Maturogenesis of an Immature Dens Evaginatus Nonvital Premolar with an Apically Placed Bioceramic Material (EndoSequence Root Repair Material®): An Unexpected Finding

Abstract

Dens evaginatus is a dental developmental anomaly that arises due to the folding of the inner dental epithelium that leads to the formation of an additional cusp or tubercle on the occlusal surface of the affected tooth. This accessory tissue projection may carry with it a narrow and constricted pulp horn extension. Occasionally, the tubercle easily fractures, thus leading to microexposure of the pulp horn and eventual pulp necrosis. Often, the pulp necrosis occurs at a time the root development of the affected tooth is incomplete. Apexification with calcium hydroxide and mineral trioxide aggregates has been the mainstay of treatment options before root canal obturation in immature nonvital permanent teeth. Lately, regenerative endodontics (maturogenesis) is becoming one of the preferred treatment modalities to manage such teeth. The current case highlights the possibility of a bioceramic material (EndoSequence Root Repair Material, BC RRM-Fast Set Putty™, Brasseler, USA) which supposed to provide apical root closure (apexification) and could also induce continuation of root growth (maturogenesis).

Regenerative Endodontic Management of an Immature Necrotic Premolar Using Advanced Platelet-Rich Fibrin

“…MTA has been extensively used in the last decade for the apexification of non-vital immature teeth. Although it has several setbacks such as tooth discoloration and weakening of the dentin wall, it reduces the treatment time and is more effective than CaOH [ 19 ], and therefore, it can be considered as a treatment option to save the tooth. In this case, the American Association of Endodontists (AAE) recommendations were followed for irrigation protocols and the application of CaOH medication inside the root canal for 3 weeks [ 20 ].…”

Bioceramics in Endodontics: Updates and Future Perspectives

“…However, there are also studies in which the leakage of MTA is less than that of BC Putty measured using the radioactive isotope method in the apexification model [ 218 ]. BC Putty also promotes the continued maturation and development of immature teeth with nonvital pulp [ 219 ]. The clinical success rates of BC Putty, MTA, and calcium hydroxide are similar; however, the former two materials require a shorter time for the formation of an apical barrier and only need a single visit [ 220 ].…”

Diferencias en el abordaje de dos premolares inferiores con dens evaginatus: reporte de caso

“…4 La prevalencia del DE varía entre 2-4%, siendo más frecuencia en la población con ascendencia asiática. Las premolares mandibulares tienen cinco veces más probabilidad de presentar DE que los premolares superiores 5 . Es usual observarlo de forma bilateral, con una distribución simétrica y con una ligera predilección por el sexo femenino.…”