Tuesday, October 16, 2012

Apexification using Pulpal Regeneration - 2 Yr Results

At Superstition Springs Endodontics, we are leaders in novel endodontic treatments including pulpal regeneration. The traditional treatment for immature roots of CaOH apexification fails to strengthen the root of the tooth and leaves the root more prone to fracture over the lifespan of the tooth. 

Pulpal regeneration allows "pulp-like" tissue to re-grow into the immature root and continue the development of the root. This provides the root with stronger, thicker root walls. Here's another successful case of pulpal regeneration.

 
This young patient had a traumatic incident to tooth #9 5 months earlier. At our initial evaluation, the tooth responded normal to thermal testing. We decided to monitor the tooth over time. At a follow up visit, #9 exhibited no response to thermal testing with an open apex.

Pulpal regeneration was started. Complete pulpectomy was performed with minimal instrumentation to the apex, and irrigation with 5.25% NaOCl. A blood clot was initiated into the canal, a collagen plug was placed and an (white) MTA coronal barrier was placed below the level of the CEJ.


At six month recall, the tooth is asymptomic and functional. The radiograph shows dentinal bridging apical to the MTA placed intracoronally.

 

A sagittal view using CBCT also clearly shows the dentinal bridging below the MTA plug.

At the 2 yr recall of #9, the tooth is asymptomatic, fully functional and orthodontic treatment has been completed.

3 comments:

Justin M. Parente, DMD said...

Nice case and great scan!

NateandMarie said...

What was the restoration placed in the access and to the level of the MTA?

Jason J. Hales D.D.S., M.S. said...

Good question. As you can see, this tooth did not have a permanent restoration placed to the level of the MTA. Normally, I would just place a resin filling in the access cavity. I typically use a resin reinforced glass ionomer.
The image you are seeing has cotton and glass ionomer, which was replaced with a glass ionomer down to the level of the MTA.