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ENDODONTICS
ENDODONTICS
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Mehmet Kemal C ß kan, Mehmet Abstract – Spontaneous apical closure in non-vital immature teeth has been
Emin Kaval rarely encountered and outcome of non-surgical endodontic treatment of
Department of Endodontology, School of related teeth associated with periapical lesions has not yet been adequately
Dentistry, Ege University, Izmir, Turkey elucidated. The aim of this article was to report endodontic management of
spontaneous apical closure of infected untreated immature teeth with peri-
apical lesions and to review previously proposed mechanisms for the devel-
opment of spontaneous hard tissue barrier. Three patients were referred at
different time intervals to the endodontic clinic for treatment of their maxil-
lary anterior incisors with acute or chronic apical periodontitis. Dental histo-
Key words: Calcium hydroxide; endodontic
therapy; immature teeth; periapical healing; ries indicated that related teeth had been subjected to trauma approximately
spontaneous apical closure 12–18 years previously. Radiographically, the involved teeth exhibited
incomplete root formation with spontaneous apical closure and were associ-
Correspondence to: Dr. Mehmet Emin Kaval,
ated with an apical radiolucency. After biomechanical preparation, calcium
Department of Endodontology, School of
Dentistry, Ege University, 35100 Izmir, Turkey hydroxide paste was applied and was changed once or twice within
Tel.: +90 232 311 46 06 3 months. All canals were then filled with gutta-percha and AH Plus and the
Fax: +90 232 388 03 25 follow-up period was 16–50 months; both clinical and radiographic examina-
e-mail: mehmetkaval@hotmail.com tions revealed adequate function, the absence of clinical symptoms and sig-
Accepted 22 December, 2014 nificant healing of the periapical radiolucency.
Traumatic injuries which are frequently encountered in extracted (14, 15), one had incomplete endodontic ther-
children and adolescents may cause pulp necrosis in apy (18), and one had received no treatment at all (14).
immature teeth (1). As apical closure process has not Only six teeth with spontaneous apical closure were
been completed, obturation of the canals during the treated endodontically (14, 16, 17, 19, 20). The purpose
endodontic therapy could be challenging. First step of of this article is to present three cases of spontaneous
the treatment protocol in these teeth group is providing apical closure of teeth that required endodontic treat-
the formation of the apical barrier using intracanal ment due to pulpal necrosis and apical periodontitis,
medicaments following the root canal preparation. His- and to review previously proposed mechanisms for the
torically, several biologic activators have been advo- occurrence of non-induced apical closure.
cated to obtain the apical barrier (2, 3); but up to date,
the most preferred materials have been calcium hydrox-
Case reports
ide (3–7) and mineral trioxide aggregate (MTA) (8, 9).
On the other hand, previous animal studies showed
Case 1
formation of apical closure in teeth which had been left
open after pulpectomy (10–13) and the authors dis- A 25-year-old male with a non-contributory medical
cussed possible mechanisms involved in spontaneous history was referred to the clinic of Endodontic
apexification. However, the exact biologic mechanism Department, School of Dentistry, Ege University for
of apical closure has not yet been adequately eluci- evaluation and treatment of a diffuse swelling in the
dated. Review of the literature revealed relatively few maxillary left anterior vestibule, after his patient’s fam-
case reports which demonstrated spontaneous apical ily dentist had performed the initial dental intervention,
closure of human immature teeth following pulp necro- and prescribed antibiotics and anti-inflammatory
sis and consequent development of periradicular patho- agents. His dental history revealed that the maxillary
sis (14–20). Even though spontaneous apical closure left central incisor had sustained a crown fracture at
cases have been reported previously, endodontic treat- the age of 7 years during a bicycle accident.
ment has not been performed in all of those teeth. The maxillary left central incisor was slightly sensi-
Among 11 teeth reported in the literature, three were tive to percussion and palpation and failed to respond
© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd 1
2 ß alısßkan & Kaval
C
Fig. 1. (a) Preoperative radiograph demonstrating large periradicular lesion associated with osseous extension involving apices of
maxillary left central and lateral incisors and extremely large root canal space with apparent apical closure of the left central
incisor. (b) Radiograph demonstrating the presence of calcium hydroxide paste in the root canal. (c) One-year recall examination
after completion of endodontic treatment. Note the decrease in size of the periradicular radiolucency. (d) Four years follow-up
radiograph, showing significant healing of the periapical lesion.
© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Endodontic management of immature teeth 3
© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
4 ß alısßkan & Kaval
C
this report, as the teeth are asymptomatic and the asso- III. Effect of debridement and disinfection procedures in
ciated periapical radiolucencies have either completely the treatment of experimentally induced pulp and periapi-
or partially resolved following intracanal calcium cal disease. Oral Surg Oral Med Oral Pathol 1973b;
35:532–40.
hydroxide therapy, there could be cautious optimism
13. England MC, Best E. Non-induced apical closure in imma-
for their long-term retention. ture roots of dogs teeth. J Endod 1977;3:411–7.
14. Barker BCW, Mayne JR. Some unusual cases of apexifica-
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