www.ijcmr.com International Journal of Contemporary Medical Research Volume 3 | Issue 11 | November 2016 | ICV (2015): 77.83 | ISSN (Online): 2393-915X; (Print): 2454-7379 3382 Biodentine for Apical Barrier for Immature Necrotic Permanent Teeth: Report of Cases Shilpi Gupta 1 , Kanchi Upadhyay 2 , Tapas Kumar Sarkar 3 , Soumik Roy 2 CASE REPORT ABSTRACT Introduction: Treatment of traumatized non-vital teeth with an open apex requires elimination of bacteria from the root canal system and induction of apical closure for favorable outcome and to conine the root canal illing within the canal. A new calcium silicate based cement as Biodentine was introduced by Septodont in 2010 Case report: This article describes the successful treatment of 5 traumatized permanent central incisors with open apex using Biodentine. After access opening and biomechanical preparation, the interappoinment dressing of either calcium hydroxide or triple antibiotic paste was placed in the canals. Later, Biodentine apical plug was placed in the apical part.The remainder of the canal was back illed with gutta-percha and access cavity restored with composite resin followed by full crown. The patients were followed for 1 year. All patients were asymptomatic clinically and radiographically. Conclusion: Biodentine seems to be a promising material to be used in apical barrier formation procedure. Keywords: apical barrier, Biodentine TM , open apex, apical plug INTRODUCTION Traumatic injury to an immature permanent tooth leads to loss of pulp vitality and arrested root development. Thus, endodontic management of these teeth in young pediatric patients is a great challenge. The walls are divergent and wide open apex makes debridement and obturation dificult. 1 An Apical root closure may result from apexiication or bridge formation. Apexiication is deined as a method to induce a calciied barrier in a root with an open apex or continued apical development of an incomplete root in a tooth with necrotic pulp. 2 Various techniques were used to induce the apexiication process. The most common traditionally used medicament is Calcium Hydroxide. It was irst introduced by Kaiser and Frank in 1960’s. The approximate time for induction of calciied apical barrier varies between 6 months and 24 months. Although technique is eficient with predictable outcomes, it has several disadvantages like prolonged treatment time, chances of reinfection and risk of cervical fracture. 3 An alternative to apexiication with calcium hydroxide is formation of an artiicial apical barrier technique using MTA. Literature suggests that MTA is biocompatible with cementogenic properties and has superior sealing ability. But it has certain disadvantages like questionable antimicrobial activity, dificult to handle, potential for discolouring the tooth. 4 To overcome the disadvantages of MTA, a new calcium silicate based material, Biodentine TM (Septodont, Saint–Maur– Des-Fosses, France) has been introduced in 2009 claiming to be a revolutionary material capable of offering a bioactive and biocompatible replacement for dentine. The endodontic indications of the novel material are similar to MTA but are reported to offer several advantages including better consistency, improved handling, quicker setting time(12 minutes). 5 The following case series describes successful management of traumatized permanent anterior teeth with open apex with Biodentine apexiication followed by root canal treatment and full crown restoration. CASE REPORT 5 necrotic single rooted teeth with open apices were treated in the Department of Pedodontics and Preventive Dentistry, Hitkarini Dental College and Hospital, Jabalpur. Patients were between 8 and 12 years old. Medical histories of all patients were non –contributory. In all the cases, none of the teeth responded to the vitality testing (Digitest, Parkell, Farmingdale, NY, USA). All of the teeth had normal periodontal probing and showed physiologic mobility. Palpation and percussion tests were carried out. A summary of data of cases in the irst visit are shown in Table 1. Informed written consent were obtained from all patients. Treatment procedure: After local anaesthesia with 2% lidocaine and 1:2,00,000 adrenaline(Ligno-Ad,Vishal Dentocare Pvt Ltd, Ahmedabad, India) and rubber dam isolation, root canals were accessed using endo-access bur (Dentsply, Maillefer, Switzerland). BMP was done with alternate irrigation of 5.25%sodium hypochlorite and saline and gently iling with size 50K ile (Dentsply, Maillefer, Ballaigues, Switzerland). Then, the root canals were dried with size 50 paper points (Dentsply, Maillefer,Switzerland). In all the 5 teeth treated, either triple antibiotic paste (prepared by mixing ciprolocaxin, metronidazole and cefaclor in the ratio of 1:1:1 with propylene glycol)or calcium hydroxide with iodoform (Metapex) as an intracanal medicament was placed in the canal and teeth were sealed with IRM (Cavitemp, Ammdent). After 2 weeks, the patients were recalled and intracanal medicament were removed by irrigating with alternating solutions of 5.25% Sodium hypochlorite and saline. The canals were then dried with paper points. Apical plug placement and obturation: After the canals have been dried till the working length, Biodentine TM cement powder 1 Reader, 2 PG Student, 3 rd year, Department of Pedodontics and Preventive Dentistry, Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, 3 Assistant Professor, Department of-???, Calcutta National Medical College, Kolkata, West Bengal, India Corresponding author: Dr. Shilpi Gupta, Reader, Department Of Pedodontics and Preventive Dentistry, Hitkarini Dental College and Hospital, Hitkarini Hills, Dumna road Jabalpur 482005, India How to cite this article: Shilpi Gupta, Kanchi Upadhyay, Tapas Kumar Sarkar, Soumik Roy. Biodentine for apical barrier for immature necrotic permanent teeth: report of cases. International Journal of Contemporary Medical Research 2016;3(11):3382-3384. Department is missing