CDA Essentials 2015 • Volume 2 • Issue 5 - page 31

31 Volume2 Issue5 |
Supporting Your Practice
Treatmentoptions
FrankTechnique
In this traditional approach, calciumhydroxide
isplaced ina lightlycleansedcanal to induce
apexification. Thecalciumhydroxide is replenished
every3–6monthswithin thecanal. It hasbeen shown
that it requires approximately18–24monthsof active
treatment togainadequateapical closurebeforegutta
perchaobturationcanbeperformed.
However, this long-term treatment canbe
unpredictablewith respect to the formation
of anapical seal. Also, the treatment period required
toachieveanapical seal is variableandcan lead to
difficulty inappropriate follow-up (see ➊, ➋).
Apical Plug
Mineral TrioxideAggregate (MTA) has beeneffective
in inducing apexificationof rootswhenused
as an apical plug. TreatmentwithMTAhas the
advantages of a shorter treatment time, fewer patient
appointments, andmorepredictableoutcomes in
creating an apical barrier, especially in immature
permanent teethwithnecroticpulps. However,
similar to treatmentwith calciumhydroxide, MTA
only addresses the creationof an apical seal andnot
root formation along the lengthof the root.
Follow-up radiograph taken
24monthsafter completionof
treatment.
Doyouhaveanyburningclinicalquestions related toyoureverydaypractice?Areyou facinga challenging
clinicalcaseandneedadvice?Sendyourqueries toOasisDiscussions forexpertguidance.The following
questionwassubmitted toOasisDiscussionsbyageneraldentist.Drs.MichaelCasasandSuhamAlexander
provideda response.
➋
Question
Response
Apexification
is theprocessof inducing
apical root closure ina
necrotic immature tooth.
For traumatically induced
pulpnecrosis, the tooth
requiringapexification is
most commonlyan incisor.
Traumatic injuriesaccount
forapproximately5%of the
dental treatments sought
bypatients.
What are the current standards for treatment of permanent teeth that
have had trauma and require apexification?
OasisDiscussions
AskYourColleagues
Preoperativediagnostic
radiograph showing teeth11and
12withopenapicesandperiapical
radiolucencies.
➊
Case1
Erratum
CDAEssentialsdidnot reference the source JCDAarticlewhere the images shown inCase1originallyappeared. The images
presented inCase1wereadapted from:
Raldi DP,Mello I, HabitanteSM, Lage-Marques JL, Coil J. Treatment options for teethwithopenapices andapical
periodontitis. JCanDentAssoc2009Oct;75(8):591-6.
CDAEssentials apologizes to theauthors for thisoversight.