Sinha Nidhi, Singh Bijay, Patil Santosh
Department of Conservative Dentistry and Endodontics, Jodhpur Dental College General Hospital, Jodhpur, Rajasthan, India.
Department of Prosthdontics, Jodhpur Dental College General Hospital, Jodhpur, Rajasthan, India.
J Conserv Dent. 2014 May;17(3):285-9. doi: 10.4103/0972-0707.131805.
A symptomatic endodontically treated immature tooth with periapical pathology presents multiple challenges to the clinician. Owing to incomplete root formation, gutta percha removal has to be done carefully without further damaging the periapical tissue or pushing the obturating material beyond the apex. Nonsurgical approach toward treating such a tooth would necessitate the creation of an apical barrier followed by conventional root canal treatment. Current literature suggests one-step apexification with mineral trioxide aggregate (MTA), with an apical matrix as the treatment of choice. A new calcium silicate-based cement also called as dentine substitute by the manufacturers with good handling properties has been introduced recently by the trade name Biodentine™ (Septodont, St. Maurdes Fossés, France). This case report presents management of a secondary endodontic case with an open apex treated with the concept of 'lesion sterilization and tissue repair (LSTR)' using triantibiotic paste and Biodentine™ for apical barrier formation. A 12-month follow up with cone beam-computed topography (CBCT) exhibited progressive involution of periapical radiolucency with indications of good healing of the periapical tissues and absence of clinical symptoms.
患有根尖周病变的有症状的经牙髓治疗的未成熟牙齿给临床医生带来了多重挑战。由于牙根形成不完全，去除牙胶时必须小心操作，以免进一步损伤根尖周组织或使充填材料超出根尖孔。对这类牙齿进行非手术治疗需要先建立根尖屏障，然后进行常规根管治疗。目前的文献表明，以矿物三氧化物凝聚体（MTA）进行一步法根尖诱导成形，以根尖基质作为首选治疗方法。一种新型的硅酸钙基水门汀最近已被推出，商品名为Biodentine™（法国圣莫尔德福塞Septodont公司），制造商称其为具有良好操作性能的牙本质替代物。本病例报告介绍了一例采用“病变消毒和组织修复（LSTR）”概念治疗的开放性根尖继发牙髓病病例的处理过程，使用三联抗生素糊剂和Biodentine™形成根尖屏障。锥形束计算机断层扫描（CBCT）随访12个月显示根尖周透射区逐渐缩小，根尖周组织愈合良好且无临床症状。
