Open apex management using bioceramics
In the presented case we’ll describe a management of a maxillary premolar with open apex and large periapical lesion.
Figure 1: Preoperative radiographic analysis
-16 years old male patient presented with complain of discomfort on chewing on the upper left side for 2 weeks, with old history of dental trauma.
-On clinical examination teeth are sound with tenderness to percussion on teeth no. 23,24.
-Preoperative radiograph showing large radiolucency related to maxillary canine and premolar region with resorption like lesion to the apex of tooth no. 24
-Clinical tests reveals a non responsive tooth no. 24 to cold and hot test with positive response of neighboring teeth.
-Case diagnosed as necrotic tooth no. 24 with Chronic Apical Periodontitis.
CBCT cuts showing the lesion is more related to palatal root
After local anesthesia administration, Access opened.
W L confirmed, root canal system disinfected using 5.25% Sodium Hypochlorite , EDTA solution 17% with sonic and ultrasonic activation.
Non setting Calcium Hydroxide kept inside the canal for 2 weeks as intracanal medication as to raise the PH of the environment to be more suitable to receive the plug material.
Bioceramic Putty material applied to the apex for a more controlled apical seal followed by backfilling the canal using warm Gutta Percha.
Post operative radiograph showing a well adapted apical plugs of putty Bioceramics material with a well filled pulp space.
In the video a step by step application of the Putty Bioceramic material to the apex and backfilling the root space using warm Gutta Percha.
Diagnosis should be performed in a very systematic method applying all needed clinical tests to avoid over treatment or treatment to teeth that are not involved as a reason for disease.
Managing immature roots providing 3D sealing to the root canal system might represent a challenge to the operator.
Using biocompatible filling materials like MTA or Bioceramics that provide superior sealing properties over conventional Gutta percha in this kind of cases is considered a solution for more predictable results.
The use of magnification and right tools would facilitate the job for the clinician in such challenging procedures.
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