Traumatic injuries to an immature permanent tooth may result in cessation of dentin deposition and root maturation. Novel revascularisation endodontic procedure (REP) has been considered as an option for treatment of immature teeth with damaged pulp tissue. The continuous development of the root and the root canal has been recognised as a major advantage of this technique over traditional apexification approach. Traditional apexification procedures may resolve pathology but have not been able to prove tooth survival due to absence of continued root development and risk of root fracture. A successful REP results in resolution of signs and symptoms of pathology, radiographic signs of healing, proof of continued root development as well as presence of pulp vitality due to the regeneration of pulp tissue in the root canal. Currently, repair rather than true regeneration of the ‘pulp-dentine complex’ is achieved and further root maturation is variable. According to Glossary of Endodontic terms published by American Association of Endodontists, REP’s are biologically based procedures designed to physiologically replace damaged tooth structures, including dentin and root structures, as well as cells of the pulp-dentin complex.1,2 Apexification treatment has been a routine procedure to treat and preserve such teeth for many decades.3 Apexification is the process by which a suitable environment is created within the root canal and periapical tissue to allow for the formation of a calcific barrier across the open apex. Calcium hydroxide [Ca(OH)2] has been the material of choice for apexification as Frank reported its capacity to induce physiological closure of immature pulpless teeth in 1966.4 However, this technique has several disadvantages, including the unpredictability of apical barrier formation and the long duration of treatment, which often requires multiple visits.5 A retrospective study by Jeruphuaan et al.6 has shown a higher survival rate with regenerative endodontic treatment when compared to both mineral trioxide aggregate (MTA) and Ca(OH)2 apexification. The first evidence of regeneration of dental tissues was in 1932 by G.L. Feldman, who showed evidence of regeneration of dental pulp under certain optimal biological conditions.7 In 1971, a pioneer study in regenerative endodontics conducted by Nygaard-Ostby concluded that bleeding induced within a vital or necrotic canal led to resolution of signs and symptoms of necrotic cases and in certain cases, apical closure.8 According to Windley et al. (2005), the successful revascularisation of immature teeth with apical periodontitis is mainly dependent upon: 1. Canal disinfection 2. Scaffold placement in the canal for the growing tissues 3. Bacteria-tight sealing of the access opening.9 The purpose of this case report is to illustrate the outcome of a revascularisation endodontic procedure in a non-vital immature young permanent central incisor.

Introduction Taurodontism is a morpho-anatomic variation in tooth anatomy that rarely affects mandibular premolars. Literature is replete with mandibular first premolars presenting atypical additional root canals, but concurrent presence of three roots and taurodontism is exceptional. Materials and methods This case report describes the successful endodontic diagnosis and management of a rare case of taurodontism in a mandibular first premolar with chronic apical periodontitis. Cone beam computed tomography (CBCT) facilitated the diagnosis of three roots and root canals associated with concurrent taurodontism. The taurodont premolar required exceptional and diligent care in each segment of endodontic treatment for the complex root canal system. Results Taurodontism-affected premolars present with challenges in endodontic therapy as they have apically displaced pulp chambers with limited width. Cone beam computed tomography and dental operating microscope can facilitate evaluation for teeth with such complex anatomy and their successful endodontic management. How to cite this article Wadekar SI, Shah DY, Shah JR, Gathani KM. Endodontic Management of a Three-rooted Mandibular First Premolar associated with Taurodontism. J Oper Dent Endod 2016;1(2):90-92.

No abstract

No abstract