9
Endodontic Management of a Necrosed Pulp with Wide Open Apex
Antonis Chaniotis1 and Viresh Chopra2,3,4
1 Private Practice Endodontics, NKUA (National Kapodistrian University of Athens), Zografou, Greece
2 Adult Restorative Dentistry, Oman Dental College, Muscat, Oman
3 Endodontology, Oman Dental College, Muscat, Oman
4 Bart’s London School of Medicine and Dentistry, Queen Mary University, London, UK
9.1 Introduction
Endodontic materials in clinical use face several challenges [1]. Ideally, these materials should be easy to use, visible in the radiograph, biocompatible, bioactive, have antimicrobial activity, be resorbable in tissues but resist resorption within tooth structures, be nonstaining to tooth structures, strengthen the tooth, be dimensionally stable, provide a permanent, high‐quality seal with dental hard tissues yet be easy to replace, and have the mechanical strength that is optimal for the site and task they are used for [2].
Interestingly, regenerative approaches in endodontics have gained a lot of attention in the recent past. Preservation of vital and necrotic teeth with open apexes is gaining popularity with the advent of calcium silicate materials [3–5]. Bioceramic cements are used as a material of choice in such treatments for a specific purpose. They are used as a mid‐root or coronal plug after disinfection of the canal with an antibiotic paste. A blood clot is created in the apical canal or the canal is filled with platelet‐rich plasma and the area is sealed coronally with bioceramic cement, which provides a permanent, high‐quality seal [3]. A matrix such as CollaCote is often used apical to the cement to allow depth control for the cement. Materials with equal physicochemical and biological properties should be given priority. However, they should not stain the tooth structure [6].
The aim of this case report is to outline the detailed protocol to be used for regeneration using bioceramics with special emphases on the importance of recall to keep a track record of the case.
9.2 Patient Information
- Age: 16‐year‐old
- Gender: Female
- Medical history: Noncontributory
9.2.1 Tooth
- Identification: 11 (tooth 11)
- Dental history: Pain to percussion
- Clinical examination findings: At the time of the appointment, tooth 11 was percussion painful. Periodontal probing was within normal limits. Thermal and electrical vitality tests were negative.
- Preoperative radiological assessment: Radiographic examination revealed immature tooth 8 associated with a large periapical lesion (Figure 9.1a).
- Diagnosis (pulpal and periapical): Pulpal diagnosis was pulpal necrosis. Periapical diagnosis was symptomatic apical periodontitis.
9.3 Treatment Plan
Preliminary procedures:
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