VPT

Question 1

Who described apexification of nonvital teeth and what are the possible outcomes? Al Frank

Answer 1

Nonvital immature teeth treated with CaOH2 developed 4 different types of barrier formations. Was the 1st to describe technique.

1. periapex closes with definite recession of the root canal
2. obliterated apex develops without any change in canal space
3. no radiographic evidence of development in canal or apex; an apical stop is evident clinically.
4. calcific bridge forms coronal to apex that is detectable radiographically.

Question 2

How long does apexification take?

Answer 2

Cvek – 18.2 months; Yates – 9 months; Kleirer – 12 months

Question 3

Conciderations for Immature teeth to prevent fractures during apexification

Answer 3

Trope – strengthen cervical portion of immature teeth with composite during apexification to prevent fractures.

Goldberg – use resin modified glass ionomer after apexification to increase resistance to fracture in immature teeth with total crown loss.

Question 4

Materials used to form apical barrier in cases with an open apex

Answer 4

Dentin Chips
1. Brady – apical dentin plug promotes a severe periapical response and inhibits cementum/bone formation
2. Holland – ferret study – dentin + CaOH = 15% inflammatory response
Ca(OH)2
1. Hicks – CaOH 2mm thickness effective apical barrier
2. Torabinejad – CaOH has role in the induction of root end closure (apexification) than the presence of exogenous calcium.
MTA
1. Andreasen – in a guide for traumatic injuries, he recommends:
a. MTA apexification after 2-4 wks of CaOH, MTA thickness should be 4 mm.
2. Torabinejad – Apexification w/MTA, place CaOH for 1 wk in infected cases, place MTA, close w/wet cotton + cavit, obdurate after 4 hours.