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  • 11-Treatment of Immature Permanent Teeth With Pulpal Necrosis

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    Ahmed Abd
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    The document discusses treatment options for immature permanent teeth with pulpal necrosis. It describes apexification, which stimulates continued root development to achieve apical closure and prevent recurrent infection. Regenerative endodontic procedures are also discussed as a biological alternative to induce continuous root development and reduce fracture risk compared to calcium hydroxide or MTA apexification. The reaction of pulp to various capping materials like zinc oxide-eugenol, calcium hydroxide, and preparations containing formalin are reviewed. Recently, formocresol use has been limited due to its carcinogenic properties and alternatives like biodentin, MTA, lasers, and glutaraldehyde are presented.

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    The document discusses treatment options for immature permanent teeth with pulpal necrosis. It describes apexification, which stimulates continued root development to achieve apical closure and prevent recurrent infection. Regenerative endodontic procedures are also discussed as a biological alternative to induce continuous root development and reduce fracture risk compared to calcium hydroxide or MTA apexification. The reaction of pulp to various capping materials like zinc oxide-eugenol, calcium hydroxide, and preparations containing formalin are reviewed. Recently, formocresol use has been limited due to its carcinogenic properties and alternatives like biodentin, MTA, lasers, and glutaraldehyde are presented.

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    © All Rights Reserved
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    37 views5 pages

    11-Treatment of Immature Permanent Teeth With Pulpal Necrosis

    Uploaded by

    Ahmed Abd
    The document discusses treatment options for immature permanent teeth with pulpal necrosis. It describes apexification, which stimulates continued root development to achieve apical closure and prevent recurrent infection. Regenerative endodontic procedures are also discussed as a biological alternative to induce continuous root development and reduce fracture risk compared to calcium hydroxide or MTA apexification. The reaction of pulp to various capping materials like zinc oxide-eugenol, calcium hydroxide, and preparations containing formalin are reviewed. Recently, formocresol use has been limited due to its carcinogenic properties and alternatives like biodentin, MTA, lasers, and glutaraldehyde are presented.

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    © All Rights Reserved
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    of 5

    Pediatric Dentistry

    5 th
    Year

    Lec. 11
    Treatment of Immature
    Permanent Teeth with
    Pulpal Necrosis
    Assistant Professor
    Aseel Haidar
    Lec.11 Pedodontics Fifth stage

    Assist. Prof. Dr. Aseel Haidar


    Treatment of Immature Permanent Teeth with
    Pulpal Necrosis

    Apexification
    The conventional treatment of pulpless anterior teeth usually requires apical
    surgery. There is a less traumatic endodontic therapy called apexification, which has been
    found to be effective in the management of immature, necrotic permanent teeth. The
    apexification procedure should precede root canal therapy in the management of teeth
    with irreversibly diseased pulps and open apices. The procedure has been demonstrated
    to be successful in repeated clinical trials stimulating the process of root end
    development, which was interrupted by pulpal necrosis, so that it continues to the point of
    apical closure. Often a calcific bridge develops just coronal to the apex. When the closure
    occurs, or when the calcific “plug” is observed in the apical portion, routine endodontic
    procedures may be completed; the possibility of recurrent periapical pathosis is thus
    prevented.

    a) A

    preoperative
    radiograph of maxillary left central incisor with an open apex (b) Radiographic evaluation of Mineral trioxide
    aggregate level (c) Follow-up after 6 months (d) Follow-up at 18 months
    (https://jbcd.uobaghdad.edu.iq/index.php/jbcd/article/view/525)

    Baghdad College of dentistry


    18/2/2021 1
    Lec.11 Pedodontics Fifth stage

    Regenerative Endodontic Procedures (REPs)

    It is defined as biologically based procedures designed to replace damaged


    structures, which include dentin, root structures, and cells of the pulp–dentin complex.
    These procedures provide a biological alternative to induce continuous root development
    and reduce the risk of fracture associated with traditional treatments of immature teeth
    with necrotic pulps, such as calcium hydroxide or MTA or biodentin apexification, where
    the root remains thin and weak.

    Baghdad College of dentistry


    18/2/2021 2
    Lec.11 Pedodontics Fifth stage

    REACTION OF THE PULP TO VARIOUS


    CAPPING MATERIALS

    ZINC OXIDE–EUGENOL
    Zinc oxide–eugenol was used more often than any other pulp capping material
    before calcium hydroxide came into common use. Although dentists have apparently had
    good clinical results with the use of zinc oxide–eugenol, it is not recommended as a direct
    pulp-capping material.

    CALCIUM HYDROXIDE
    Calcium hydroxide used as a biological dressing. Because of its high
    alkalinity (pH 12), it is so caustic that when it is placed in contact with vital pulp tissue,
    the reaction produces a superficial necrosis of the pulp. The irritant qualities seem to be
    related to its ability to stimulate development of a calcified barrier. The superficial
    necrotic area in the pulp that develops beneath the calcium hydroxide is demarcated from
    the healthy pulp tissue below by a new, deeply staining zone comprised of basophilic
    elements of the calcium hydroxide dressing.
    The original proteinate zone is still present. However, against this zone is a
    new area of coarse fibrous tissue likened to a primitive type of bone. On the periphery of
    the new fibrous tissue, cells resembling odontoblasts appear to be lining up. One month
    after the capping procedure, a calcified bridge is evident radiographically. This bridge
    continues to increase in thickness during the next 12 months. The pulp tissue beneath the
    calcified bridge remains vital and is essentially free of inflammatory cells.

    PREPARATIONS CONTAINING FORMALIN


    The clinical success experienced in the treatment of primary pulps with these
    materials is due to the drug’s germicidal action and fixation qualities than to its ability to
    promote healing.
    Some studies have indicated that the formocresol pulpotomy technique may
    be applied to permanent teeth, but its use in permanent teeth remains an interim
    procedure, to be followed by conventional endodontic therapy.

    Baghdad College of dentistry


    18/2/2021 3
    Lec.11 Pedodontics Fifth stage

    Notes:
    Recently, because of formocresol negative systemic properties, its use
    should be limited. Formaldehyde has a known carcinogenic, immunogenic, toxic,
    and mutagenic potential, which makes it questionable and unsuitable for use in
    pedodontic endodontics.
    Therefore, Biodentin and MTA can be used instead of it and other
    experimental capping materials alternative to formocresol are:
     Laser Pulpotomy
     Electrosurgical Pulpotomy
     Bone morphogenic protein
     Calcium hydroxide Dentin chips

    FERRIC SULFATE
    Ferric sulfate (15.5% Fe2SO4) has been used as pulpotomy agent as a
    substitute for formocresol for 15–20 years. Ferric sulfate in contact with blood forms a
    ferric ion–protein complex, which seals the cut blood vessels mechanically, producing
    hemostasis. The effect of ferric sulfate is hemostatic but not bactericidal or fixative. After
    application of ferric sulfate for 15 seconds, the pulp is covered with zinc oxide–eugenol
    and the cavity sealed.

    Glutaraldehyde
    It has been widely tested, to replace formocresol. Studies have shown that
    application of 2-4% produces rapid surface fixation of the underlying pulp tissue.
    Attributes of glutaraldehyde over formocresol
    1) Forms strong intra- and intermolecular protein bonds leading to superior
    fixation by cross linkage.
    2) Diffusability is limited, thus reducing the apical extension of the material
    3) Excellent antimicrobial property
    4) Less dystrophic calcification
    5) Produces initial zone of fixation that does not proceed apically
    6) Readily excreted from the body. About 90% will be eliminated in 3 days.
    7) 15-20 times less toxic than formocresol and have little potential for
    chromosomal interference or mutagenecity.

    Baghdad College of dentistry


    18/2/2021 4

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