Tooth apicification in a tooth with incomplete rhizogenesis and pulp necrosis in an adult patient.
Patient 22 years old, female, sought care for endodontic treatment of tooth 12. The patient did not present any signs or symptoms.
On clinical examination, nothing noteworthy and positive pulp vitality test in the anterior teeth except element 12. On radiographic examination, presence of diffuse periapical radiolucent image and tooth with incomplete root formation, in Nolla stage compatible with element 7.
Because there was no possibility of future control, by travel, we opted for apicification. Preparation and decontamination with 2.5% sodium hypochlorite and EDTA and medication with calcium hydroxide for 1 month were performed. In the second session, the MIC was removed with saline and EDTA and agitation, and then a calcium hydroxide apical plug was placed, followed by filling the canal with MTA and sealing.
Case conducted by student Karlon Rodrigues from class VII, specialization in endodontics at HPG Brasília.
In: APICIFICATION OF CENTRAL UPPER INCISIVES USING CALCIUM HYDROXIDE: CASE REPORT. Saúde, Santa Maria, vol 35, n 1: p 16-20 , 2009
One of the possible consequences of trauma in young permanent teeth is pulp necrosis. If the tooth has incomplete
rhizogenesis, the endodontic treatment technique should be performed in such a way as to promote root development at the expense of Hertwig's epithelial sheath when it has viable cells (apicigenesis), or through the use of calcium hydroxide for the deposition of hard tissue in the apical region (apicification) (Heithersay, 1975).
The apicification "induces a hard tissue barrier in a root with open apex or the continuation of apical development of an incomplete root in teeth with necrotic pulp" (American Association of Endodontists, 2003).
Different techniques of apicification have been proposed, being the most common the one that uses calcium hydroxide for an undetermined period of time (Frank, 1966; Estrela et al. 2001).
Calcium hydroxide has been indicated for apicification, because its alkaline pH and its physical presence inside the canal
present a potent antibacterial effect, inhibiting osteoclastic activity and preventing the entry of exudate and granulation tissue
. This situation promotes the formation of mineralized tissue near the root apex (Cvek, 1974). According to
Felippe (2005), calcium hydroxide pastes have been used to achieve canal disinfection and to induce the formation of a barrier of calcified tissue in the apical region of depolarized teeth with incomplete root formation.
The use of calcium hydroxide was first introduced by Kaiser in 1964 and popularized by Frank in 1966 who proposed mixing this material with PMCC to induce the formation of a barrier of calcified tissue at the apex.
Calcium hydroxide can be associated with several other substances, with the purpose of enhancing its properties, and with the most varied vehicles: viscous or not. Throughout many years several associations have been tested
, however without evidence that one product is more advantageous than another (Andreasen, 1984; Leonardo et al,
1993).
Apicification.
