CLINICAL INSIGHTS

PRESENTED BY

ESCONDIDO ENDODONTICS

Robert J. Hanlon, Jr. DMD
Charles E. Jerome, DDS
Apexogenesis – continued root formation using MTA

Instrumentation and obturation of root apices in young teeth can be a challenge and highly curved roots with open apices are difficult to obturate. Apical development is usually not complete until two years after eruption of the crown. That’s plenty of time for the caries process to advance enough to cause pulpal problems. Obturation of a root canal system with a wide-open apical area is a challenge because the area is rarely circular and cone fitting cannot be precise. There are alternatives to complete endodontic treatment that will allow Hertwig’s Epithelial Root Sheath to develop fully formed tapered apices. In cases with necrotic pulp, open root apices can be managed with either apexification or placement of a barrier material. Using calcium hydroxide for apexification requires multiple visits, patient compliance, and long time periods to complete formation of the apical barrier.

#19 DEEP CARIES RESULTING IN A VITAL PULP EXPOSURE. APEXOGENESIS WITH MTA


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#19 PRE-OP DEEP CARIES 


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AFTER MTA WITH COMPOSITE 


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2 YRS AFTER MTA PLACEMENT 

Placement of a biocompatible material such as Mineral Trioxide Aggregate (MTA) in the pulp chamber provided an immediate barrier for restoration of the crown. MTA is a medical grade version of Portland Cement and is highly biocompatible. Research has consistently demonstrated that cementum and fibroblasts will grown up to and across MTA. In the case shown above, endodontic access was accomplished and the pulp tissue was removed from the chamber area only.  Pulpal hemorrhage was assessed to determine the degree of root pulp inflammation.  If the root tissue is not inflamed, MTA can be placed at the orifices of the canals, and the vitality of the root pulp tissue preserved.


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7 YRS AFTER MTA  PLACEMENT
 


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COMPLETED ENDODONTICS
 


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FINAL PFM RESTORATION 8 YEARS AFTER INITIAL MTA TREATMENT 

The second set of three images demonstrates long-term follow-up and progression of the case through completed endodontic treatment and restoration finalization with a PFM full coverage crown as the child has reached full skeletal growth with complete alveolar eruption.

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