Management of a bulbous blunderbuss maxillary central incisor with one root and three canals in a patient with cleft lip and palate.

Unique anatomical deviations in canal structure are rare in anterior teeth, especially central incisors, and thus risk being overlooked. For successful intervention, a meticulous diagnostic procedure and treatment plan, significantly aided by cone-beam computed tomography (CBCT), are crucial. The case at hand explores the management of a maxillary left central incisor in a cleft palate patient, characterized by multiple developmental lobes, a bulbous crown, and an atypical root anatomy. The primary symptom was pain, accompanied by a history of trauma at age 8 years and ensuing tooth discoloration. Initial evaluations, augmented by CBCT, revealed pulpal necrosis in a single-rooted tooth with three distinct canals. Initial clinical examination was supplemented by electrical pulp testing, RadioVisioGraphy (RVG), and CBCT, after which the root canal therapy was initiated. Informed consent was obtained from the patient. The access cavity preparation resulted in a three-orifice cavity. Subsequently, the canals were enlarged and sufficiently debrided. Calcium-hydroxide was applied for 2 weeks before the commencement of apexification and obturation, followed by esthetic rehabilitation. This case highlights the importance of recognizing rare anatomical variations in anterior teeth and demonstrates the invaluable role of CBCT in both diagnosing and managing such complexities.

Regenerative endodontic treatment and traumatic dental injuries.

Pulp necrosis is the most common complication following dental trauma and is often associated with apical periodontitis. The management of these teeth is challenging in terms of large root canals, open apices, thin dentinal walls, and short roots. Over decades the conventional treatment for these teeth was calcium hydroxide apexification, a time-consuming procedure despite high success rates. Subsequently after the introduction of mineral trioxide aggregate and hydraulic calcium silicate materials single visit apical plug procedures became increasingly practiced with comparable success rates to the conventional apexification. The search continued afterward for a clinical procedure that may stimulate further root development and apical closure to avoid the long-term complication of root fracture after apexification. Regenerative procedures using stem cells derived from the apical papilla and blood clots as scaffolds were then introduced for the management of immature teeth, with variable protocols and success rates. This review will cover the evidence available and current position of regenerative endodontic procedures in traumatized immature teeth with apical periodontitis, in terms of clinical protocols, outcome, and potential prognostic factors.

Radiographic Evaluation of Regenerative Endodontic Procedures and Apexification Treatments with the Assessment of External Root Resorption.

INTRODUCTION: This multi-centered cohort study evaluated the radiographic outcomes of regenerative endodontic procedures (REPs) and apexification treatments (APEX) of immature teeth with endodontic disease. MATERIALS AND METHODS: This cohort study included a retrospective record review and prospective data collection of pediatric patients with teeth treated with REPs or APEX between 2005-2014. Data including the presence of a periapical lesion, external root resorption (ERR), obliteration, apical hard tissue, apical closure, intracanal calcifications, and radiographic root area (RRA) change based on measurements were collected/measured from radiographic images. Univariate and multivariate analyses were conducted. RESULTS: The cohort included 190 subjects (204 teeth (92 REPs; 112 APEX)). The frequency of pre-treatment periapical pathology was similar between cases in which the clinical treatment failed versus successful treatment cases. However, the frequency of pre-treatment ERR was higher in failed cases than in successful cases (p=0.007). The mean RRA change was greater than twenty percent in 21% of the REPs cases. In traumatized teeth, REP treatment resulted in less hard tissue formation than other endodontic disease etiologies measured by RRA (p=0.001). 53% of cases with ERR (16/30) showed signs of healing/arrest and were mostly treated with REPs (11/16). CONCLUSIONS: The presence of ERR negatively affected the treatment outcome. There was significant variability in RRA change in REPs. Signs of healing/arrest of the resorptive lesion were radiographically visible in many cases treated with REPs.

Advanced Management of Open Apex Utilizing Platelet-Rich Fibrin and Bone Graft As Apical Barriers With Mineral Trioxide Aggregate (MTA) Obturation: A Detailed Case Report.

Management of open apex cases in endodontics poses a significant challenge, especially in immature teeth with necrotic pulps. Traditional apexification techniques have been the mainstay of treatment, aiming to induce the formation of a calcific barrier at the root apex. However, newer approaches incorporating biological materials such as platelet-rich fibrin (PRF) and demineralized bone matrix (DMBM) have emerged as promising alternatives. This article presents a case report of an 18-year-old male patient who presented with fractured upper central incisors, with the upper right central incisor displaying an open apex due to trauma sustained eight years prior. The treatment plan involved apexification using a combination of DMBM and PRF, with mineral trioxide aggregate (MTA) utilized as an apical barrier. The procedure was performed under rubber dam isolation, meticulously removing necrotic pulp tissue, irrigating with sodium hypochlorite solution, and placing a calcium hydroxide medicament. Subsequent visits included the placement of DMBM and PRF mixture into the canal space to create an apical barrier, followed by MTA placement and final restoration. Follow-up examinations at 3 and 12 months revealed the tooth to be asymptomatic and functionally normal, with radiographic evidence of osseous repair and complete apical closure. This case underscores the efficacy of a multimodal approach utilizing DMBM, PRF, and MTA in successfully managing open apex cases. Further research and long-term follow-up studies are warranted to validate this treatment modality's predictability and long-term success.

Prognosis of non-vital incisors after apexification using bioceramics: a retrospective study.

PURPOSE: To evaluate the outcome of apexification using bioceramics in immature permanent teeth, and to study the factors influencing treatment outcome and frequency of spontaneous cervical root fractures. METHODS: Forty-six children with 51 non-vital permanent incisors treated with a bioceramic apical plug were included. Mean age at pulp necrosis was 9.8 (SD 2.2) years and mean follow-up time was 3.3 (SD 2.4) years. Data were extracted from dental records and included stage of root development, presence of external root resorptions, clinical signs of infection, size of periapical lesion, type and placement of bioceramic plug, and spontaneous root fracture. Treatment outcome was assessed using periapical index (PAI-score) and presence of clinical symptoms. The statistical analyses were conducted using IBM SPSS Statistics for Windows, version 28 (IBM Corp., Armonk, N.Y., USA). Data were cross-tabulated and tested with chi-square statistic. RESULTS: Biodentine™ was used as apical plug in 78.4% of the teeth and MTA in 21.6%. Complete healing or signs of healing was reported in 86.3% of the teeth, whilst seven teeth (13.7%) were non-healed. All non-healed teeth had preoperative clinical signs of infection. No difference was found in stage of root development, presence of root resorption, and type and placement of bioceramic plug in healed and non-healed teeth (p > 0.05). Five teeth (9.8%) exhibited root fracture 1-6 years after treatment and all had very immature root development. Type of bioceramic or external root resorption was not associated with spontaneous root fracture. CONCLUSION: Apexification using bioceramics showed favourable prognosis in immature permanent teeth. Very immature teeth were at risk of root fracture after apexification with bioceramics.

Outcomes of apexification in immature traumatised necrotic teeth and risk factors for premature tooth loss: A 20-year longitudinal study.

BACKGROUND/AIM: To evaluate the long-term survival of immature traumatized incisors with pulp necrosis and apical periodontitis after endodontic treatment with two apexification techniques (calcium hydroxide apexification and MTA-apical plug) and to identify major factors affecting the survival of these teeth. MATERIALS AND METHODS: Records of 2400 children and adolescents were screened for presence of traumatic dental injuries to immature incisors where endodontic treatment with the two apexification techniques was performed during January 2003 and December 2022, compared to a control group of mature teeth treated with conventional endodontic techniques. The studied variables were age; sex; apexification technique, presence of luxation and hard tissue injuries; preoperative root development stage (RDS), preoperative and postoperative periapical index (PAI), the time-point for tooth loss, and overall survival time in years. Kaplan-Meier estimates were used to graphically present the survival functions and Cox proportional hazard model to calculate hazard ratios (HR, 95% CI). RESULTS: The median survival time was 10 years for calcium hydroxide apexification, 16.1 for MTA-apexification, for luxation injuries other than intrusions and avulsions 15.5 years, for intrusions 12.5 years and for avulsions 6.8 years. The variables with significant negative impact on tooth survival were calcium hydroxide apexification, avulsion and postoperative PAI 3-5. No significant relationships were found for the variables MTA apexification, concussion; subluxation; lateral luxation; extrusion, intrusion, hard tissue injuries, preoperative RDS and PAI scores and postoperative PAI 1-2. After adjustment, the risk for premature tooth loss was 13.5 times higher in calcium hydroxide apexification, approximately 2 to 4 times higher in PAI 3-5, and 5.6 times higher in avulsions. CONCLUSIONS: Calcium hydroxide apexification, avulsion, and postoperative PAI 3-5 were identified as prognostic variables with significant negative impact on the risk for premature tooth loss.

Access to Care Considerations for the Endodontic Treatment of Immature Permanent Teeth: A National Survey of Pediatric Dentists and Endodontists.

INTRODUCTION: This study aimed to investigate access to care and financial considerations associated with the endodontic treatment of immature permanent teeth. METHODS: Surveys were distributed to endodontists (n = 2,457) and pediatric dentists (n = 3,974) in the United States. Data were analyzed using X2 analysis and logistic regression. The level of significance was set to 0.05. RESULTS: The response rate was 13% (n = 840). Respondent specialist groups were similar by age and years since specialty residency completion, but significantly different with regard to primary practice setting (eg private practice, Federally Qualified Health Center, hospital), (P = .001). The majority (91%) of respondents reported participation with dental insurance. Pediatric dentists (69%) were significantly more likely than endodontists (17%) to participate with public-payer dental insurance (P < .001). The majority of respondents (82%) indicated that patients reported economic factors (time or money) as a barrier to accessing endodontic treatment. Pediatric dentists were significantly more likely to consider economic factors when planning for treatment (P < .001). Pediatric dentists were more likely than endodontists to have the opinion that endodontic procedures for treatment of necrotic immature permanent teeth should cost less than root canal therapy (apexification, P < .001; regenerative endodontic procedures, P = .002). Pediatric dentists (33%) reported encountering barriers when attempting to refer their patients to an endodontist. Inability to find an endodontist that participates with dental insurance was the most frequently cited barrier. CONCLUSIONS: Limited clinician participation with dental insurance and gaps in insurance coverage for endodontic procedures appear to contribute to access to care barriers for pediatric patients.

Micro-computed tomography (micro-CT) evaluation of root canal morphology in immature maxillary third molars.

The endodontic treatment of immature permanent teeth with necrotic pulp is a significant clinical challenge. The success of regenerative endodontic procedure is highly dependent on disinfection of the root canal and an accurate anatomical knowledge of the root canal. The aim of this study was to use micro-computed tomography (micro-CT) analysis to investigate the configuration of root canals in the upper permanent third maxillary molars with incomplete root development in their coronal, apical and middle third portions. Thirty immature third permanent maxillary molars were scanned using a micro-CT system. Then, we measured the diameters and areas of the root canal in the coronal, middle and apical third of the roots. The ratio between the long and short diameter of each root canal was then calculated and the canals were divided into several groups: round, oval, long oval, flat and irregular. The round configuration was not observed in the distobuccal and mesiobuccal roots in any of their anatomical regions. Oval and long oval canals predominated in the distobuccal root. The greatest variations were observed in the mesiobuccal root, with the ribbon-shaped canal predominating in the middle region and an irregular shape in the apical region. In the coronal region of the palatal canal, the round configuration predominated; in the middle third, we observed an almost equivalent distribution between round and oval configurations; apically, the oval shape predominated. In conclusion, we observed significant complexity and variation in the morphology and configuration of root canals in immature permanent molars, thus generating additional obstacles for the success of regenerative endodontics.

Open Apex and its Management: Review Article.

During root development, the teeth are subjected to a variety of assaults. Due to this, the root stops forming and the closure of the apex does not take place. Root canal treatment becomes a major challenge in these cases because of the width of the canal and wide-open apices. Management of open apices includes apexogenesis in vital young permanent teeth and apexification, which is a method to induce a calcified barrier in the root. Newer concepts include regeneration and revascularization procedures, which still need to be experimented with further.

Intraradicular reinforcement of traumatized immature anterior teeth after MTA apexification.

This review article describes the methods and clinical recommendations for reinforcing traumatized anterior immature teeth with pulp necrosis treated with mineral trioxide aggregate (MTA) apexification. Traumatic injury can cause pulp necrosis and incomplete root formation in immature teeth. MTA apexification is the treatment of choice for necrotic immature teeth, particularly during the middle or late stages of root development. MTA apexification has a high success rate; however, failures due to cervical or root fractures occasionally occur. The risk of fracture is higher in immature teeth with thin root dentin, particularly those with external root resorption. Furthermore, the loading force from any parafunctional habit also increases fracture risk. Therefore, intra-radicular reinforcement may be necessary after MTA apexification. In vitro, intraradicular restoration with a resin composite/core build-up material or a prefabricated fiber post demonstrated better root reinforcement than root canal obturation materials (i.e., gutta-percha and sealer). However, the root-reinforcement effect of MTA orthograde filling in the entire root canal remains unclear. In vivo, the survival of fractured teeth with intraradicular restorations (resin composite/core build-up material or prefabricated fiber posts) is extremely high. Moreover, the survival of teeth with gutta-percha/sealer obturation or MTA orthograde filling and restoration with resin composite extending into the cervical third of the root canal approximately 1-2 mm below the cemento-enamel junction is acceptably high. Based on this evidence, the remaining tooth/root structure and loading force should be carefully examined when considering intra-radicular reinforcement of immature anterior teeth treated with MTA apexification.

Failed Regenerative Endodontic Case Treated by Modified Aspiration-irrigation Technique and Apexification.

AIM: This report addresses the management of a large persistent discharging lesion in an 11-year-old boy. The report describes the use of aspiration-irrigation technique for the management of immature necrotic tooth with persistent discharge after a failed regenerative procedure. BACKGROUND: Regenerative endodontics aim to provide an increase in root canal width, length, and in apical closure. Alternative procedures, such as apexification, should be attempted when regeneration fails. If the canal cannot be dried to persistent discharge, the aspiration-irrigation technique can be used. The technique relies on using aspiration along with irrigation to remove pus from the periapical area. CASE DESCRIPTION: This is a case for an 11-year-old patient who had trauma to tooth #11, which resulted in the complicated crown fracture. He had an emergency management that included pulpectomy and intracanal medication at another clinic. Two years later, the patient was presented to our clinic. Upon examination, the diagnosis was previously initiated therapy with asymptomatic apical periodontitis in immature tooth #11. Regeneration was attempted first but failed. The mineral trioxide aggregate (MTA) plug was removed, and the canal had persistent pus discharge. The canal was filled with intracanal medication, and then 2 weeks later, the canal was filled with triple antibiotic paste (TAP). Next visit, and due to continuous discharge, tooth #11 was treated conservatively with an intracanal aspiration-irrigation technique. An IrriFlex needle attached to a high-volume suction was used to aspirate the cystic fluid. Mineral trioxide aggregate plug apexification was performed in a later visit and the tooth was restored. CONCLUSION: During the 3-month and 16-month follow-up, there was resolution of the symptoms, a decrease in the periapical lesion size, and soft tissues appeared within normal limits. CLINICAL SIGNIFICANCE: Regenerative procedures are a good option for immature necrotic teeth. These procedures may fail due to persistent pus discharge from the root canals. The aspiration-irrigation technique is a good treatment option in cases of consciously discharging canals. How to cite this article: Alsofi L, Almarzouki S. Failed Regenerative Endodontic Case Treated by Modified Aspiration-irrigation Technique and Apexification. J Contemp Dent Pract 2024;25(1):92-97.

Modified single-step apexification and strengthening of thin dentinal walls with Biodentine.

Apexification is a technique used to create a mineralized barrier in a root having an open apex or to continue the apical growth of a root that is still not fully developed in teeth with necrotic pulps. Biodentine is a versatile material which can help in achieving apical closure as well as reinforcement of thin dentinal walls, thus improving the overall prognosis and preserving the natural dentition. In the present case, the radiographic evaluation showed thinner dentinal walls and an open apex with periapical radiolucency in relation to the upper right central incisor. The large open root apex and thin dentin walls of immature permanent teeth render them challenging to treat with root canal therapy. This case report describes a modified single-step apexification procedure and strengthening of the dentinal walls of the root canal using Biodentine.

Evaluating the Effectiveness of a Virtual Simulation Platform for Apexification Learning.

The traditional teaching methods for apexification face difficulties in meeting dental students' practical training needs. Herein, we aimed to find optimal techniques of learning apexification and to evaluate whether a virtual simulation platform for apexification learning was effective. A virtual simulation learning platform for apexification was developed. Ninety-nine 4th-year dentistry students were classified randomly into the control group (Con, receiving conventional teaching) and the experimental group (Exp, receiving virtual simulation teaching). Theoretical tests before (test 1) and after the virtual simulation training (test 2) assessed the effect of learning. In the Exp group, a questionnaire was used to assess student understanding of the virtual simulation platform. In the Exp group, the test-2 scores were significantly better compared those in the Con group (p < 0.001). Furthermore, in the Exp group, the test-2 scores exceeded those of test 1 (p < 0.001). Feedback using the questionnaire covered the evaluation of the Exp group for the virtual reality platform and offered useful suggestions. Applying the virtual simulation learning platform had positive effects on improving learning quality related to apexification.

Management of a permanent lateral incisor with a talon cusp and immature apex: A case report.

This case report focuses on the diagnosis and treatment of a maxillary lateral incisor affected by a talon cusp, a rare developmental dental anomaly. The case presented with irreversible pulpitis and an immature apex. The article discusses the prevalence, etiology, classification, and treatment options for talon cusps, highlighting their clinical significance and potential complications. Clinical and radiographic findings obtained from a periapical radiograph and a cone-beam computed tomography (CBCT) scan are outlined. The treatment approach involved the removal of the talon cusp, endodontic therapy including apexification with mineral trioxide aggregate, and aesthetic restoration of the tooth. The report underscores the value of precise diagnosis, careful treatment planning, and the utility of CBCT scans in effectively managing talon cusps.

The applications of the plasma matrix in the treatments of dental pulp and periapical diseases / 口腔疾病防治

@#The plasma matrix is a kind of autologous blood conduct. It has been widely used in maxillofacial tissue regeneration, skin cosmetology and some other fields. Recently, to preserve the dental pulp as well as the teeth, pulp regeneration therapy and apical surgery have become increasingly important as well as the applications of bioactive materials. As a kind of autologous bioactive material, the plasma matrix has some natural advantages as it is easy to obtain and malleable. The plasma matrix can be used in the following cases: ①pulp revascularization of young permanent teeth with open apical foramina that cannot stimulate apical bleeding; ② apical barrier surgery with bone defects and large area perforation repair with bone defects or root sidewall repair surgery; ③ apical surgeries of teeth with large area of apical lesions, with or without periodontal diseases. The plasma matrix is a product derived from our blood, and there are no obvious contraindications for its use. Several systematic reviews have shown that the plasma matrix can effectively promote the regenerative repair of dental pulp in patients with periapical diseases. However, the applications of plasma matrix are different because its characteristics are affected by different preparation methods. In addition, there is still a lack of long-term clinical researches on the plasma matrix, and the histological evidences are difficult to obtain, so a large number of in vitro and in vivo experimental studies are still needed. This article will describe the applications of different kinds of plasma matrix for dental pulp regeneration and bone tissue regeneration in apical surgeries to provide references for clinicians in indication selection and prognosis evaluation.

Comparative Evaluation of the Physical and Antimicrobial Properties of Mineral Trioxide Aggregate, Biodentine, and a Modified Fast-Setting Mineral Trioxide Aggregate Without Tricalcium Aluminate: An In Vitro Study.

Background Tricalcium aluminate, one of the major constituents of mineral trioxide aggregate (MTA), has been shown to have cytotoxic properties. Mineral trioxide aggregate has moderate to low antimicrobial activity against the most common endodontic pathogen, Enterococcus faecalis. Aim To assess the physical and antimicrobial properties of a newly modified formulation of mineral trioxide aggregate. Materials & methods The final setting time, compressive strength, and antimicrobial properties were tested for three groups of materials. The material used for Group 1 was mineral trioxide aggregate (white MTA, Angelus, Londrina, Brazil); the material for Group 2 was Biodentine (Septodont, Saint Maur des Fossés, France); and for Group 3, a modified MTA formulation was used. Results Group 1 had the longest setting time, and Group 2 had the shortest setting time. Group 3's material was set at 83.65 ± 0.28 minutes. This difference among the groups was statistically significant (p < 0.05). The highest mean compressive strength during all the time periods was seen in Group 2, followed by Group 3, and the least in Group 1. This difference in compressive strength was statistically significant (p=0.001). The largest zone of inhibition against Enterococcus faecalis, Candida albicans, and Streptococcus mutans was seen in Group 3, followed by Group 2 and Group 1. Conclusion Under the limitations of the present study, the newly modified MTA could serve as an alternative to the conventional MTA in terms of faster setting, higher strength, and better antimicrobial properties.

Cost-Effectiveness Analysis of Regenerative Endodontics versus MTA Apexification.

INTRODUCTION: With the introduction of stem cell engineering in dentistry, regenerative endodontics has emerged as a potential alternative to mineral trioxide aggregate (MTA) apexification in the management of necrotic immature permanent teeth. However, the utility of this modality in terms of cost-effectiveness has not yet been established. Therefore, we performed cost-effectiveness analysis to determine the dominant treatment modality that would influence decision making from the private payer perspective. METHODS: A Markov model was constructed with a necrotic immature permanent tooth in a 7-y-old patient, followed over the lifetime using TreeAge Pro Healthcare 2022. Transition probabilities were estimated based on the existing literature. Costs were estimated based on United States health care, and cost-effectiveness was determined using Monte Carlo microsimulations. The model was validated internally by sensitivity analyses, and face validation was performed by an experienced endodontist and health economist. RESULTS: In the base-case scenario, regenerative endodontics did not turn out to be a dominant treatment option as it was associated with an additional cost of USD$1,012 and fewer retained tooth-years (15.48 y). Likewise, in the probabilistic sensitivity analysis, regenerative endodontics was again dominated by apexification against different willingness-to-pay values. CONCLUSION: Based on current evidence, regenerative endodontic treatment was not cost-effective compared with apexification in the management of necrotic immature permanent teeth over an individual's lifetime. KNOWLEDGE TRANSFER STATEMENT: The study provides valuable insight regarding the cost valuation and cost-efficacy of regenerative endodontic treatment versus apexification in the management of necrotic immature permanent teeth, as this would aid in effective clinical decision making, allowing for the functional allocation of resources.

Apexification Outcomes in the United States: A Retrospective Cohort Study.

INTRODUCTION: This epidemiological analysis used procedure codes from dental insurance claims data to identify apexification cases and evaluate survival at the tooth-level. METHODS: Dental insurance claims data from New York State (2006-2019) and Massachusetts (2013-2018) were used in an observational, retrospective cohort study to evaluate the provision and treatment outcomes of apexification. Statistical analyses included Kaplan-Meier survival estimates and Cox proportional hazards regression. Cox proportional hazard regression was used to evaluate the hazard of adverse event occurrence by age, gender, tooth type, placement of permanent restoration, and dental provider type. A sensitivity analysis evaluated potential bias in the survival estimates and adjusted hazard ratios (aHRs) due to differential loss to follow-up. Robust standard errors were used to account for potential dependence between teeth within an individual. RESULTS: The analytic cohort of 575 individuals included 632 teeth, with an average follow-up time of 64 months. The survival rates of apexification procedures were 95% at 1 year; 93% at 2 years; 90% at 3 years; and 86% at 5 years. Tooth retention following apexification was 98% at 1 year; 96% at 2 years; 95% at 3 years; and 90% at 5 years. Tooth type and subsequent placement of a permanent restoration were significant predictors of survival after apexification. CONCLUSIONS: The procedural and tooth survival outcomes of apexification were high and comparable to studies that analyzed clinical data on tooth survival following apexification.

Comparison of three different biomaterials used in in vitro molar apexification models.

OBJECTIVES: New biomaterials had some advantages such as mixing and easier application as compared to traditional MTA in single step apexification method. This study aimed to compare the three biomaterials used in the apexification treatment of immature molar teeth in terms of the time spent, the quality of the canal filling and the number of x-rays taken to complete the process. METHODS: The root canals of the extracted thirty molar teeth were shaped with rotary tools. To obtain the apexification model, ProTaper F3 was used retrograde. The teeth were randomly assigned into three groups based on the material used to seal the apex; Group 1: Pro Root MTA, Group 2: MTA Flow, Group 3: Biodentine. The amounts of the filling, the number of radiographs taken until treatment completion and the treatment duration were recorded. Then teeth were fixed for micro computed tomography imaging for quality evaluation of canal filling. RESULTS: Biodentine was superior to the other filling materials according to time. MTA Flow provided greater filling volume than the other filling materials in the rank comparison for the mesiobuccal canals. MTA Flow had greater filling volume than ProRoot MTA in the palatinal/distal canals(p = 0.039). Biodentine had greater filling volume more than MTA Flow in the mesiolingual/distobuccal canals (p = 0.049). CONCLUSIONS: MTA Flow was found as a suitable biomaterial according to the treatment time and quality of root canal fillings.

Apexification with a bioceramic reparative cement: a case report.

The aim of this case report is to describe the treatment of a maxillary right central incisor with pulpal necrosis and incomplete root formation. The 14-year-old patient had experienced trauma to both maxillary central incisors approximately 2 years earlier. Therapy consisted of apexification with a bioceramic reparative cement to form an apical plug. After the clinical and radiographic evaluations, the clinician opened the crown, performed the chemical-mechanical preparation, and placed calcium hydroxide-based medication. At the next appointment, 24 days later, the intracanal medication was removed through passive ultrasonic instrumentation; the canal was dried; and the bioceramic cement was inserted into the apical portion with the aid of a mineral trioxide aggregate holder. A sterile cotton ball, moistened with distilled water, was used to maneuver the material in the apical region, and a periapical radiograph was exposed to confirm the correct placement of the bioceramic reparative cement. The canal was filled with gutta percha cones and a bioceramic root canal sealer. All procedures were performed with the aid of microscopic magnification. Clinical and radiographic evaluations at the 18-month follow-up visit showed that the treated tooth was asymptomatic, suggesting that the bioceramic reparative cement is effective for apexification.