Apexification with apical growth and closure using Metapex in a Necrotic Immature Permanent Tooth with Periapical abscess: A Case Report with 16 months follow-up.
Apexification of a Necrotic Infected Immature Permanent Tooth.
The purpose of this report is to present the case of a patient wherein apexification of an immature permanent maxillary left central incisor tooth was induced by the Metapex paste (Calcium hydroxide and Iodoform). It has been reported in the literature of dentistry that apexification treatment in teeth with open apex is more than 40 years old. Apexification procedures had been carried out in different ways using various techniques and materials. Regardless of the type of materials used for apexification method by different authors, apexification procedures appear to be the most subtle and accepted clinical practice in non-vital young permanent teeth. In our case, radiographic examination showed the start of apical closure 6 months after the completion of the treatment protocol. The growth of root end and complete apical closure was confirmed 16 months after the treatment, indicating the implausible potential of Metapex to induce apical growth and closure in young permanent tooth with periapical lesion.
1. Rafter M. Apexification: a review. Dent Traumatol 2005; 21: 1–8.
2. American Association of Endodontists. Glossary of endodontic terms, 7th edn. Chicago: American Association ofEndodontists; 2003
3. Dylewski J. Apical closure of non-vital teeth. Oral Surg 1971 ;32:82-9. 3.
4. Moller AJ, Fabricius L, Dahlen G, Ohman AE, Heyden G.Influence on periapical tissues of indigenous oral bacteriaand necrotic pulp tissue in monkeys. Scand J Dent Res1981;89:475–84.
5. Finucane D, Kinirons MJ. Non‐vital immature permanent incisors: factors that may influence treatment outcome. Endod Dent Traumatol 1999; 15: 273– 7.
6. Nygaard-Ostby B. The role of the blood clot in endodontictherapy. Acta Odontol Scand 1961;19:323–46.23.
7. Wong FSL, Kolokotsa K. The cost of treating children and adolescents with injuries to their permanent incisors at a dental hospital in the United Kingdom. Dent Traumatol 2004; 20: 327– 33.
8. Weisenseel, J. A., Hicks, M. L., & Pelleu, G. B. (1987). Calcium hydroxide as an apical barrier. Journal of Endodontics 1987;13(1), 1–5.
9. Kaiser HJ. Management of wide open apex canals with calcium hydroxide. Presented at 21st Annual meeting of the American Association of Endodontics, Washington DC, April 17, 1964.
10. Frank AL. Therapy for the divergent pulpless tooth by continued apical formation. J Am Dent Assoc 1966;72:87-93.
11. Sridhar N, Tandon S. Continued root end growth and apexification using calcium hydroxide and iodoform paste (Metapex): Three case reports. J Contemp Dent Prac 2010;11(5):63-70.
12. Thibodeau B., Trope M. Pulp revascularization of a necrotic infected immature permanent tooth: case report and review of the literature. Pediatr Dent. 2007;29:47–50.
13. M. Duggal, H. J. Tong, M. Al-Ansary, W. Twati, P. F. Day, H. Nazzal. Interventions for the endodontic management of non-vital traumatised immature permanent anterior teeth in children and adolescents: a systematic review of the evidence and guidelines of the European Academy of Paediatric Dentistry. Eur Arch Paediatr Dent. 2017; 18(3): 139–151.
14. Cvek M. Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with gutta-percha: a retrospective clinical study. Endod Dent Traumatol. 1992;8:45–55.
15. Heithersay GS. Stimulation of root formation in incompletely developed pulpless teeth. Oral Surg 1970;29:620-30.
16. Pitts DL, Jones E J, Oswald RJ. A histological comparison of calcium hydroxide plugs and dentin plugs used for the control of gutta-percha root canal filling material. J Endodon 1984; 10:283-93.
17. Yates JA. Barrier formation time in non‐vital teeth with open apices. Int Endod J 1988; 21: 313– 9.