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      One-step apexification in immature tooth using grey mineral trioxide aggregate as an apical barrier and autologus platelet rich fibrin membrane as an internal matrix

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          Abstract

          Immature teeth with necrotic pulp and periapical lesion are difficult to treat via conventional endodontic therapy. Numerous procedures and materials have been utilized to induce root-end barrier formation. Traditionally, calcium hydroxide has been the material of choice for the apexification of immature permanent teeth; however, Mineral Trioxide Aggregate holds significant promise as an alternative to multiple treatments with calcium hydroxide. One of the technical problems associated with the placement of the restorative materials used as artificial barrier is to prevent overfill and underfill. Using a matrix avoids the extrusion of the material into the periodontal tissues. This case report presents the successful healing and apexification with combined use of Mineral Trioxide Aggregate as an apical barrier, and autologus platelet rich fibrin membrane as an internal matrix.

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          Most cited references31

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          Sealing ability of a mineral trioxide aggregate when used as a root end filling material.

          This in vitro study used rhodamine B fluorescent dye and a confocal microscope to evaluate the sealing ability of amalgam, super EBA, and a mineral trioxide aggregate when used as root end filling materials. Thirty single-canal teeth were cleaned, shaped, and obturated with gutta-percha and root canal sealer. After application of nail polish to the external surface, the apical 3 mm of each root was resected and 3-mm deep root end preparations were made. The roots were randomly divided into three groups and the root end preparations filled with the experimental materials. All roots were then exposed to an aqueous solution of rhodamine B fluorescent dye for 24 h, longitudinally sectioned, and the extent of dye penetration measured using a confocal microscope. Statistical analysis showed that the mineral trioxide aggregate leaked significantly less than amalgam and super EBA.
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            Long-term calcium hydroxide as a root canal dressing may increase risk of root fracture.

            It has been proposed (Cvek 1992) that immature teeth are weakened by filling of the root canals with calcium hydroxide dressing and gutta-percha. The aim of the present study was to test the hypothesis that dentin in contact with calcium hydroxide would show a reduction in fracture strength after a certain period of time. Immature mandibular incisors from sheep were extracted and divided into two experimental groups. Group 1: the pulps were extirpated via the apical foramen. The root canals were then filled with calcium hydroxide (Calasept) and sealed with IRM(R) cement, and the teeth were then stored in saline at room temperature for 0.5, 1, 2, 3, 6, 9, or 12 months. Group 2: the pulps were extirpated and the root canals were filled with saline and sealed with IRM(R) cement. The teeth were then stored in saline for 2 months. Intact teeth served as controls and were tested immediately after extraction. All teeth were tested for fracture strength in an Instron testing machine at the indicated observation periods. The results showed a markedly decrease in fracture strength with increasing storage time for group 1 (calcium hydroxide dressing). The results indicate that the fracture strength of calcium hydroxide-filled immature teeth will be halved in about a year due to the root filling. The finding may explain the frequent reported fractures of immature teeth filled with calcium hydroxide for extended periods.
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              Apexification: a review.

              This paper reviews the rationale and techniques for treatment of the non-vital immature tooth. The importance of careful case assessment and accurate pulpal diagnosis in the treatment of immature teeth with pulpal injury cannot be overemphasized. The treatment of choice for necrotic teeth is apexification, which is induction of apical closure to produce more favorable conditions for conventional root canal filling. The most commonly advocated medicament is calcium hydroxide, although recently considerable interest has been expressed in the use of mineral trioxide aggregate. Introduction of techniques for one-visit apexification provide an alternative treatment option in these cases. Success rates for calcium hydroxide apexification are high although risks such as reinfection and tooth fracture exist. Prospective clinical trials comparing this and one-visit apexification techniques are required.
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                Author and article information

                Journal
                J Conserv Dent
                J Conserv Dent
                JCD
                Journal of Conservative Dentistry : JCD
                Medknow Publications & Media Pvt Ltd (India )
                0972-0707
                0974-5203
                Apr-Jun 2012
                : 15
                : 2
                : 196-199
                Affiliations
                [1]Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College & Hospital, Sawangi (Meghe), Wardha Maharashtra, India
                [1 ]Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College & Hospital, Sawangi (Meghe), Wardha Maharashtra, India
                Author notes
                Address for correspondence: Dr. Kavitarani B. Rudagi, Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College, D.M.I.M.S (DU), Sawangi (Meghe), Wardha District, Maharashtra, India. E-mail: kavitarudagi_11@ 123456rediffmail.com
                Article
                JCD-15-196
                10.4103/0972-0707.94582
                3339020
                22557824
                2c0456e7-21fe-4905-9473-561cf492e2e6
                Copyright: © Journal of Conservative Dentistry

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 19 April 2011
                : 07 July 2011
                : 11 August 2011
                Categories
                Case Report

                Dentistry
                apexification,mineral trioxide aggregate,apical barrier,platelet rich fibrin,internal matrix

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