of 312 teeth. The minimum time of a follow-up period was 12 months. The irrigation solution most used was sodium hypochlorite, for both of the apexification and revascularization techniques. The medication commonly chosen in the apexification groups was Ca(OH)2, with antibiotic triple paste in the revascularization groups. The clinical rate of success in the groups treated with revascularization varied from 76% to 100%, while in the groups treated with apexification, it ranged from 68% to 100%. Only two studies reached a success rate equal to 100%. Conclusions: Variable levels of evidence were observed in relation to the treatments. However, it was confirmed that revascularization is an excellent option since its outcomes produced a greater gain of thickness and root length, besides developing a decrease in the apical foramen.

Introdução: O objetivo desta revisão sistemática foi comparar as técnicas de apexificação, com hidróxido de cálcio (Ca(OH)2) ou agregado trióxido mineral (MTA), com a técnica de regeneração pulpar, utilizando estudos coorte, ensaio clínico não randomizado e randomizado. Métodos: A metodologia foi baseada em pesquisa eletrônica nas seguintes bases de dados: PubMed, MEDLINE, Google Acadêmico, SciELO e LILACS. Além disso, foi realizada uma pesquisa manual utilizando as referências listadas nos artigos encontrados. Resultados: Foram encontrados 403 estudos potencialmente elegíveis, sendo sete incluídos nos critérios de inclusão desta revisão sistemática. Os sete estudos envolveram um total de 312 dentes. O tempo mínimo de um período de acompanhamento foi de 12 meses. A solução de irrigação mais utilizada foi o hipoclorito de sódio, para as técnicas de apexificação e revascularização. O medicamento comumente escolhido nos grupos de apexificação foi o Ca(OH)2, com pasta tripla antibiótica nos grupos de revascularização. A taxa clínica de sucesso nos grupos tratados com revascularização variou de 76% a 100%, enquanto nos grupos tratados com apexificação variou de 68% a 100%. Apenas dois estudos atingiram uma taxa de sucesso igual a 100%. Conclusões: Níveis variáveis de evidência foram observados em relação aos tratamentos. No entanto, confirmou-se que a revascularização é uma excelente opção, pois seus desfechos produzem maior ganho de espessura e comprimento radicular, além de diminuir o forame apical.

Técnica de apexificación con un sustituto bioactivo de la dentina en una sola sesión: caso clínico / Apexification technique with a bioactive dentin substitute in a single session: a clinical case

Las piezas con necrosis pulpar y ápice abierto son un desafío de la práctica clínica endodóntica. Durante mucho tiempo estas piezas han sido tratadas con la técnica de apexificación con hidróxido de calcio. Esta técnica estimula la formación de una barrera calcificada a nivel apical, pero a partir de varias sesiones de tratamiento y los riesgos asociados que esto conlleva. Hoy en día, con el desarrollo de nuevas tecnologías, están a disposición materiales biocerámicos que permiten realizar el protocolo en una sola sesión. El Biodentine es un biocerámico con tiempo de fraguado corto y buena capacidad de sellado, que permite reducir los tiempos clínicos. El objetivo de este trabajo es presentar un caso clínico de una pieza dentaria diagnosticada con necrosis pulpar y con apicoformación incompleta, tratada con una técnica de apexificación con Biodentine en una sesión (AU)

Ex Vivo Evaluation of a Restoration Protocol for Teeth with Simulated Incomplete Rhizogenesis / Evaluación ex vivo de un protocolo de restauración para dientes con rizogénesis incompleta simulada

Abstract: The use of phosphate buffered saline (PBS) as an intracanal medication triggers a biomineralization process within mineral trioxide aggregate (MTA) apical plugs during the apexification process in teeth with incomplete rhizogenesis. However, no consensus is available in the literature regarding a restorative protocol for this type of treatment. Thus, the objective of this study was to use scanning electron microscopy (SEM) to evaluate the processes of biomineralization and adhesion in a restorative protocol for teeth with simulated incomplete rhizogenesis. Methodology: Root sections with a thickness of 2mm and cavities with a diameter of 2mm were used. The sections were randomly prepared and filled with the following materials: Group 1 (n=12), ProRoot MTA; and Group 2 (n=12): MTA Exp. Subsequently, the samples were immersed in PBS for 35 days. Every 5 days, the PBS was replaced, and the precipitates were collected, dried, and weighed. Two samples from each group were analyzed by SEM. Moreover, 24 single-rooted teeth were standardized, incomplete rhizogenesis was simulated, and 5-mm-long apical plugs were created with Pro Root MTA. As an intracanal medication, PBS was used for different periods of time: Group 1:48 h; Group 2:7 days; and Group 3:15 days. Then, fiberglass posts were cemented with the REBILDA® Post System. The samples were prepared and analyzed by SEM. Results: ProRoot MTA and MTA Exp effectively promoted the formation of carbonated apatite precipitates and biomineralization with dentin. ProRoot MTA yielded more carbonated apatite precipitates compared to MTA Exp (p=0.0536). The use of PBS as an intracanal medication for 7 and 15 days promoted intratubular mineralization (MIT), and treatment for 15 days was more effective (p < 0.05). The REBILDA® Post System effectively promoted the microimbrication of the adhesive system and the formation of resinous tags with lateral adhesive branches. Conclusion: Apexification with MTA associated with the use of PBS as an intracanal medication for 15 days, in addition to the use of the REBILDA® Post System, seems to be a feasible restorative protocol.

Resumen: El uso de solución salina tamponada con fosfato (PBS) como medicamento intracanal desencadena un proceso de biomineralización en los plugs apicales con agregado de trióxido mineral (MTA) durante el proceso de apexificación en dientes con rizogénesis incompleta. Sin embargo, no hay consenso disponible en la literatura sobre un protocolo restaurador para este tipo de tratamiento. Por lo tanto, el objetivo de este estudio fue utilizar microscopía electrónica de barrido (MEB) para evaluar los procesos de biomineralización y adhesión en un protocolo restaurador para dientes con rizogénesis incompleta simulada. Metodología: Se utilizaron secciones de raíz con un espesor de 2mm y se realizaron cavidades con un diámetro de 2 mm. Las cavidades en las secciones se obturaron con: Grupo 1 (n=12), ProRoot MTA; y Grupo 2 (n=12): MTA Exp. Posteriormente, las muestras se sumergieron en PBS durante 35 días. Cada 5 días, se reemplazó el PBS y se recogieron los precipitados, se secaron y pesaron. Dos muestras de cada grupo fueron analizadas por MEB. Además, se estandarizaron 24 dientes de raíz única, se simuló la rizogénesis incompleta y se crearon tapones apicales de 5mm de longitud con Pro Root MTA. Como medicamento intracanal, se utilizó PBS durante diferentes períodos de tiempo: Grupo 1:48 h; Grupo 2:7 días; y Grupo 3:15 días. Posteriormente, los postes de fibra de vidrio se cementaron con el sistema de postes REBILDA®. Las muestras fueron preparadas y analizadas por MEB. Resultados: ProRoot MTA y MTA Exp promovieron efectivamente la formación de precipitados de apatita carbonatada y la biomineralización con dentina. ProRoot MTA produjo más precipitados de apatita carbonatada en comparación con MTA Exp (p=0.0536). El uso de PBS como medicamento intracanal durante 7 y 15 días promovió la mineralización intratubular (MIT), siendo el tratamiento durante 15 días más efectivo (p <0.05). El sistema de postes REBILDA® promovió efectivamente la microimbricación del sistema adhesivo y la formación de tags resinosos. Conclusión: La apexificación con MTA asociada con el uso de PBS como medicación intracanal durante 15 días, además del uso del sistema de postes REBILDA®, parece ser un protocolo factible y eficaz en este tipo de tratamientos.

Induction of root development and apical closure in permanent mandibular molar with irreversible pulpitis through total pulpotomy with application of mineral trioxide aggregate / Inducción del termino de desarrollo radicular y cierre apical en molar mandibular permanente con pulpitis irreversible a través de pulpotomía total con aplicación de agregado de trióxido mineral

Loss of teeth vitality when root formation is incomplete, results in weaker structures leaving them prone to fractures and unfavourable long-term prognosis. Apexogenesis is currently the treatment of choice in immature teeth and is indicated in vital teeth without pulpal pathologies. The treatment aims to eliminate the causal agent of the damage, and provide the necessary conditions to preserve vitality in the tooth and induce apical root closure. A 6-year-old male patient was treated at the Endodontics Clinic, Universidad de La Frontera upon complaining of acute pain in tooth 30. The tooth presented incomplete root development due to dental caries with pulp exposure and a diagnosis of irreversible symptomatic pulpitis. Total pulpotomy was performed with the application of Mineral Trioxide Aggregate and controlled at 1, 4, 6, 7 and 12 months, achieving root development and apical closure in the permanent molar. The result was comparable with studies that support this therapy in teeth with irreversible pulpitis. This work seeks to contribute to the existing evidence on the management of immature permanent teeth with irreversible pulpitis to induce root development and apical closure, and maintain pulp vitality.

La pérdida de vitalidad en dientes con formación radicular incompleta trae como resultado el debilitamiento de estos, dejándolos propensos a fracturas con un desfavorable pronóstico a largo plazo. Las terapéuticas actuales de regeneración pulpar en dientes inmaduros estan principalmente indicadas en cuadros de pulpitis irreversible y buscan eliminar el agente causal de daño y brindarle al diente las condiciones y estímulos necesarios para preservar vitalidad e inducir el cierre apical radicular. Un paciente de 6 años de edad y de sexo masculino, acude a la Clínica de Especialidad de Endodoncia de la Universidad de la Frontera, consultando por un dolor agudo en diente 4.6 el cual presentaba un desarrollo radicular incompleto producto de una caries con exposición pulpar con diagnóstico de Pulpitis Irreversible Sintomática. Se realiza una pulpotomia total con aplicación de Mineral Trioxide Aggregate y se controla a los 1, 4, 6 y 7 meses obteniendo un interesante resultado comparable con estudios que avalan dicha terapeutica en dientes con pulpitis irreversible. Este trabajo busca contribuir a la evidencia existente sobre el manejo de dientes permanentes inmaduros con cuadros de pulpitis irreversible para inducir el desarrollo radicular, cierre apical y mantener vitalidad pulpar.

Apexificación de un molar permanente a través de silicato tricálcico / Apexification of a permanent molar with tricalcium silicate

Paciente pediátrico de 9 años y género masculino, que acudió para valoración odontológica por presentar dolor dental tras ingerir alimentos fríos. El diagnóstico definitivo quedó establecido como pulpitis reversible del molar 3.6, decidiendo conducta terapéutica de recubrimiento pulpar directo con silicato tricálcico para lograr apexificación. La decisión clínica resultó exitosa, el seguimiento de la evolución permitió apreciar que el diente mantuvo su vitalidad, las raíces continuaron desarrollándose y no aparecieron signos o síntomas de lesiones periapicales.

9-year-old pediatric male patient, who came for dental evaluation because of dental pain after eating cold food. The definitive diagnosis was established as reversible pulpitis of the molar 3.6, deciding on the therapeutic behavior of the direct pulp coating with tricalcium silica to achieve apexification. The clinical decision was successful, the follow-up of the evolution identified the affected tooth as vital, the roots continued to develop, and no signs or symptoms of periapical lesions appeared.

Biodentine: um substituto ao MTA? / Biodentine: an alternative to MTA?

Objetivo: o objetivo desse estudo é realizar uma revisão de literatura em relação às propriedades físico- -químicas e biológicas do Biodentine, seu emprego na Endodontia e discutir, com base nas evidências científicas encontradas na literatura, se esse material poderá ser um substituto ao MTA. Métodos: foi realizada uma busca na literatura na base de dados PubMed, usando os termos em inglês: Biodentine, calcium silicate, MTA, properties, setting time, radiopacity, solubility, physicochemical properties, porosity, hydration, biocompatibility, bioactivity, microhardness, compressive strength, bond strength, irrigants, furcal perforation, retrograde filling material, revitalization, revascularization, endodontics, apexification. Cinquenta artigos foram incluídos. Resultados: os artigos revisados sugerem que o Biodentine tem características favoráveis e que tem alcançado resultados promissores em relação ao MTA. Conclusão: o Biodentine pode ser considerado um eventual substituto ao MTA (AU).

Introduction: This study aim to review the literature about the physicochemical and biological characteristics of Biodentine, a cement used in endodontics, and discussed whether this material might be an alternative to MTA according to the scientific evidence found in the literature. Methods: A literature search was performed on PubMed using the following terms: Biodentine, calcium silicate, MTA, properties, setting time, radiopacity, solubility, physicochemical properties, porosity, hydration, biocompatibility, bioactivity, microhardness, compressive strength, bond strength, irrigants, furcal perforation, retrograde filling, revitalization, revascularization, endodontics, apexification. Fifty studies met inclusion criteria. Results: Biodentine seems to have favorable characteristics, and the results of its use are promising when compared with those of MTA. Conclusion: Biodentine may be a possible alternative to MTA (AU).

Polymicrobial Leakage and Retention of MTA and Portland Cement in a Model of Apexification

Abstract Objective: To evaluate the sealing capacity and retention of apical barriers made with mineral trioxide aggregate (MTA) and Portland cement (PC). Material and Methods: Fifty-six bovine incisors were sectioned 8 mm above and 12 mm below the cement-enamel junction. The root canal was enlarged with a diamond drill to create a standard 2.5 mm diameter opening. Apical sheets of 5 mm thickness were placed using white MTA-Angelus or white PC. Fifteen samples of each material were exposed to human saliva in a dual chamber apparatus and casting was evaluated at 30 days. Samples without apical barriers and fully sealed samples were used as positive and negative controls (n = 3), respectively. Data were analyzed by Fisher's exact test (p<0.05) after 3 periods: 1 to 10 days (P1); days 11 to 20 (P2); and days 21 to 30 (P3). Then, three 1 mm thick sections were obtained at the apical level of other root samples of each material (n = 10) and the push-out test was performed Results: The leakage rates in P1, P2 and P3 were 60%, 73.3% and 100% for the MTA; and 73.3%, 86.7% and 100% for CP, with no significant difference between materials, regardless of the period analyzed. There were no significant differences between the bond strengths for both cements (p>0.05) Conclusion: Mineral trioxide aggregate and Portland cement apical barriers presented similar sealing ability and bond strength values.

Técnica de revascularización en odontopediatría paso a paso. A propósito de un caso / écnica da revascularização em odontopediatria passo a passo. Relato de caso / Technique of revascularization in odontopediatria step by step. A case report Abstract

Introducción: La revascularización es un procedimiento actual para dientes necróticos con ápice inmaduro; supone una opción de manejo clínico más conservador con respecto a los tratamientos tradicionales de apicoformación, en el cual, por medio de la inducción de las células madre de la papila dental periapical, se crea un sangrado dentro del conducto radicular, el cual se convierte en un coágulo estable que permite la maduración fisiológica radicular, a la vez que el engrosamiento de las paredes del conducto. El objetivo de este tratamiento es permitir un cierre completo del ápice. Caso clínico: Se presenta el caso de un niño de 7 años de edad con abceso apical en el diente 21, se realiza un tratamiento de revascularización siguiendo la técnica descrita por Hoshino (1996) de apósitos intraconducto con alguna modificación. Siguiendo la teoría descrita por Iwaya en 2001, y Banchs y Trope en 2004, el canal casose desinfecta con abundante irrigación y se rellena con una combinación de pasta bi-antibiótica. Una vez que se completa el protocolo de desinfección, el ápice se irrita mecánicamente para iniciar el sangrado en el canal y producir un coágulo sanguíneo hasta el nivel de la unión cemento-esmalte, colocando Agregado Trióxido Mineral como barrera entre el coágulo y la restauración final. En este caso, la combinación de un canal desinfectado, una matriz en la que podría crecer tejido nuevo y un sello coronal efectivo parece producir el ambiente necesario para una revascularización exitosa. Conclusiones: Bajo las circunstancias de este caso, se puede concluir que el protocolo del tratamiento seguido (regeneración apical y tapón de MTA) es un tratamiento de éxito clínico para conseguir el cierre apical en dientes inmaduros. Este éxito también dependerá de variables como el material de desinfección radicular: el Cloruro Sódico seguido de una solución salina es capaz de desinfectar los conductos sin tener que instrumentar las débiles paredes dentinarias. El uso de pasta bi-antibiótica intracanal utilizada en el caso clínico previene de la pigmentación dental que provocan las tetraciclinas cuando se utilizan en la pasta tri-antibiótica. Se necesitan revisiones de control radiográfico cada 3 meses el primer año y anualmente hasta los 4 años de realizada la revascularización, para comprobar el éxito del tratamiento. Actualmente la regeneración tisular está enfocada hacia el desarrollo de sistemas de cultivo que permitan reproducir células embrionarias hacia tejidos dentales perdidos.

Introdução: A revascularização é um procedimento atual para dentes necróticos com ápice imaturo; É uma opção de gestão clínica mais conservadora em relação aos tratamentos tradicionais de apicificação, onde, através da indução das células-tronco da papila periapical, é criada uma hemorragia dentro do canal radicular, que se torna um coágulo estável que permite a maturação radicular fisiológica, ao mesmo tempo as paredes dos canais radiculares sofrem um espessamento. O objetivo deste tratamento é permitir o fechamento completo do ápice. Caso clínico: apresentamos o caso de um menino de 7 anos com um abscesso apical no dente 21, um tratamento de revascularização foi realizado seguindo a técnica descrita por Hoshino (1996) com alguma modificação. Seguindo a teoría descrita por Iwaya em 2001 e Banchs e Trope em 2004, usando na revascularização pasta bi-antibiótica e Agregado Trióxido Mineral como barreira entre o coágulo e a restauração final. Conclusões: nos últimos estudos publicados, o hidróxido de cálcio e a pasta tri-antibiótica foram utilizados como materiais de preenchimento entre as fases do tratamento. Mas estes foram substituidos por uma mistura bi-antibiótica. Como a sua eficácia contra o hidróxido de cálcio por si só não foi comprovada, este continua a ser utilizado como o único material intermediário entre as etapas do tratamento de revascularização. Com esta técnica, tentamos alcançar um desenvolvimento radicular completo e paredes mais espessas, evitando assim o problema da fratura radicular.

Introduction: Revascularization is a current procedure for necrotic teeth with an immature apex; It is a more conservative clinical management option with respect to traditional apicoformation treatments, where, through the induction of the stem cells of the periapical dental papilla, a bleeding is created inside the root canal, which becomes a stable clot that allows the physiological radicular maturation, at the same time as the thickening of the duct walls. The objective of this treatment is to allow a complete closure of the apex. Clinical case: The case of a 7-year-old boy with apical abscess on tooth 21 is presented, a revascularization treatment is performed following the technique described by Hoshino (1996). Following the theory described by Iwaya in 2001, and Banchs and Trope in 2004, using bi-antibiotic paste in the revascularization, and mineral trioxide aggregate as a barrier between the clot and the final restoration. Conclusions: In the last published studies, calcium hydroxide and tri-antibiotic paste have been used as filling materials between phases, to use a bi-antibiotic mixture. Its effectiveness against calcium hydroxide alone has not been proven, which is used again as the only intermediate material between the steps of the revascularization treatment. With this technique we try to achieve a complete root development and thicker walls, thus avoiding the problem of root fracture.

Influence of photobiomodulation therapy on root development of rat molars with open apex and pulp necrosis

Abstract This study aimed to evaluate the role of photobiomodulation (PBM) in apexification and apexogenesis of necrotic rat molars with an open apex. Rat molars were exposed to the oral environment for 3 weeks. Canals were rinsed with 2.5% NaOCl and 17% EDTA, filled with antibiotic paste and sealed. After 7 days, canals were rinsed and divided into six groups (n=6): mineral trioxide aggregate (MTA); blood clot (BC); human dental pulp stem cells (hDPSC); MTA+PBM; BC+PBM; and hDPSC+PBM. In hDPSC groups, a 1% agarose gel scaffold was used. Two groups were not exposed: healthy tooth+PBM (n = 6), healthy tooth (n = 3); and one was exposed throughout the experiment: necrotic tooth (n = 3). In PBM groups, irradiation was performed with aluminum gallium indium phosphide (InGaAlP) diode laser for 30 days within 24-h intervals. After that, the specimens were processed for histological and immunohistochemical analyses. Necrotic tooth showed greater neutrophil infiltrate (p < 0.05). Necrotic tooth, healthy tooth, and healthy tooth+PBM groups showed absence of a thin layer of fibrous condensation in the periapical area. All the other groups stimulated the formation of a thicker layer of fibers (p < 0.05). All groups formed more mineralized tissue than necrotic tooth (p < 0.05). PBM associated with MTA, BC, or hDPSC formed more mineralized tissue (p < 0.05). MTA+PBM induced apexification (p < 0.05). Rabbit polyclonal anti-bone sialoprotein (BSP) antibody confirmed the histological findings of mineralized tissue formation, and hDPSC groups exhibited higher percentage of BSP-positive cells. It can be concluded that PBM improved apexification and favored apexogenesis in necrotic rat molars with an open apex.

Apicificação com MTA para obturação de dente traumatizado: relato de caso / Apexification with MTA for traumatized tooth: a case report

Introdução: o tratamento de dentes jovens traumatizados requer atenção especial, devido à possível presença de ápice incompleto e paredes dentinárias delgadas, o que pode dificultar ou comprometer o tratamento endodôntico convencional. Faz-se necessária a realização de um procedimento para induzir a formação de uma barreira mineralizada, com o auxílio de materiais biocompatíveis, como o hidróxido de cálcio e o agregado trióxido mineral (MTA). Objetivo: relatar um caso clínico em que foi realizada apicificação, com tampão de MTA, em um incisivo lateral superior traumatizado. Conclusão: o uso de MTA como material obturador de dentes com ápice incompleto mostrou- se eficiente, pois permitiu resolução do caso com sucesso e a manutenção do dente na arcada, exercendo suas funções primárias quanto à estética e à mastigação.

Outcome of Regenerative Endodontic Treatment for an Avulsed Immature Permanent Tooth: A Case Report / 대한소아치과학회지

Dental avulsion, defined as the complete displacement of a tooth from the alveolar bone with consequent loss of the blood and nerve supply, was reported as one of the most severe dental injuries. Avulsion can cause tissue ischemia, which leads to pulp necrosis.Apexification is a conventional treatment method that induces an apical calcified barrier in immature roots with pulp necrosis. However, root development characterized by an increase in the root thickness and length cannot be achieved by apexification.The purpose of this case report was to describe the radiographic and clinical outcomes of regenerative endodontic treatment for the avulsed and necrosed permanent tooth with an immature root after replantation in a 5-year-old girl; the treatment was performed using a mixture of ciprofloxacin, metronidazole and cefaclor, CollaTape and Biodentine.

One-visit Apexification Using MTA and Reattachment of a Crown-root Fractured Tooth with Severe Coronal Damage: A Case Report / 대한소아치과학회지

In dental trauma, reattachment of the original tooth fragment improves the reproduction of original tooth shape, texture, color, and radiolucency; thus, it provides good aesthetics.A 9-year-old boy was referred due to complicated crown-root fracture of the maxillary right central incisor. Although it had poor prognosis due to severe coronal damage and subcrestal fracture, reattachment of the tooth fragment was chosen due to the patient's age. One-visit apexification with mineral trioxide aggregate (MTA) was performed, followed by osteotomy and reattachment of the tooth fragment with post placement.Regular observation revealed no clinical signs or symptoms and no radiologic complications.

Triple antibiotic paste: momentous roles and applications in endodontics: a review

This study investigated the latest findings and notions regarding ‘triple antibiotic paste’ (TAP) and its applications in dentistry, particularly endodontics. TAP is a combination of 3 antibiotics, ciprofloxacin, metronidazole, and minocycline. Despite the problems and pitfalls research pertaining to this paste has unveiled, it has been vastly used in endodontic treatments. The paste's applications vary, from vital pulp therapy to the recently introduced regeneration and revascularisation protocol. Studies have shown that the paste can eliminate the root canal microorganisms and prepare an appropriate matrix for further treatments. This combination is able to remove diverse groups of obligate and facultative gram-positive and gram-negative bacteria, providing an environment for healing. In regeneration protocol cases, this allows the development, disinfection, and possible sterilization of the root canal system, so that new tissue can infiltrate and grow into the radicular area. Moreover, TAP is capable of creating a discipline in which other wanted and needed treatments can be successfully performed. In conclusion, TAP, as an antibacterial intracanal medication, has diverse uses. Nevertheless, despite its positive effects, the paste has shown drawbacks. Further research concerning the combined paste and other intracanal medications to control microbiota is a must.

Regenerative Endodontic Procedure in Korean Children and Adolescents: A Case Report / 치위생과학회지

Mineral trioxide aggregate (MTA) is widely used in endodontic therapy as a pulp-capping material, root or furcal perforation repair material, and for apexification and obturation of the root canal system. The purpose of this study was to formally document cases of MTA application in South Korean children and adolescents. Through this research, the practice of using MTA will be introduced and familiarized to the clinical practitioners. This study involved endodontic treatment using MTA for fractured crowns in 11- and 12-year-old. The children were followed up for 12 months until the pulp vitality was confirmed; in young permanent teeth with immature roots, the pulp is integral to the process of apexogenesis. These observational results regarding the use of MTA as an apexification material in non-vital immature permanent incisors appear to provide promising results in the search for new materials to meet existing endodontic needs.

Apexificación utilizando el hidróxido de calcio como primera alternativa de tratamiento / Apexification using calcium hydroxide as a first alternative treatment

Cuando una necrosis pulpar se instala en dientes jóvenes que aún no han completado el cierre apical o no han terminado el desarrollo radicular, la apexificacion es el tratamiento indicado, el cual induce la formación de una barrera calcificada que oblitere el orificio apical 0 que permita el desarrollo radicular completo. La mezcla del hidróxido de calcio Ca(OH)2 con suero fisiológico es la forma más deseable y sencilla de inducir la apexificacion con pronóstico exitoso. El caso clínico que se presenta es un paciente masculino de 10 años de edad, al cual se diagnostica necrosis pulpar en O.D.36, radiográficamente con zona radiohicida en ápices y furca, retracción pulpar y falta de cierre apical al cual se realiza el tratamiento de apexificacion con hidroxido de calcio, mostrando en el control radiográfico disminución de la lesión en furca y ápices, lográndose el cierre apical permitiendo el tratamiento de endodoncia con gutapercha y finalmente la rehabilitación con corona de acero cromo...

When a pulp necrosis it's established in young teeth that have not developed an apical seal or the incomplete development of the root, an apexitication is the election treatment, because it inducts the formation of a calcified barrier that obliterates the apical foramen or allows the complete radicular development. The mixture of Calcium Hydroxide with physiological serum is the most simple technique of inducting apexification. The case report presents a 10 year old male, with necrotic pulp in O.D 36, in the x-ray can be observed radiolucent zone in apex and furcation, pulp retraction and lack of apical seal; in this teeth apexification was performed with calcium hydroxide, and it shows a correct evolution in decrasing of lesion in furcation and seal in apex; that permits the obturation or radicular system and finally the rehabilitation with a steel crown...