Restor Dent Endod.  2020 May;45(2):e4. 10.5395/rde.2020.45.e4.

Observation of an extracted premolar 2.5 years after mineral trioxide aggregate apexification using micro-computed tomography

• Lee G
• Chung C
• Kim S
• Shin SJ

• KMID: 2503507
• DOI: http://doi.org/10.5395/rde.2020.45.e4

Abstract

Although numerous studies have been conducted on apexification using mineral trioxide aggregate (MTA), direct observation of extracted human teeth after the procedure has been rarely reported. This case report describes a mandibular premolar treated 2.5 years ago and extracted recently for orthodontic treatment. The tubercle of the right mandibular premolar of a 12-year-old boy with dens evaginatus was fractured and the pulp was exposed. The tooth was diagnosed with pulp necrosis and asymptomatic periapical abscess. During the first visit, copious irrigation was performed with 2.5% sodium hypochlorite. Calcium hydroxide paste was placed as an intracanal medicament. The sinus tract had disappeared at the second visit after 3 weeks. MTA was applied on to the bleeding point as a 4-mm-thick layer, followed by a 3-mm-thick gutta-percha filling and resin core build-up. After 2.5 years, the tooth and three other premolars were extracted for orthodontic treatment. The right and left mandibular premolars were scanned with micro-computed tomography to determine the root shape and canal anatomy. Irregular root growth was observed and the root outline of the right mandibular premolar differed from that of the contralateral tooth. Apexification with MTA leads to the formation of roots with irregular morphology, without any pulpal space.

Keyword

Apexification; Dens evaginatus; Microcomputed tomography; Mineral trioxide aggregate

Figure

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  Figure 1 Series of periapical radiographs taken during the treatment of tooth #45. (A) A preoperative periapical radiograph showing an immature root with periapical radiolucency with tooth #45. A gutta-percha cone was used to trace the periapical lesion to tooth #45. (B) A postoperative periapical radiograph showing apexification with tooth #45. (C) A periapical radiograph taken 6 months after the treatment demonstrating the resolution of the previous periapical radiolucency. (D) A periapical radiograph taken 1.5 years after the treatment showing the formation of the root apex. (E) A preoperative panoramic view. (F) A panoramic view taken 2.5 years after the root canal treatment with tooth #45.op, operative.

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  Figure 2 Reconstructed 3D images of teeth #45 and #35 obtained by micro-computed tomography. (A) Reconstructed 3D image of tooth #35. (B) Reconstructed 3D image of tooth #45.3D, three-dimensional; MTA, mineral trioxide aggregate; GP, gutta-percha.

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  Figure 3 Representative colored images of tooth #45 obtained by micro-computed tomography (micro-CT). (A) A coronal image of micro-CT of tooth #45 showing composite resin, gutta-percha (GP), and mineral trioxide aggregate (MTA) filling in the canal. An irregularly shaped root tip was observed. (B) A sagittal image of tooth #45. (C) A transaxial view of tooth #45.

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