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This study was conducted to evaluate the effect of the use of apical matrix, with Mineral Trioxide Aggregate (MTA) or calcium hydroxide Ca(OH)2 Apexification on apical healing and calcific barrier formation of immature teeth with non- vital pulp.
Conventional root canal ļ¬lling procedures are challenging in cases of teeth with necrotic pulp, immature apices, and periapical lesions because of the absence of natural apical constriction and the presence of moisture contamination. In these cases, the risk of extrusion of the root ļ¬lling materials and the difļ¬culty in managing apical seals compromise the long-term outcome of treatment.
Management of immature teeth with non-vital pulp were confined to custom fitting the filling material, paste fills and apical surgery. The limited success enjoyed by these procedures resulted in significant interest in the phenomenon of establishment of an apical barrier like apexification or continued apical development. Apexification defined as a procedure to induce a calcified barrier in a root with an open apex and necrotic pulp Traditionally, the most commonly used material for apexification is Ca(OH)2 .Despite the high success rate of The long-term Ca(OH)2 apexification , there are several disadvantages to this technique; Length of time for induction of apical hard tissue barriers. Incomplete apical hard tissue barriers because of vascular inclusions.To avoid the challenges associated with long-term Ca(OH)2 apexification procedures, a non-surgical, one-step apexification using MTA as apical plug.
The major problem in cases of a wide open apex is the need to limit the apexification material at the apex, thus avoiding the extrusion of a large amount of material into the periodontal tissue. The use of a matrix is advisable since its placement in the area of bone destruction provides a base on which the sealing material can be packed .
This randomized controlled trial study was carried out to compare the clinical and radiographic outcome of Ca(OH)2 and MTA with or without internal matrix in non-vital immature maxillary incisors.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Ca(OH)2 Apexification | Active Comparator | Apexification was performed with calcium hydroxide. calcium hydroxide dressing was applied directly against the open apex .The canals were back filled with Ca(OH)2 dressing, followed by proper coronal seal. Patients were recalled every 3, 6 and 12 months for evaluation clinically and radiographically. Once the calcific apical barrier was detected the root canals were then obturated and final restoration was done. |
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| Ca(OH)2 Apexification with apical matrix | Experimental | Treated by condensation of calcium hydroxide dressing against an internal matrix , a piece (4X4mm) of resorbable collagen membrane (Biocollagen; Bioteck:Turin, Italy) was gently compacted toward the apex before insertion of Ca(OH)2 dressing, followed by proper coronal seal. Patients were recalled every 3, 6 and 12 months for evaluation clinically and radiographically. Once the calcific apical barrier was detected the root canals were then obturated and final restoration was done. |
|
| MTA Apexification | Active Comparator | Apexification was performed with MTA as apical plug. A 3-5 mm thickness of MTA using a hand plugger was applied as apical plug and verified radiographically. Moist cotton pellet was placed over the MTA followed by application of coronal seal. After 48 h, the set of the MTA was checked and final obturation of the root canal was done |
|
| MTA Apexification with apical matrix |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Apexification | Procedure |
|
| Measure | Description | Time Frame |
|---|---|---|
| Change in pain on percussion | Assessed by tapping the tooth with the back of the mirror (Present or absent) binary outcome | baseline, 3 months, 6 months, and 12 months |
| Change in swelling and/or sinus | Assessed by visual examination of labial vestibule.The presence of swelling or sinus reported by a binary question yes/no | baseline, 3 months, 6 months, and 12 months |
| Change in periapical pathosis | Change in periapical bone density on follow up radiographs to assess the healing process | 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| presence of a calcified apical barrier or not | Teeth will be reviewed clinically and radiographically in order to detect the calcific barrier formation | 3, 6 and 12 months |
| Periapical Lesion scored with periapical index ( PAI) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Mervat IB Fawzy, Professor | Professor of Endodontics AL-Azhar university | Study Director |
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| ID | Term |
|---|---|
| D003790 | Dental Pulp Necrosis |
| ID | Term |
|---|---|
| D003788 | Dental Pulp Diseases |
| D014076 | Tooth Diseases |
| D009057 | Stomatognathic Diseases |
| D009336 | Necrosis |
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| ID | Term |
|---|---|
| D056624 | Apexification |
| D000068437 | Pemetrexed |
| C000624565 | ProRoot MTA |
| ID | Term |
|---|---|
| D012390 | Root Canal Therapy |
| D004708 | Endodontics |
| D003813 | Dentistry |
| D006147 | Guanine |
| D007042 |
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participants are allocated at random to receive one of 4 interventions according to the research plan.
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An internal (apical) matrix was used as a base for condensation of MTA apical plug, a pieces of (4X4mm) of resorbable collagen membrane (Biocollagen; Bioteck:Turin, Italy)were compacted toward the apex with premeasured suitable size schilder plugger. Moist cotton pellet was placed over the MTA followed by application of coronal seal. After 48 h, the set of the MTA was checked and final obturation of the root canal was done |
|
| MTA | Drug |
|
|
| Ca(OH)2 | Drug |
|
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| Apical matrix | Drug | collagen membrane (Biocollagen; Bioteck:Turin, Italy) |
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Radio graphically The periapical index provides an ordinal scale of 5 scores ranging from ''healthy'' to ''severe periodontitis with exacerbating features''. (1) Normal periapical structures. (2) Small changes in bone structure. (3) Changes in bone structure with some diffuse mineral loss.(4) Periodontitis with well-deļ¬ned radiolucent area. (5) Severe periodontitis with exacerbating features. (1, 2: healthy and 3, 4, 5: pathological).baseline, 3 months, 6 months, and 12 months
| 12 months |
| D010335 |
| Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| Hypoxanthines |
| D011688 | Purinones |
| D011687 | Purines |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D006571 | Heterocyclic Compounds |
| D005971 | Glutamates |
| D024342 | Amino Acids, Acidic |
| D000596 | Amino Acids |
| D000602 | Amino Acids, Peptides, and Proteins |
| D000600 | Amino Acids, Dicarboxylic |