Biodentine® And Apexification: Practical Therapy for Necrosis of Immature Permanent Teeth

The permanent tooth can be subjected to a variety of stresses during its formation, such as caries damage or trauma.In the short or long term, these aggressions can damage the pulp tissue, potentially leading to its necrosis, which in turn can cause infectious problems.The timing of the necrotizing event affects the state of development of the tooth, with roots still forming and residual thin walls, leading to root fragility.(1) Management of these cases by conventional endodontic treatment then becomes difficult, not only because of the width of the apical diameter and the thinness of the root walls, but also because of their divergence, which makes complete debridement difficult, as well as problems of drying and apical sealing.( 2) For a long period, calcium hydroxide paste was employed to create a calcified barrier followed by root canal treatment.However, in 1993, mineral trioxide aggregate (MTA) became the preferred material due to its sealing properties and biocompatibility, good radiopacity, low solubility, high pH, expansion after setting and antimicrobial properties.However, the long setting times, manipulation difficulties and risk of coronal discoloration associated with MTA led to the search for alternative materials, a new calcium silicate-based material, Biodentine ® (Septodont), has been developed recently to maintain the beneficial properties and clinical applications of MTA without its negative characteristics.(3) Biodentine ® can be employed to substitute dentin in coronal restorations, pulp linings, pulpotomies, repair of root perforations, internal and external resorptions and the construction of apical barriers in apexification treatments.(4)These biological properties, together with the product's good color stability (16), lack of genotoxicity ( 17) and low cytotoxicity (18), make it ideal for endodontic practice and the material of choice for apexification treatments, especially in anterior teeth.On the other hand, one possible downside of Biodentine is its low radiopacity.( 5)The aim of this article is to illustrate, through a case study, the treatment of an immature permanent tooth with a Biodentine® apexification. CLINICAL CASE:A 19-year-old male patient presented with lateral dislocation of tooth 21 following trauma, who was treated in the pathological and surgical dentistry department, with a 4-week semi-regid contention from tooth 14 to 24. (Fig 1)