This case report describes the use of Biodentine as a novel apical matrix for nonsurgical endodontic management of open apex teeth. A 25-year old male with a non-vital tooth exhibiting a large periapical radiolucency underwent root canal treatment. Biodentine was used to form an apical plug after initial calcium hydroxide dressing. Follow up at 18 months showed complete healing of the periapical lesion and regeneration of periradicular tissues, indicating Biodentine's potential as an alternative to calcium hydroxide for single-visit apexification. Biodentine has bioactive properties that may promote faster periapical healing compared to other materials. This case demonstrates the

1. ENDODONTIC MANAGEMENT OF OPEN APEX
USING BIODENTINE AS A NOVEL APICAL MATRIX

2. CONTENTS
INTRODUCTION
CASE REPORT
DISCUSSION
CONCLUSION
REFERENCES

3. INTRODUCTION
 Biodentine - calcium silicate based cement.
 Physical and chemical properties - Portland cement derivatives.
 Biocompatibility
 Bioactive dentin substitute
 Root perforations
 Apexification
 Retrograde root filling
 A modified powder composition, the addition of setting accelerators and softeners, and a new predosed capsule formulation for use
in a mixing device, largely improved the physical properties of this material making it much more user-friendly with a shorter setting
time.
 Therefore, present case report highlights the nonsurgical management of teeth with immature apices and large periapical
radiolucencies using biodentine matrix to promote periapical healing.

4. CASE REPORT
 25-year-old male
 H/O - Trauma
 Non- vital
 Radiographic examination

5.  Endodontic access
 The working length. Biomechanical preparation
was done using No: 80 K-file
 Root canal debridement
 The root canal was then dried with sterile paper
points.
 Calcium hydroxide - recalled after 1 week.

6. → Biodentine : five drops of liquid - triturator for 30 s.
→The material was then delicately pushed towards the apex with a root-canal plugger.
→ Several increments were required to form a plug of adequate thickness
→ After verifying that the material was hard-set
→ Gutta-percha obturation was performed using obtura II and the access cavity was
sealed using composite resin.

7. → The clinical follow-up at 18 months showed the patient functioning
well with no reportable clinical symptoms and the absence of any sinus
tract formation.
→ The radiographic follow-up showed complete healing of the periapical
radiolucency and regeneration of the periradicular tissues.
PRE-OPERATIVE POST-OPERATIVE

8. DISCUSSION
 The goal of this treatment is to obtain an apical barrier to prevent the passage of
toxins and bacteria into periapical tissues from the root canal.
 Technically, this barrier is necessary to allow compaction of root filling material.
 Despite higher success rate of apical barrier formation using calcium hydroxide, long
term follow-up is essential.
 Using a suitable biocompatible material reduces leakage in the sealing material and
allows favorable response of the periodontal tissues for periapical healing and
apexification.
APEXIFICATION
'a method to induce a calcified barrier in a root with an open apex or the continued apical development of an
incomplete root in teeth with necrotic pulp‘ (American Association of Endodontists).
BIODENTINE

9. APEXIFICATION
CALCIUM HYDROXIDE
INFECTION
CONTROL
RECURRENCE
CERVICAL FRACTURE
MTA
SETTING TIME
DISCOLORATION
LOW RESISTANCE
HIGH COST
BIODENTINE
POWDER:
TRICALCIUM SILICATE
CaCO 3 AND ZrO 2
LIQUID:
CALCIUM CHLORIDE

10. BIODENTINE
EFFECTIVE
TIME
REGENER
ATION
BIO
COMPATIBLE
POTENTIAL
FOR
FRACTURE
APICAL
SEAL

11. • Laurent et al. investigated the capacity of Biodentine to affect transforming growth factor-β1 (TGF-β1)
secretion from pulp cells
• CONCLUSION: Biodentin caused a significant increase of TGF-β1 secretion from pulp cells, thus inducing
an early form of dental pulp mineralization shortly after its application.

12. • HAN AND OKIJI compared calcium and silicon uptake by adjacent root canal dentine in the presence of
phosphate buffered saline using Biodentine and ProRoot MTA.
• RESULTS: Both materials formed a tag-like structure composed of the material itself or calcium-or phosphate rich
crystalline deposits. The thickness of the Ca-and Si-rich layers increased over time, and the thickness was
significantly larger in Biodentine compared to MTA after 30 and 90 days
• CONCLUSION: Dentine element uptake was greater for Biodentine than for MTA.

13.  KOKATE AND PAWAR compared the microleakage of glass ionomer cement, MTA and Biodentine when
used as a retrograde filling material
 CONCLUSION: Biodentine exhibited the least microleakage when compared to other materials used.
 Research suggests that a high pH and released calcium ions are required for a material to stimulate
mineralization in the process of hard tissue healing.

14.  SULTHAN evaluate the pH and calcium ion release of MTA and Biodentine when used as
root end fillings.
 CONCLUSION: Biodentine presented alkaline pH and ability to release calcium ions similar to
that of MTA.
 The 24-h push-out strength of MTA was less than that of Biodentine.
 Blood contamination affected the push-out bond strength of MTA irrespective of the setting
time.

15. CONCLUSION
This case report emphasizes the novel approach of using Biodentine to
achieve single visit apexification of the cases with an open apex and large
periapical lesion.
The use of Biodentine has been demonstrated to induce faster periapical
healing for single visit apexification of the cases with large periapical lesions.
Although the efficacy of BioDentine as a dentin substitute is yet to be
clinically proven for its therapeutic indications, it may be a promising
material for apexification.

16. REFERENCES
1 Giuliani V, Baccetti T, Pace R, Pagavino G. The use of MTA in teeth with necrotic pulps and open apices. Dent Traumatol 2002;18:217-21.
2 Parirokh M, Torabinejad M. Mineral trioxide aggregate: A comprehensive literature review - Part III: Clinical applications, drawbacks, and mechanism of action. J
Endod 2010;36:400-13.
3 Saidon J, He J, Zhu Q, Safavi K, Spångberg LS. Cell and tissue reactions to mineral trioxide aggregate and Portland cement. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 2003;95:483-9.
4 Laurent P, Camps J, De Méo M, Déjou J, About I. Induction of specific cell responses to a Ca (3) SiO (5)-based posterior restorative material. Dent Mater
2008;24:1486-94.
5 Wang X, Sun H, Chang J. Characterization of Ca3SiO5/CaCl2 composite cement for dental application. Dent Mater 2008;24:74-82.
6 Wongkornchaowalit N, Lertchirakarn V. Setting time and flowability of accelerated Portland cement mixed with polycarboxylate superplasticizer. J Endod
2011;37:387-9.
7 Komabayashi T, Spångberg LS. Comparative analysis of the particle size and shape of commercially available mineral trioxide aggregates and Portland cement: A
study with a flow particle image analyzer. J Endod 2008;34:94-8.
8 Trope M. Treatment of immature teeth with non vital pulps and apical periodontitis. Endotopic 2007;14:51-9.

17. THANK YOU