Advanced Management of Open Apex Utilizing Platelet-Rich Fibrin and Bone Graft As Apical Barriers With Mineral Trioxide Aggregate (MTA) Obturation: A Detailed Case Report.

Management of open apex cases in endodontics poses a significant challenge, especially in immature teeth with necrotic pulps. Traditional apexification techniques have been the mainstay of treatment, aiming to induce the formation of a calcific barrier at the root apex. However, newer approaches incorporating biological materials such as platelet-rich fibrin (PRF) and demineralized bone matrix (DMBM) have emerged as promising alternatives. This article presents a case report of an 18-year-old male patient who presented with fractured upper central incisors, with the upper right central incisor displaying an open apex due to trauma sustained eight years prior. The treatment plan involved apexification using a combination of DMBM and PRF, with mineral trioxide aggregate (MTA) utilized as an apical barrier. The procedure was performed under rubber dam isolation, meticulously removing necrotic pulp tissue, irrigating with sodium hypochlorite solution, and placing a calcium hydroxide medicament. Subsequent visits included the placement of DMBM and PRF mixture into the canal space to create an apical barrier, followed by MTA placement and final restoration. Follow-up examinations at 3 and 12 months revealed the tooth to be asymptomatic and functionally normal, with radiographic evidence of osseous repair and complete apical closure. This case underscores the efficacy of a multimodal approach utilizing DMBM, PRF, and MTA in successfully managing open apex cases. Further research and long-term follow-up studies are warranted to validate this treatment modality's predictability and long-term success.

Does Cavity Disinfectant Affect Sealing Ability of Universal Self-etch Adhesive?

AIM: The purpose of this study was to evaluate 2% chlorhexidine disinfectant (CHX), chitosan, and octenidine dihydrochloride (as cavity disinfectants) on microleakage in cavities restored with universal self-etch adhesive. MATERIALS AND METHODS: Eighty extracted human permanent premolars were selected. Class V cavities were prepared on the facial surface of each tooth. The teeth were then divided into four groups of 20 teeth each. For the control group after cavity preparation, no disinfectant was applied. The other 3 groups were treated with 0.1% chitosan, 2% CHX, and 0.1% octenidine dihydrochloride (OCT). All the groups were restored with universal adhesive followed by composite resin. The teeth were then immersed in 1% methylene blue dye and were sectioned buccolingually. Microleakage was checked under a stereomicroscope on both occlusal and gingival margins. RESULT: Among all the groups chitosan-treated cavities showed the least microleakage. Chlorhexidine treated cavities showed less leakage as compared to control, OCT group at both the margins. CONCLUSION: Chitosan as a cavity disinfectant improves the sealing ability of the self-etch adhesive. Furthermore, in vivo studies need to be conducted to examine the interaction and long-term effect of chitosan with the other self-etch adhesive systems. CLINICAL SIGNIFICANCE: Chitosan a natural polysaccharide can be used as a cavity disinfectant as it improves the sealing ability of self-etch adhesive.

Radiological Appraisal of Biodentine and Pulpotec Individually or in Combination with Photo-activated Disinfection as Pulp-capping Cements in Mature Teeth.

AIM AND OBJECTIVE: The aim of the study was to evaluate and compare radiographically, Pulpotec cement and Biodentine as direct pulp-capping agents in mature teeth, individually and in combination with photo-activated disinfection (PAD). MATERIAL AND METHODS: In the present study, 80 mature teeth with deep occlusal caries were selected for direct pulp-capping procedure and randomly assigned to one of the four groups [Pulpotec (I), Biodentine (II), Pulpotec + PAD (III), and Biodentine + PAD (IV)] allocating 20 teeth to each group. Direct pulp capping and cavity disinfection were performed based on the group allotted followed by permanent restoration with composite. The teeth were evaluated radiographically (densitometric analysis) at intervals of 3, 6, and 12 months. The radiographic gray values obtained at follow-up periods for each group were subjected to two-way analysis of variance (ANOVA) with repeated measures. RESULTS: There was a significant improvement (p <0.0001) in the scores of all the groups at follow-ups as compared to the baseline. There was a significant difference between group I/group II with groups III and IV (p = 0.000) with group IV scoring highest at all follow-ups. However, the difference between groups I/II and groups III/IV was nonsignificant. CONCLUSION: Both, Biodentine and Pulpotec can be used for direct pulp capping of mature teeth. Furthermore, PAD prior to material application significantly improved the radiographical success of Biodentine and Pulpotec, with Biodentine showing better results than Pulpotec. CLINICAL SIGNIFICANCE: Biodentine and Pulpotec demonstrated comparable success as a pulp-capping agent and PAD application exhibited a synergistic effect when used in conjunction with these materials.