Introduction
Apexification is a method to induce a calcific barrier across an open apex of an immature, pulpless tooth.1, 2 It is the process in which an environment is created within the root canal and periapical tissues after death of pulp, which allows a calcified barrier formation to occur on an open apex.3, 4 An open apex due to the absence of sufficient root development to provide a conical taper to the canal is called Blunder Buss canal.1, 5 Apexogenesis can also be defined as the treatment of a vital pulp by pulp capping or pulpotomy in order to permit continued physiological closure of open apex and growth of root.6 Although opposite has been reported by Chala et al.7 duration of this method has several drawbacks such as the risk of tooth fracture due to prolonged use of CaOH2 8 with re-infection of the root canal9 or difficulties in patient recall. Considering all these negative factors, single-visit apexification is suggested for the management of teeth with open apex.10 Mineral trioxide aggregate (MTA) was first introduced in 1993 by Torabinejad et al 11 and received food and drug administration approval in dentin formation occured around large particles in contrast to small particles. It was described as an alternative to traditional apexification treatment 12 which incorporates the application of the material in the apical third of the canal to create an apical barrier. MTA is a biomaterial with excellent biocompability and superior sealing abilities even in the presence of moisture. Kaiser in 1964 first introduced Calcium Hydroxide in apexification mixed with CMCP which was later popularized by frank, Klein & Levy 1974 5 used Calcium Hydroxide and Cresatin. Other materials used are MT A, Biphasic calcium phosphate, Hydroxyapatite and dentin chips. Nevins (1978) suggested use of collagen-calcium phosphate gel.
Case Report
An 8 year-old boy had reported to Dr. Shakir’S Dentzmania Dental Care with the chief complaint of pain and swelling in the maxillary anterior region for the past 1 week. He had suffered dental trauma 5 years back. On Intraoral examination Ellis class II fracture in maxillary left central incisor. Coronal access was prepared with a round burr and the canal was easily located. Working Length was determined through radiography. Gentle circumferential filing used to remove necrosed pulp. Copious irrigation with 2.5% NaOCl was done along with continuous aspiration. The canal was dried with sterile paper points and a mixture of CaOH2 with Iodoform was placed inside.
Figure 1
a: An intraoral periapical radiograph revealed an open apex along with periapical radiolucency; b: The canal filled with calcium hydroxide paste with iodoform and sealed temporarily with IRM and Immediate postoperative radiograph was taken to confirm the presence of calcium hydroxide in the canals; c: Calcium hydroxide paste with iodoform placed and IOPA was taken after 2months. The patient was kept on 4 months recall and on every visit the radiograph was taken. It took 4-8 months for the complete apical barrier to be formed; d: Once the apex was formed obturation was done.
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