Apexification with calcium hydroxide and mineral trioxide aggregate: Report of two cases
A 9-year-old female patient reported complaining of pain in the upper front tooth since 3 days. There was a history of trauma to the same tooth due to fall about 4 days back. On clinical examination, Elli's Class III fracture in permanent maxillary right central incisor was evident. Periapical radiograph showed incomplete root formation with wide open apices for the same tooth []. Apexification with calcium hydroxide dressing was planned. In the first visit, an access cavity was prepared with a straight line entry into the root canal. The working length was established within one mm of the radiographic apex by using size 30 Hedstrom file. Next, pulp extirpation and complete debridement of the canal was done using H file number 40 followed by copious irrigation with normal saline. After drying of the canal using paper points, calcium hydroxide powder was mixed with normal saline and this mixture was placed into the canal and pushed to the short of apex using plugger. Access opening was restored with glass ionomer cement []. Patient was called after 3 months. After 3 months when patient came back, a periapical radiograph was taken, which showed complete formation of the root apex in maxillary right central incisor, without any signs and symptoms and periapical radiolucency. Clinically, apical barrier formation was confirmed by using a size 30 Gutta-percha (GP) point to check for the presence of a resistant “stop” and absence of hemorrhage, exudates or sensitivity []. In the next visit, complete obturation was carried out with GP using lateral condensation technique [] followed by composite restoration.