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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 11  |  Issue : 6  |  Page : 481-484  

Management of traumatized immature vital tooth: A case report


Department of Pedodontics and Preventive Dentistry, Rajas Dental College and Hospital Tirunelveli, Tamil Nadu, India

Date of Web Publication28-May-2019

Correspondence Address:
Dr. Esai Amutha Prabha Arumugam
Department of Pedodontics and Preventive Dentistry, Rajas Dental College and Hospital, Kavalkinaru Junction, Tirunelveli 627 105, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JPBS.JPBS_283_18

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   Abstract 

Trauma to front tooth is one of the disturbing conditions for children and parents. The treatment strategies used to treat the immature young dentition are important for the long-term prognosis of teeth and should aim at preserving pulp vitality to secure tooth maturation and root development. This article describes a case of trauma to upper front tooth with open apex. The patient was treated with vital pulp therapy with mineral trioxide aggregate to induce apexogenesis.

Keywords: Apexogenesis, traumatized immature tooth, vital pulp therapy


How to cite this article:
Thomas JM, Arumugam EA, Harris A, Ravi VV. Management of traumatized immature vital tooth: A case report. J Pharm Bioall Sci 2019;11, Suppl S2:481-4

How to cite this URL:
Thomas JM, Arumugam EA, Harris A, Ravi VV. Management of traumatized immature vital tooth: A case report. J Pharm Bioall Sci [serial online] 2019 [cited 2019 Jun 18];11, Suppl S2:481-4. Available from: http://www.jpbsonline.org/text.asp?2019/11/6/481/258826




   Introduction Top


Trauma to front tooth is one of the distressing conditions for children and parents. Various factors should be considered in treating immature young permanent tooth. Among the various factors, the most important are age of the patient and root end completion. Traumatic injuries of immature teeth cause physical, psychological, and esthetic considerations.[1]

The immature young permanent tooth should be treated with strategies that are important for the long-term prognosis of teeth. The treatment strategies should try to preserve the pulp vitality to secure continued root development.[2] The term apexogenesis is used to describe vital pulp therapies performed to allow the continuation of the root end.[3]

Mineral trioxide aggregate (MTA), the newer material, gold standard for vital pulp therapies, provides long-term seal, acceptable biocompatibility, and dentinal bridge formation.[4]


   Case Report Top


A 9-year-old male patient reported with the chief complaint of trauma to upper front tooth 1 day before. Clinical examination revealed Ellis class III fracture in 11 [Figure 1]. Radiographic examination in relation to 11 revealed an open apex [Figure 2]. There was no periapical pathology in relation to 11. Considering the age of the patient and open apex, it was decided to perform apexogenesis in 11 through vital pulp therapy.
Figure 1: Clinical preoperative

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Figure 2: Preoperative radiograph

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Cvek’s pulpotomy was performed and MTA was placed [Figure 3] and [Figure 4]. The tooth was sealed coronally with zinc oxide eugenol paste. After 3 days, the coronal seal was performed with glass ionomer cement. When the patient was reviewed after 1 week, there were no signs of inflammation. Then the patient was followed up at 3 months, 6 months, and 1 year. There were no signs of inflammation and mobility clinically. Radiographs at 3 months, 6 months, and 1 year revealed continued root end development [Figure 5], [Figure 6], [Figure 7]. After 1 year, the tooth was restored esthetically [Figure 8].
Figure 3: Pulpotomy performed

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Figure 4: Mineral trioxide aggregate placed

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Figure 5: Three-month follow-up

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Figure 6: Six-month follow-up

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Figure 7: One-year follow-up

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Figure 8: Postendodontic restoration

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   Discussion Top


Traumatic injuries to young permanent teeth are common and affect most of the children. Mostly the traumatic incidents occur before root formation is complete.[5] Trauma to immature tooth causes termination of dentin formation and root end development. Due to this, the root canal remains large with thin walls and wide apex. In such cases, attempts to induce continued root end development (apexogenesis) or closure at current level (apexification) are the treatment options left. Apexogenesis performed within 24h has positive outcome.[1] In this case considering the age of the patient, an open apex vital pulp therapy was performed to induce apexogenesis.

Calcium hydroxide was once considered as the gold standard for pulp-capping materials. Long-term studies have shown unpredictable results. The material does not closely adapt to dentin and does not induce odontoblast differentiation, and in cell cultures, it is cytotoxic. MTA is a bioactive cement that has been proved to be an effective pulp-capping material. MTA has been proved to induce pulp cell proliferation and hard tissue formation. The material has the advantages of hydrophilic nature, nonabsorbable, a relatively high compressive strength, and a sustained high alkaline pH.[6] Hence in this case, MTA was selected for vital pulp therapy.


   Conclusion Top


Trauma to anterior teeth at a young age is a challenging condition. The clinician should try to preserve the vitality of the involved tooth whenever possible. With the invention of newer materials, a positive outcome for vital pulp therapies has increased. So one should be thoughtful before treating a patient with open apex.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest



 
   References Top

1.
Viddyasagar M, Choudhari S, Raurale A, Dahapute S. Apexification and apexogenesis—A case report. Int J Contemp Den 2010;1:52-4.  Back to cited text no. 1
    
2.
Kvinnsland SR, Bårdsen A, Fristad I. Apexogenesis after initial root canal treatment of an immature maxillary incisor—a case report. Int Endod J 2010;43:76-83.  Back to cited text no. 2
    
3.
Patel R, Cohenca N. Maturogenesis of a cariously exposed immature permanent tooth using MTA for direct pulp capping: A case report. Dent Traumatol 2006;22:328-33.  Back to cited text no. 3
    
4.
Nosrat A, Seifi A, Asgary S. Pulpotomy in caries-exposed immature permanent molars using calcium-enriched mixture cement or mineral trioxide aggregate: A randomized clinical trial. Int J Paediatr Dent 2013;23:56-63.  Back to cited text no. 4
    
5.
Rafter M. Apexification: A review. Dent Traumatol 2005;21:1-8.  Back to cited text no. 5
    
6.
Bogen G, Kim JS, Bakland LK. Direct pulp capping with mineral trioxide aggregate: An observational study. J Am Dent Assoc 2008;139:305-15; quiz 305–15.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]



 

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   Case Report
   Discussion
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