Management of a Traumatized Open Apex Tooth with a Combination of Mineral Trioxide Aggregate Apical Plug and Platelet-rich Fibrin Apical Matrix

Abstract

The absence of a natural apical constriction in permanent tooth makes endodontic treatment a challenge. Traditionally, calcium hydroxide was used for inducing the formation of an apical barrier. Currently, mineral trioxide aggregate (MTA) has shown promising results for apexification procedures. In an open apex, it is imperative to limit the MTA placement within the confines of the root canal for predictable healing. The placement of an internal matrix may limit the extrusion to some extent. Many materials can be used as internal matrix such as collagen membrane, calcium sulphate, hydroxyapatite, freeze dried bone, and platelet-rich fibrin (PRF) among others. This case report presents a successful demonstration of the management of an open apex using MTA placed over an internal apical matrix of PRF.

Management of a Flared Root Canal with an Iatrogenically Widened Apex

“…Al-Kahtani et al 21 observed that 5 mm provided a good seal in immature permanent teeth with open apices, and imparted enough depth to resist displacement and also completely prevented bacterial leakage. Previous studies 22,23 have incorporated the same method with successful results.…”

Evaluation of one-visit apexification with MTA apical plug versus traditional Calcium hydroxide apexification with the help of Platelet Rich Fibrin apical matrix

“…In the present study the Platelet-rich fibrin (PRF) membrane was used as internal apical matrix to avoid the extrusion of the MTA or the calcium hydroxide apically, and has advantages of low cost, ease of procedure, does not dissolve quickly after application, and is biocompatible. The success of this technique depends entirely on the speed of blood collection and transfer to the centrifuge, if prolonged failure will occur (15) .…”

“…Ten milliliters of patient's venous blood was collected in BD Vacutainer® blood collection tube (Belliver Industrial Estate, Plymouth, PL6 7BP, UK) without anticoagulant and immediately centrifuged (Process® centrifuge PC-02; Process Ltd., Nice, France) at 3000 rpm for 15 minutes (15) . After centrifugation there will be of three layers a base of red blood corpuscles (RBCs) at the bottom, acellular plasma on the surface, and PRF (Platelet Rich Fibrin) clot in the middle (Fig.…”

Management of Traumatized Open Apex Teeth with Mineral Trioxide Aggregate Apexification and Demineralized Freeze-dried Bone Allograft as Apical Matrix

“…25 The BMPs attract mesenchymal stem cells and induce their differentiation into chondrocytes leading to endochondral bone formation. 7 The BMPs produce multiple effects on bone by acting as mitogens on undifferentiated mesenchymal cells and osteoblast precursors, inducing the expression of the osteoblast phenotype, e.g., increasing alkaline phosphatase activity in bone cells and acting as chemoattractant for mesenchymal cells and monocytes as well as binding to extracellular matrix type IV collagen. 26 In open apex cases along with wide apical opening, the radicular dentin is thin and fragile; thus, it is important to reinforce the roots, else it would result in root fracture.…”

“…Various materials, such as CaOH, hydroxyapatite, resorbable collagen, platelet-rich fibrin (PRF), calcium sulfate, and demineralized freeze-dried bone allograft (DFDBA) are recommended as a matrix material for treating open apex. 7,8 The matrix material, DFDBA, is a widely used graft material in procedures of periodontal and oral surgery, 6 but very few cases are reported where it is used as an apical matrix. The DFDBA is obtained from cortical plate of long bones.…”