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VOLUME 4 , ISSUE 1 ( January-June, 2019 ) > List of Articles


Endodontic Management of Tooth with Open Apex Using MTA as an Apical Barrier: A Case Report

Rakhi P Veedu, Merin Joseph, Emi George

Keywords : Apexification, Calcium hydroxide, Immature teeth, MTA, Open apex

Citation Information : Veedu RP, Joseph M, George E. Endodontic Management of Tooth with Open Apex Using MTA as an Apical Barrier: A Case Report. Cons Dent Endod J 2019; 4 (1):14-17.

DOI: 10.5005/jp-journals-10048-0042

License: CC BY-NC 4.0

Published Online: 01-12-2018

Copyright Statement:  Copyright © 2019; The Author(s).


Background: Endodontic therapy of a tooth with open apex and necrotic pulp presents multiple challenges during treatment. Microbial elimination from chronic lesions makes treatment all the more difficult. Apexification and pulp revascularization are the treatment options available. Apexification with calcium hydroxide has certain disadvantages and mineral trioxide aggregate (MTA) may be considered as a promising alternative. Case description: This case report describes the management of a symptomatic maxillary left central incisor with immature apex and a chronic periapical lesion. Sodium hypochlorite of 3% and EDTA were used as irrigants for microbial elimination. Repeated intracanal dressings with calcium hydroxide were given for better periapical healing. MTA was used for apical barrier formation. After confirming the hard set of MTA, obturation was done with thermoplasticized gutta-percha and access cavity sealed with composite resin restoration. Conclusion: In this case, MTA helped to form an apical barrier in the immature necrotic maxillary central incisor and showed a good clinical and radiographic success. The use of irrigants and calcium hydroxide as an intracanal medicament promoted the periapical healing of the chronic apical periodontitis.

  1. Taneja S, Kumari M, et al. Management of open apex in anterior teeth using MTA-report of three cases. J Dent Spec 2013;1(1):114–119.
  2. Magura ME, Kafrawy AH, et al. Human saliva coronal microleakage in obturated root canals: an in vitro study. J Endod 1991;17:324–331. DOI: 10.1016/S0099-2399(06)81700-0.
  3. Andresen JO, Munksgaard EC, et al. Comparison of fracture resistance in root canals of immature sheep teeth after filling with calcium hydroxide or MTA. Dent Traumatol 2006;22:154–156. DOI: 10.1111/j.1600-9657.2006.00419.x.
  4. Andreasen JO, Farik B, et al. Long term calcium hydroxide as a root canal may increase risk of root fracture. Dent Traumatol 2002;18:134–137.
  5. Muhammed AH, Azzaldeen A, et al. Mineral trioxide aggregate (MTA) in apexification. Endodontology 2013;25(2):97–101.
  6. Koh ET, Pittford TR, et al. Mineral trioxide aggregate stimulates cytokine production in human osteoblasts. J Bone Min Res 1995;10S:S406.
  7. Subramanyam D, Somasundaram S. Evaluation of the stability and antibacterial activity of various concentrations of triple antibiotic paste against streptococcus mutans-an in vitro study. Int J Curr Med Pharm Res 2017;3(5):1696–1699.
  8. Dixit S, Dixit A, et al. Non surgical treatment of two periapical lesions with calcium hydroxide using two different vehicles. Case Rep Dent 2014;2014:901497. DOI: 10.1155/2014/901497.
  9. Milosevic A. Calcium hydroxide in restorative dentistry. J Dent 1991;19(1):3–13.
  10. Anantharaj A, Praveen P, et al. Challenges in pulpal treatment of young permanent teeth-a review. J Dent Sci Res 2011;2(1):142–155.
  11. Wigler R, Kaufman A, et al. Revascularization: a treatment for permanent teeth with necrotic pulp and incomplete root development. J Endod 2013;39(3):319–326. DOI: 10.1016/j.joen.2012.11.014.
  12. Nygaard-Ostby B, Hjortdal O. Tissue formation in the root canal following pulp removal. Scand J Dent Res 1971;79:333–349.
  13. Banchs F, Trope M. Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol? J Endod 2004;30:196–200. DOI: 10.1097/00004770-200404000-00003.
  14. Trope M. Treatment of the immature tooth with a non-vital pulp and apical periodontitis. Dent Clin North Am 2010;54:313–324. DOI: 10.1016/j.cden.2009.12.006.
  15. Sheehy EC, Roberts GJ. Use of calcium hydroxide for apical barrier formationand healing in non-vital immature permanent teeth: a review. Br Dent J 1997;183(7):241–246. DOI: 10.1038/sj.bdj.4809477.
  16. Gaitonde P, Bishop K. Apexification with mineral trioxide aggregate:an overview of the material and technique. Eur J Prosthodont Restor Dent 2007;15(1):41–45.
  17. Fridland M, Rosado R. Mineral trioxide aggregate (MTA) solubility and porosity with different water-to-powder ratios. J Endod 2003;29:814–817. DOI: 10.1097/00004770-200312000-00007.
  18. Sarkar NK, Caicedo R, et al. Physicochemical basis of the biologic properties of mineral trioxide aggregate. J Endod 2005;31:97–100.
  19. Shabahang S, Torabinejad M, et al. A comparative study of root-end induction using osteogenic protein-1, calcium hydroxide, and mineral trioxide aggregate in dogs. J Endod 1999;25:1–5. DOI: 10.1016/S0099-2399(99)80388-4.
  20. Torneck CD, Smith JS, et al. Biologic effects of endodontic procedures on developing incisor teeth. IV. Effect of debridement procedures and calcium hydroxide-camphorated parachlorophenol paste in the treatment of experimentally induced pulp and periapical disease. Oral Surg Oral Med Oral Pathol 1973;35(4):541–554. DOI: 10.1016/0030-4220(73)90012-1.
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