Boufdil H, Mtalsi M, El Arabi S, Bousfiha B Apexification with calcium hydroxide vs. revascularization. Case Rep Dent. 2020; 2020 https://doi.org/10.1155/2020/9861609
Witherspoon DE, Small JC, Regan JD, Nunn M Retrospective analysis of open apex teeth obturated with mineral trioxide aggregate. J Endod. 2008; 34:1171-1176 https://doi.org/10.1016/j.joen.2008.07.005
Steinig TH, Regan JD, Gutmann JL The use and predictable placement of mineral trioxide aggregate in one-visit apexification cases. Aust Endod J. 2003; 29:34-42 https://doi.org/10.1111/j.1747-4477.2003.tb00496.x
El-Meligy OA, Avery DR Comparison of apexification with mineral trioxide aggregate and calcium hydroxide. Pediatr Dent. 2006; 28:248-253
Songtrakul K, Azarpajouh T, Malek M Modified apexification procedure for immature permanent teeth with a necrotic pulp/apical periodontitis: a case series. J Endod. 2020; 46:116-123 https://doi.org/10.1016/j.joen.2019.10.009
Fahl N, Ritter AV Composite veneers: the direct-indirect technique revisited. J Esthet Restor Dent. 2021; 33:7-19 https://doi.org/10.1111/jerd.12696
AlSaeed T, Nosrat A, Melo MA Antibacterial efficacy and discoloration potential of endodontic topical antibiotics. J Endod. 2018; 44:1110-1114 https://doi.org/10.1016/j.joen.2018.03.001
Swaikat M, Faus-Matoses I, Zubizarreta-Macho Á Is revascularization the treatment of choice for traumatized necrotic immature teeth? a systematic review and meta-analysis. J Clin Med. 2023; 12 https://doi.org/10.3390/jcm12072656
Liang Y, Ma R, Chen L Efficacy of i-PRF in regenerative endodontics therapy for mature permanent teeth with pulp necrosis: study protocol for a multicentre randomised controlled trial. Trials. 2021; 22 https://doi.org/10.1186/s13063-021-05401-7
Tang Q, Jin H, Lin S Are platelet concentrate scaffolds superior to traditional blood clot scaffolds in regeneration therapy of necrotic immature permanent teeth? A systematic review and meta-analysis. BMC Oral Health. 2022; 22 https://doi.org/10.1186/s12903-022-02605-4
Balkaya H, Topçuoğlu HS, Demirbuga S Effect of different coronal restorations on the fracture resistance of teeth with simulated regenerative endodontic treatment: an in vitro study. Aust Endod J. 2022; 48:331-337 https://doi.org/10.1111/aej.12573
Fadag A, Negm M, Samran A Fracture resistance of endodontically treated anterior teeth restored with different post systems: an in vitro study. Eur Endod J. 2018; 3:174-178 https://doi.org/10.14744/eej.2018.70299
Immature necrotic permanent teeth with a significant amount of coronal hard tissue loss are treated by apexification procedures. These procedures do not encourage further root maturation, predisposing the teeth to possible root fractures. The modified apexification procedure simulates regenerative endodontic procedures in encouraging root development in terms of increased dentine thickness contributing to improved resistance to fracture, while allowing the canal space to be used for core retention. This case report presents an immature tooth treated by the modified apexification procedure with an 18-month follow-up.
CPD/Clinical Relevance: An alternative therapy in managing immature necrotic permanent teeth is of relevance to clinicians.
Article
Immature permanent teeth with necrotic pulps may be a challenge to treat because of their thin dentinal walls, shortened roots, and open apices, which could result in the extrusion of root-filling material into the peri-apical tissues.1 Such teeth are often managed by apexification, a method employed to induce an apical barrier in necrotic teeth with incompletely formed roots. Various bio-ceramic materials have been used to create an apical calcified tissue barrier.
Calcium hydroxide apexification is no longer routinely employed to manage open apices because of prolonged treatment time, further weakening of tooth structure and unpredictability of the calcified barrier formed.1 Mineral trioxide aggregate allows single-visit apexification with the formation of a reliable calcified barrier.2,3 These procedures do not encourage further root maturation, predisposing the root to fracture. Hence, regenerative endodontic procedures must ideally be employed for immature necrotic permanent teeth.4 Teeth with significant coronal tooth tissue loss may require the canal space for post retention and might not be ideal candidates for regenerative procedures.5 In such teeth, the modified apexification procedure may be employed. This includes placement of a collagen sponge in the apical one-third followed by 3–4 mm of MTA/Biodentine (Septodont, Saint-Maur-des-Fossés, France) to prevent extrusion into peri-apical tissues. The remainder of the canal space can serve for core retention.6
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