Professional Documents
Culture Documents
Dr. Muralee Mohan Dr. Smitha Bhat Dr. Arvind Karikal Dr. Shyam S Bhat
Professor Asst. Professor Asst Professor P.G. Student
Department of Oral and Maxillofacial Surgery, A.B. Shetty Memorial Institute of Dental Sciences, Mangalore (Karnataka)
Introduction Submandibular Sialolithiasis was made. occur in the duct or gland, with multiple
Abstract strategies is the only feasible solution in less- chance of a low-birth-weight baby, premature
have been recognized as "ideally positioned whether they use tobacco products25 making it 2. Relating tobacco to short-term
to counsel against the use of tobacco difficult to identify them in the first place. adverse effects such as staining of teeth,
products." They can relay specific Globally about 70% of 13-15 year olds halitosis, loss of taste may be more relevant
information concerning the oral ill effects of who currently smoke have a desire to quit. and meaningful to an adolescent than long-
tobacco use. The dental encounter probably Though a high number of tobacco users want term health effects such as cardiovascular or
constitutes a "teachable moment" when the to quit, few make a dedicated quit attempt lung diseases30
patient is receptive to counseling about life- (around 40%) and a negligible proportion of 3. Highlighting role models abstaining
style issues. Oral health professionals should these (around 3%) are successful in achieving from tobacco use and making the dental clinic
integrate tobacco use, prevention and long term abstinence18. Parents are more adopt a no tobacco policy can also be used.
cessation services into their routine and daily likely to approve than disapprove of the However, it is important to realize that
practice19 for the following reasons. dentist counseling the child and the parent.26. tobacco cessation is a process and a number
1. They are especially concerned about The lack of training at the graduate level of stages are encountered in the process.
the adverse effects of tobacco practices in the is also an important barrier that hinders large- Some of the attributes required for the
oro-pharyngeal region of the body. scale involvement of dentists. The clinician are to be persistent, supportive and
2. They have easy access to children, professional skills required by the dentists to not to give up.31
youths and their caregivers, thus providing provide tobacco cessation counseling to their The 5 A's (ask, advice, access, assist and
opportunities to influence individuals to patients ideally should be learnt during the arrange) is a brief intervention method, used
avoid all together, postpone initiation or quit dental curriculum and reinforced within to guide the dentist in tobacco cessation
using tobacco before they become dependent. continuing education. Dental colleges need to counseling. It is important to include some
3. They often have more time with incorporate into their curricula not just sort of intervention to bring behavior change,
patients than many other clinicians, providing didactic instruction on the oral health impact in cases where the adolescent wishes to quit
opportunities to integrate education and of tobacco use, but relevant counseling tobacco.32
intervention methods into practice. techniques and training in nicotine
4. T h e y o f t e n t r e a t w o m e n o f replacement therapy. Initial question about tobacco use
Whether the person uses tobacco currently (type and quantity)
childbearing age, thus are able to inform such ideally should be learnt during the dental ASK & if so whether the Individual is interested at present in stopping
patients about the potential harm to their curriculum and reinforced within continuing
babies from tobacco use. education. Dental colleges need to
To quit tobacco
5. They can build their patient's interest incorporate into their curricula not just ADVICE
in discontinuing tobacco use by showing didactic instruction on the oral health impact
actual tobacco effects in the mouth. of tobacco use, but relevant counseling Determine stage of readiness to change,
Dentists in many parts of the world have a techniques and training in nicotine commitments and barriers
ACCESS
positive attitude about intervening for their replacement therapy.
adolescent patients. The majority of dentists Brief Interventions Firm commitment to change; user to
consider smoking cessation and prevention Dentists can help youth by providing ASSIST change by action and maintenance
for adolescents and children as part of their advice on when to quit, help the patient to
responsibility20. Pediatric dentists should identify problems and strategies to deal with
problems. Follow-up to monitor progress
encourage, advice and assist tobacco users to ARRANGE
quit21. Behavioral interventions for tobacco use
Ask every adolescent a simple question developing countries. NHANES III. J Periodontol 2000; 71: 743-51.
14. Bergstrom, J., Eliasson, S., Dock, J. 10-year
about current tobacco use and use record 3. Cessation programs implemented in prospective study of tobacco smoking and
system in the clinic to document his/ her isolation with lack of supportive periodontal health. Journal of Periodontology 2000;
tobacco use status during every visit. Once a environment and government policies for 71, 1338-47.
tobacco user is identified, assess willingness tobacco control. 15. Davis JM. Tobacco Cessation for the Dental Team: A
Practical Guide Part: I background and overview. J
to make a quit attempt, the dentist should urge 4. Low importance placed by oral health Contemp Dent Pract 2005;3:158-66.
him or her, in a clear, strong and professional on tobacco cessation. 16. Allard, R., Johnson, N., Sardella A et al.Tobacco and
personalized manner, to quit. The dentist can Conclusion Oral Diseases: Report of EU Working Group. Journal
of Irish Dental Association 1999; 46, 12-23.
assist tobacco users by helping them set a quit Though we do not fully understand all the 17. WHO: Tobacco-related Oral Mucosal Lesions and
date; referring them to a telephone counseling factors that contribute to onset of tobacco use, D e n t a l D i s e a s e s 4 . 7 . Av a i l a b l e f r o m :
service, cessation group or intensive which leads to addiction and eventual adverse http://www.whoindia.org/ SCN/ Tobacco/
cessation program; prescribing pharmaco- health outcomes; we do need to understand Report/03-Chapter-04.7.pdf
18. Global youth meet on tobacco control (GYM 2009).
therapy; and providing educational materials better the patterns of use and how the Youth advocacy for global tobacco control: insight,
about tobacco cessation. Follow-up contact to determinants of initiation interact. issues and incentives. HRIDAY
support and guide a patient's quit attempt As oral health care providers, dentists 19. Petersen PE.The World Oral Health Report 2003.
Continuous improvement of oral health in the 21st
should be arranged otherwise, users may slip must take the responsibility of providing century and the approach of the World Health
back to earlier stages of change. tobacco cessation services and encourage Organization Global Oral Health Programme.
Users unwilling to make a quit may non-users to be tobacco free, though few Geneva,World Health Organization, 2003
respond to a motivational intervention that translate this into practice. Admittedly, there 20. Wyne AH, Chohan AN, Al-Moneef MM, Al-Saad AS.
Attitudes of General Dentists about Smoking
provides the clinician an opportunity to are several barriers in this process, both real Cessation and Prevention in Child and Adolescent
educate, reassure, and motivate. Motivational and perceived, which should be addressed Patients in Riyadh, Saudi Arabia. J Contemp Dent
intervention is built around the '5 R's': with further research. Screening for tobacco Pract 2006;1:35-43.
21. Gansky SA, Ryan JL, Ellison JA, Isong U, Miller AJ,
Relevance, Risks, Rewards, Roadblocks and use, interventions, referring adolescents to Walsh MM. Patterns and correlates of tobacco control
Repetition.Such counseling involves talking additional resources for cessation, and behavior among American Association of Pediatric
about tobacco and quitting and then establishing a follow-up system that will Dentistry members: a cross-sectional national study.
reinforcing the points most likely to motivate track each adolescent's progress should be BMC Oral Health 2007;7:13.
22. Kast KR, Berg R, Deas A, Lezotte D, Crane LA.
adolescents to quit. Information should be of made mandatory. Brief advice from a dentist Colorado Dental Practitioners Attitudes and
their relevance, such as health concerns, for adolescents is cost-effective and has a Practices Regarding Tobacco-Use Prevention
rewards or specific barriers to quitting. A potentially large reach. Activities for 8- Through 12-Year-Old Patients. J Am
Dent Assoc 2008:139:467-75.
discussion of the health effects of tobacco and Success in relation to cessation does not 23. Goodman H S., Vargas C M. et al. Maryland. General
the benefits of quitting (such as immediate only mean that more number of patients has and pediatric dentists attitudes regarding tobacco use
improved oral health and financial savings) quit, but it also includes educating the masses, prevention and cessation in their child and adolescent
may allow the dentist to identify and highlight so that the number of individuals taking to patients. Public health and the environment. APHA
2004. p. 6-10.
risks and rewards that seem most relevant to this habit afresh will also reduce. Today, we 24. Beaglehole, R.H.The role of oral health professionals
the user. Identifying the patient's perceptions the members of the oral health profession in tobacco control in OECD countries: policies and
of roadblocks to quitting, such as fear of along with policy makers should help in initiatives. Master's Thesis. University College
London, 2003.
withdrawal symptoms or weight gain and achievement of a tobacco-free society so that 25. Hennrikus D, Rindal DB, Boyle RG, Stafne E,
address those barriers. The motivational we can protect the health of the coming Lazovich D, Lando H. How well does the health
intervention should be repeated during every generations. history form identify adolescent smokers? J Am Dent
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27. Carr A, Ebbert J. Interventions for tobacco cessation
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29. Johnson JG, Cohen P, Pine DS, Klein DF, Kasen S,
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for adolescents or implemented in the periodontitis in the United States: findings from
36 Heal Talk | July-August 2012 | Volume 04 | Issue 06
Early Childhood Caries & Feeding Practices in Children aged
3 Yrs. Attending Anganwadi Centers of Bangalore South
Dr. Ramakrishna T. Dr. Shilpashree K.B. Dr. Shabana A G
Professor Senior Lecturer Senior Lecturer
Oral & Maxillofacial Surgery Dept. Preventive& Public Health Dentist Dept. of Public Health Dentistry
The Oxford Dental College, Hospital and Research Center,, 10th mile stone, Bommanahalli, Hosur Road, Bangalore-560078
Abstract health, even with dramatic advances in the feeding practices in children attending
Table 5: Distribution of The Study status of preschool children in Hong Kong. British 8. How long was the child bottle fed?
Dental Journal 1999; 187: December 11: 616-20.
Population Based on the Bottle Feeding at 9. National Oral Health Survey and Fluoride Mapping
Never [ ]
Bed Time 2002-2003, Karnataka by Dr R.K.Bali, Dr S.S. Less than six months [ ]
Bottle fed Number %age Hiremath and Dr Manjunath Puranik. Dental Council Six months to one year [ ]
at Night (393) of India, New Delhi
10. Carino KMG, Shinada K and Kawaguchi Y. Early
More than one year [ ]
Yes 97 75.4% childhood caries in Northern Philippines. 9. Time of bottle feeding in a day?
No 296 24.6% Community Dent Oral Epidemiol 2003; 31: 81-9. Never [ ]
Table 6: Mean dmft Score in Different Age 11. Shafer, Hine and Levy. A Textbook of Oral Pathology, Once a day [ ]
4th edition 2000
Groups According to Duration of Breast 12. Hallet K.B and Rourke P.K. Pattern and severity of Twice a day [ ]
Feeding Early Childhood caries. Community Dent Oral Thrice a day [ ]
Type of feeding dmft Prevalence Epidemiol 2006, 34: 25-35. More than thrice a day [ ]
Breast fed only 0.882.00 < 0.001** 13. Ferreira S.H, Beria J.U, Kramer P.F, Feldans E.G and
Feldens C.A. Dental caries in 0-5 year old Brazilian 10. Was the child bottle fed at night?
Bottle fed only 0.962.04 < 0.001** children: prevalence, severity, and associated Yes / No [ ]
Both 0.912.04 < 0.001** factors.International Journal of Pediatric Dentistry 11. If yes, Contents of feeding bottle
Duration of Breast Feeding 2007; 17:289-296.
14. Dileep C.L, Basavaraj P, Jayaprakash K and
Milk [ ]
Not breast fed 0.721.41 0.77 Bhargava R. Journal of Indian Association of Public Milk and Milk powder [ ]
Less than 6 months 1.603.83 - Health Dentistry 2007; 9: 60-62. Any other liquids _________
6 months-one year 0.920.011 0.011 15. Hallet K.B and Rourke P.K. Early Childhood Caries Was sugar added to the contents of
and infant feeding practice. Community Dental
> 1 year 0.962.04 < 0.001 Health 2002 19, 237-242. bottle? Yes / No [ ]
Bottle Feeding at Night 16. Bian M.D.Z, Guo L, Holt R, Champion J and Bedi R. 12. At what age did child start?
Yes 1.002.12 < 0.001* Caries patterns and their relationship to infant feeding A. drinking from a cup / glass_________
and socio-economic status in 2-4 year old Chinese
No 0.881.96 < 0.06 children. International Dental Journal 2000 B. Eating solid foods _______________
Table 7: Mean dmft Score in Different Age Dec;50(6):385-9. 13. Does your child have between meal
Groups According To Dietary Habits 17. Livny A, Assali R and Cohen H.D. Early Childhood snacks? Yes / No [ ]
Dietary Habits Caries among a Bedouin community residing in the
eastern outskirts of Jerusalem. BMC Public Health; If yes, what kind________ & how many
Snacks Preference 2007 Jul 24;7:167 times ________
Yes 1.052.21 < 0.064 Annexure
No 0.951.85 < 0.489 The Oxford Dental College, Hospital &
Frequency of Snack consumption Research Centre, Dept. of Preventive &
Once daily 0.882.00 < 0.05 Community Dentistry, Questionnaire For Coming soon...
Twice daily 0.62.04 < 0.064 Parents
Thrice daily 0.912.04 < 0.01 1. Name of child ___________________
References 2. Name of parents
1. Schroth R.J. and Douglas J. Brothwell. Prevalence of Mother _________ Father _________
Early Childhood caries in 4 Mannitoba communities.
J Can Dent Assoc 2005; 71 (8): 567a-f. 3. Date of birth - day / month / year_____
2. Benjamin Peretz, Diana Ram, Elinor Azo, Yaakov Age_______ sex: M / F
Efrat. Preschool Caries as an indicator of Future 4. Manner of feeding for the child?
Caries: a Longitudinal Study. Pediatric Dentistry
2003; 25(2): 114-8. Breast fed [ ]
3. Gomez F.J.R, Tomar S.E, Ellison J, Artiga N, Sintes J Bottle fed [ ]
and Vicuna G. Assessment of early childhood caries Both [ ]
and dietary habits in a population of migrant Hispanic
5. How long have you breast fed your
jkstkuk
2feuV
children in Stockton, California. Journal of Dentistry
for Children 1999; Nov- Dec; 66(6): 395-403, 366. child?
4. Ismail A.I. Determinants of health in children and the Never [ ] Brushing
problem of early childhood caries. Pediatric Dentistry Less than six months [ ] Healthy Teeth
5. Hallet K.B and Rourke P.K. Social and behavioural Six months to one year [ ]
determinants of Early Childhood Caries. Australian More than one year [ ]
6.
Dental Journal 2003; 48(1); 27-33.
Chandranee Y.A, Wadher B.J, Khan A and Khan Z.H.
6 Times of breast feeding in a day? j[ksa LoLFk
Never [ ]
7.
Prevalence of Dental Caries in nursery school
children of Akola city. J Indian Soc Pedo Prev Dent
1998; Mar; 16(1):21-5.
Bhat P.K, Sequeira P and Peter S. Prevalence of
Once a day
Twice a day
Thrice a day
[ ]
[ ]
[ ]
nkr
Dental caries among Pre-school children going to
More than thrice a day [ ]
private english medium and government anganwadi
schools of Mangalore. Karnataka State Dental 7. Was the child breast fed on demand? Heal Talk
A Journal of Clinical Dentistry
Media 14
A Journal of Clinical Dentistry
The fact that most third molars, impacted evidence supporting or refuting the practice British Journal of Oral and Maxillofacial Surgery.
1998; 36(1):14-18.
or not, do not become diseased and that the of prophylactic removal of asymptomatic 5. Daley TD. Third molar prophylactic extraction: a
risk of iatrogenic injury from such surgery is third molars. Regarding clinical practice, the review and analysis of the literature. General
greater than the risk of leaving asymptomatic, decision to remove asymptomatic wisdom Dentistry 1996; 44(4): 310-320.
nonpathologic teeth alone does not override teeth appears to be best based on careful 6. Von Wowern N, Nielsen HO. The fate of impacted
lower third molars after the age of 20. A four-year
the expert opinion of oral and maxillofacial consideration by practitioners of the potential clinical follow-up. International Journal of Oral and
surgeon On the other hand, the probability of risks and benefits for individual patients, Maxillofacial Surgery 1989; 18(5): 277-280.
impacted third molars causing pathological explaining to the patient regarding the same 7. Vasir NS, Robinson RJ. The mandibular third molar
and late crowding of the mandibular incisors a
changes in the future may have been and decision be made by the consent of the review British Journal of Orthodontics 1991; 18: 59-
exaggerated.3,7 In addition, third molar patient 66.
surgery is not risk free, the complications and References 8. Mercier P, Precious D. Risks and benefits of removal
suffering following third molar surgery may 1. NHS Centre for Reviews and Dissemination. of impacted third molars. International Journal of
Prophylactic removal of impacted third molars: is it Oral and Maxillofacial Surgery 1992; 21: 17-27.
be considerable. Therefore, prophylactic justified? Effectiveness Matters [Internet]. 1998 Oct 9. Song F, Landes DP, Glenny AM, Sheldon TA.
removal should only be carried out if there is [cited 2010 Jul 9];3(2):1-4. Available from: Prophylactic removal of impacted third molars: an
good evidence of patient benefit. http://www.york.ac.uk/inst/crd/EM/em32.pdf assessment of published reviews. British Dental
2. Jasinevicius TR, Pyle MA, Kohrs KJ, Majors JD, Journal. 1997; 182(9): 339-346.
Conclusion Wanosky LA. Prophylactic third molar extractions: 10. Carmichael FA, McGowan DA. Incidence of nerve
It is not possible to predict reliably US dental school departments' recommendations damage following third molar removal: a review..
whether impacted third molars will develop from 1998/99 to 2004/05. Quintessence Int. 2008 British Journal of Oral and Maxillofacial Surgery
pathological changes if they are not removed. Feb;39(2):165-76. 1992; 30(2):78-82.
3. Cabbar F, Guler N, Comunoglu N, Sencift K, Cologlu 11. Evaluation and management of asymptomatic third
Surgical removal of third molars can only be S. Determination of potential cellular proliferation in molars: Lack of symptoms does not equate to lack of
justified when clear long term benefit to the the odontogenic epithelia of the dental follicle of the pathology Raymond P. White, Jr and William R.
patient is expected. Based on evidence and asymptomatic impacted third molars. J Oral Proffit American Journal of Orthodontics and
Maxillofac Surg. 2008 Oct;66(10):2004-11. Dentofacial Orthopedics July 2011 Vol 140 Issue 1
guidelines from the past ten years of 4. Worrall SF, Riden K, Haskell R, Corrigan AM.
evidence, there is currently insufficient UKNational Third Molar project: the initial report.
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Abstract broken instruments from the canal have been ProTaper series orifice shaper (Dentsply
A
veneering.
im: To present a case of
immature tooth which was
obturated with MTA and
discoloration treated by direct composite
patient compliance and prolonged exposure
of root dentin to calcium hydroxide9,
10
.Clinical studies have reported that 77% to
85% of teeth with open apices healed
teirrigation. To obtain canal disinfection prior
to MTAplacement, a slurry of calcium
hydroxide mixedwith Metrohexwas applied
twice within an interval of two weeks
andtemporized. After two weeks sinus tract
completely 1 to 3 years after the placement of
Summary: A discolored upper left MTA apical plugs. disappeared and placement of MTA was
central incisor was subjected to radiographic MTA has been described as a good decided.
examination revealing an open apex and a materialfor this procedure owing to its good The white MTA(ProRoot, Dentsply,
periapicalradioluscency. The canal was canal sealingproperty, biocompatibility and Tulsa, OK) was mixed to a pasteconsistency
cleaned using K-files and 5.25% of NaOCl ability to promotedental pulp and with sterile water and delivered to thecanal
irrigation. The canal was disinfected with periradicular tissue regeneration11, 12, 13. using an amalgam carrier in about
slurry of calcium hydroxide repeated two Recently, MTA has been used as an 3mmthickness. Cotton was wrapped onto a
times at the interval of 1 week. After two obturating material in cases of apexification, 80 K-file, moistened and used as a plugger to
weeks the canal was obturated with MTA and dens in dente, before surgery, and in internal condense the MTA apically. MTA can also be
remainder of canal was filled with glass- resorption cases14. used as aobturating material. So it was
ionomer cement. The discoloration was This report demonstrates a tooth with decided to fill the canal with MTA upto
treated with direct composite veneering. A open apex and discoloration which was middle third. A moist cotton pellet wassealed
six-month follow up demonstrated clinically treated by MTA obturation and direct inside forsetting of MTA. Patient was recalled
asymptomatic and adequately functional composite veneering. after two days and the hard set of MTA was
tooth, with radiographic signs of healing. Case Report confirmed and remained of canal was filled
Keywords: Immature tooth, MTA, A 32 year old female presented to the with glass ionomer cement followed by
Direct composite veneering. department of conservative dentistry and composite resin to reinforce and to obtain
Introduction endodonticsin the St Joseph dental college, better seal.
Conventional root canal filling Eluru, with discolored upper left central Patient returned after 1 week requesting
techniques rely on the presence of a incisor. The patient gave history of trauma treatment for the discolored tooth. Treatment
constriction at the apical level of the canal; when she was 10 year old. The treatment was alternatives and cost was explained and
therefore, the absence of the apical not taken as the tooth was asymptomatic. patient opted for composite veneering. Shade
constriction because of incomplete root When patient was about 18 years old she selection was done taking left lateral incisor
development, aggressive apical resorption, or underwent orthodontic treatment for the as reference. A uniform reduction of 0.5 to 1
i a t r o g e n i c e n l a rg e m e n t p r e s e n t s a malocclusion. The tooth showed evidence of mm was done. The tooth was slightly placed
management challenge. Placement of the root color change during the course of treatment. labially so reduction was done accordingly.
filling in a canal with an open apical foramen Once treatment was finished sinus opening The preparation was etched with 37%
carries the risk of root filling material was noted with relation to upper left incisor. orthophosphoric acid for 15 seconds, and was
extrusion1, 2. She consulted dentist for which medication thoroughly rinsed with air and water leaving
Of the options currently available for the was prescribed and patient didn't went for moist for wetbonding adhesion. Bonding
management of root canals with an open further treatment as sinus opening resolved. agent was applied to the water-moistened
apex, the use of calcium hydroxide dressing The episode of sinus opening and resolving preparation.excess solvent was blowed off
to induce an apical hard tissue barrier occurred for quite number of time. Then with a one second blast of air. Light curing
(apexification) has gained the widest finally she visited our college where detail was done for 10 seconds. Composite resin
acceptance. This procedure normally requires history was taken. Clinical and radiographic was applied incrementally and cured for 20
several visits to the dentist over a period of 5 examination revealed a discolored tooth 21, seconds. Finishing and polishing was done to
to 20 months3. This approach requires sinus tract over the attached gingiva, wide provide contour and proper texture to the
temporary restoration to be paced for long open apex and periapically radiolucent area restoration.
period of time which may result in (Fig.1). Discussion
microleakage and also long term Calcium A diagnosisof immature nonvital tooth There are many ways of treating a tooth
hydroxide may alter the mechanical with periapicalradioluscency was made. A with an immature apex. These include
properties of dentin4, 5, 6. one step apexification preceded by apexogenesis, apexification, apical plug,
A one step apexification procedure canaldisinfection for two weeks with calcium conventional root canal treatment with tailor-
eliminatesthese problems. It implies the non- hydroxide followed by composite veneering made gutta-percha, surgery15. Apexogenesis
surgicalcompaction of a biocompatible was planned for this tooth. can be followed only when the inflammation
material into theapical end of the root canal, After application of rubber dam and is limited to coronal pulp and is carried out by
thus, creating an apicalstop and enabling accesscavity preparation, working length was performing pulpotomy16.
immediate filling of the rootcanal7. obtained.At this stage, the number 80 file was Apexification with calcium hydroxide
An alternative to apexification with found looseand easily passing beyond the has been the traditional method followed.
calcium hydroxide is to seal the open apical apical limit of thecanal. The working length However, the technique has some
foramen with a mineral trioxide aggregate was determined by apex locator (Root ZX, J disadvantages. The primary disadvantage is
(MTA) apical plug8. This procedure can be Morita corporation, Kyoto, Japan) and that it typically takes between 6 and 18
completed in oneor two treatment sessions, subsequently confirmed by radiograph. The months for the body to form the hard tissue
making it possible to restore the tooth within a canal was thoroughly cleaned usingintracanal barrier. The patient needs to reportevery 3
Heal Talk | July-August 2012 | Volume 04 | Issue 06 49
Ainapur, et al. : Conservative Management of Teeth with an Open Apex
months to evaluate whether the calcium obturation was carried out at a subsequent Apr;29(1):34-42
8. Holden DT, Schwartz SA, Kirkpatrick TC, et al. Clinical
hydroxide has washed out and/or thebarrier is visit to enable setting of MTA.A moist cotton outcomes of artificial rootendbarriers with mineral
complete enough to provide a stop to a filling pellet was left over the MTA to facilitate trioxide aggregate in teeth with immature apices. J
Endod2008;34:8127.
material. This requires patientcompliance for setting. 9. Sarris S, Tahmassebi JF, Duggal MS, et al. A clinical
up to 6 visits before the procedure is Studies have shown that intracoronal evaluation of mineral trioxideaggregate for root-end
completed. It has also beenshown that the use bonded restorations can internally strengthen closure of non-vital immature permanent incisors in
children-a pilot study. Dent Traumatol 2008;24:7985.
of calcium hydroxide weakens the resistance endodontically treated teeth and increase 10. Witherspoon DE, Small JC, Regan JD, et al.
of the dentin to fracture. Thus it is common their resistance to fracture20, 21.Since the canal Retrospective analysis of open apex teethobturated with
for the patient to sustain another injury and mineral trioxide aggregate. J Endod 2008;34:11716.
was wide at the coronal and middle third, 11. Torabinejad M, Watson TF, Pitt FTR . The sealing ability
also fracture theroot before the hard tissue glass ionomer was placed with ease in of a mineral trioxide aggregate as a retrograde root filling
barrier is formed4. The barrier produced by remainder of the canal. material J Endodon 1993 ; 19:591 5
12. Torabinejad M, ChivianN . Clinical applications of
calcium hydroxide apexification has been Among the different approaches for the mineral trioxide aggregate . J Endodon 1999 ; 25 : 197
reported to beincomplete having swiss cheese management of discolored teeth, composite 205
appearance, andcan allow apical veneering was selected as a temporary mode 13. Simon, F. Rilliard, A. Berdal& P. Machtou. (2007) The
use of mineral trioxide aggregate in one-visit
microleakage17. The use of calcium hydroxide of treatment since the patient was placed apexification treatment: a prospective study.
apical barriers has also been associated with under observation to evaluate the healing. International Endodontic Journal 40:3, 186197
14. George Bogen, Sergio Kuttler. Mineral Trioxide
unpredictability of apical closure, risks of re- Conclusion Aggregate Obturation: A Review and CaseSeries.
infection resulting from the difficulty in MTA has numerous applications in JEndodon, 2009; 35, 770-790.
creating long term seals with provisional endodontic therapy that range from 15. K. J . Ramesh, Srinidhi, Ravi kumar, Ch. N. Murali
Krishna
restorations18. apexification to pulpotomy. The primary 16. Principles and practice of endodontics Torabinejad
Pulp revascularization remains a good advantages of this material include 17. Martin Trope. Treatment of theImmature Tooth witha
NonVital Pulp andApical Periodontitis. Dent Clin N Am
treatment option for such cases but the patient development of proper apical seal and 54 (2010) 313324.
was not agreeable to the time constraints. So, excellent biocompatibility.The use of MTA as 18. El-Meligy OA, Avery DR. Comparison of apexification
one step apexification with MTA was decided an obturating material along with composite with mineral trioxide aggregateand calcium hydroxide.
Pediatr Dent 2006;28:248 53
for this case. veneering showed a positive initial clinical 19. Torabinejad M, Pitt Ford TR, McKendry DJ, Abedi HR,
Recenty MTA was used as an alternative outcome for the immature tooth. Long term Miller DA, KariyawasamSP. Histologic assessment of
follow up is necessary to ensure success. mineral trioxide aggregate as a rootendfilling in monkeys.
to gutta-percha14. The reported advantage of J Endod. 1997; 23(4): 2258.
using MTA as an obturating material include References 20. Katebzadeh N, Dalton BC, Trope M. Strengthening
1. Ritchie GM, Anderson DM, Sakumura JS. Apical immature teeth during and after apexification. J Endod
superior sealabilityagainst bacterial extrusion of thermoplasticized Gutta-percha used as a 1998;24:256.
microleakage, demonstrates antibacterial and root canal filling. J Endod 1988;14:12832. 21. Goldberg F, Kaplan A, Roitman M, et al. Reinforcing
bioinductive properties that can improve 2. Sjogren U, Hagglund B, Sundqvist G, et al. Factors effect of a resin glassionomer in the restoration of
affecting the long-term results of endodontic treatment. J immature roots in vitro. Dent Traumatol 2002;18:70.
treatment outcomes. Furthermore, the Endod 1990;16:498504.
material is sterile, radiopaque, resistant to 3. Rafter M. Apexification: a review. Dent Traumatol
Legends
2005;21:18. Fig. 1 Pre-operative radiograph
moisture, and nonshrinking and stimulates 4. Andreasen JO, Farik B, Munksgaard EC. Long-term Fig. 2 Working length determination
mechanisms responsible for the calcium hydroxide as a rootcanal dressing may increase Fig. 3 Radiograph showing MTA obturation up to
bioremineralization and resolution of risk of root fracture. Dent Traumatol 2002;18:1347. middle third.
5. Rosenberg B, Murray PE, Namerow K. The effect of Fig. 4 Backfilling the remainder of the canal with
periapical disease. Hence it was thought to calcium hydroxide root filling ondentin fracture strength. glass-ionomer cements.
obturate the root canal with MTA upto middle Dent Traumatol 2007;23:269. Fig. 5 Discolored left central incisor
third of the canal. 6. Pace R, Giuliani V, Pini Prato L, Baccetti T, Pagavino G. Fig. 6 Tooth preparation for direct composite
Apical plug technique using mineral trioxide aggregate: veneering
MTA consists of fine hydrophilic results from a case series. IntEndod J 2007; 40:478 84. Fig. 7 After direct composite veneering
particles that set in the presence of moisture in 7. Steinig TH, Regan JD, Gutmann JL. The use and
predictableplacement of Mineral Trioxide Aggregate in
approximately 4 hours19. In this case final one-visitapexificationcases.AustEndod J. 2003