This document details a case study focused on apexification using biodentine for a patient with an immature root apex and pulp necrosis. It highlights the assessment, treatment plan, and subsequent healing process, emphasizing that biodentine facilitates quicker apical barrier formation and healing. The conclusion supports biodentine as a predictable alternative to traditional methods in managing such dental cases.

3. INTRODUCTION
• Proper assessment of the affected tooth is critical in
determining an accurate diagnosis and prescribing
the appropriate treatment plan.
• The complete formation of root and closure of the
apical foramen occurs up to 3 years after the
eruption.
• Injuries during this period may cause pulpal
inflammation or necrosis and subsequent incomplete
development of the dentinal walls and root apices
which allow the penetration of bacteria and their
irritants.

4. 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

5. OPTIONS …!!!
It is today we must create world for future.
•Calcium hydroxide, Surgicel/amalgam,
•Freeze-dried bone or dentin
•Resorbable ceramic,
•Tricalcium phosphate,
•MTA
•BIODENTINE

6. BIODENTIN
E
BETTER
HANDLING AND
SAFETY
FASTER
SETTING
DOES NOT
REQUIRE TWO
STEP
OBTURATION
LOWER RISK OF
BACTERIAL
CONTAMINATION
It is today we must create world for future.

7. It is today we must create world for future.
Case
Report

8. CASE PRESENTATION
DATE: 18/07/2017 REG. NO:
470774
NAME: Sandeep Kumar
AGE: 28 YEARS
SEX: MALE

9. CASE PRESENTATION
• CHIEF COMPLAINT: Patient complains of pain in right
upper front tooth region on biting since 1-2 months .
• HISTORY: History of trauma by fall from bicycle 20 years
back and remained asymptomatic. Patient felt pain 1-2
months back in upper front tooth region on chewing. Pain
was dull, boring and intermittent in nature. It initiates on
biting and subsides on its own.

10. • Past Medical History – No significant finding
• Dental history- No significant finding
• Family History- No significant finding
• Tenderness on percussion- present

11. INTRA ORAL EXAMINATION
Soft Tissues Examination
GINGIVA – no abnormality detected.
HardTissues Examination
TEETH – No abnormality detected
Color - no discoloration present

12. VITALITY TEST
Electric Pulp Testing and Cold Test--were
negative irt 21
Heat test– Negative
irt 21

13. RADIOGRAPHIC
EXAMINATION
• Wide root canal with open apex with 21
• Periapical radiolucency irt 21

14. PROVISIONAL DIAGNOSIS
• Chronic Periapical Abscess irt 21
• Pulp necrosis with apical periodontitis
FINAL DIAGNOSIS
• Immature root apex with pulp necrosis with
chronic apical periodontitis

15. TREATMENT PLAN
1 VISIT : Access openingirt 11
2 VISIT: Biomechanical preparation followed by
intracanal medicament.
3 VISIT: apexification with biodentine followed by
obturation

16. CASE
PRESENTATION
TREATMENT STEPS

17. Pre-operative IOPA of
21 associated with
periapical radiolucency
Working length
determination IOPA

18. • Biomechanical preparationwas donetill ISOsize #120 stainlesssteel K file with
copious irrigationof normal saline.
• Canal was driedusing sterile paper points and Calciumhydroxide as intracanal
medicamentwas placedfor 2 weeks.
• The patient was recalledafter2 weeks and theinvolvedtooth was foundto be
asymptomatic.
• The access cavitywas reopened, copious irrigationwas done with Normal saline
solution, the root canal was driedwithsterile paper points.
• A 4 mm diameter of absorbable gelatine sponge (collaplug) was inserted in the
canal withthe help of pluggers to serve as an apical barrier. A slight discomfort
shown by the patient revealed that it had reached the periapical tissues.
• Subsequently, Biodentine was mixedaccording to manufacturer’s protocol to a
pastelike consistencyin a triturator and delivered to the canal using amalgam
carrier and condensed withSchilder’s pluggers until a thickness of 5 mm .

19. IOPA showing placement of
apical plug of biodentine of 5 mm
thickness
Apical plug of biodentine
Thermoplasticized gutta percha
Composite resin postobturation

20. Three month follow up IOPA
showing Periapical healing

21. DISCUSSION
• The goal of apexification is to obtain an apical
barrier to prevent the passage of toxins and bacteria
into periapical tissues from the root canal.
• Apexification with Biodentine requires significantly
less time. This can lessen the treatment time
between the patient's first appointment and the final
restoration.
• The importance of this approach lies in the effective
cleaning and shaping of the root canal, followed by
apical seal with a material that favors regeneration.

22. CONCLUSION
• This case report emphasizes the novel approach of
using Biodentine to achieve apexification of the
case with an open apex and large periapical lesion.
• The use of Biodentine has been demonstrated to
induce faster periapical healing for apexification of
the case with large periapical lesions.
• Apexification in one step using an apical plug of
Biodentine can be considered a predictable
treatment and may be an alternative to mineral
trioxide aggregate apexification.

23. REFERENCES
• Dammaschke T. A new bioactive cement for direct pulp capping.
International Dentistry African 2010;2( 2).64-69.
• American Association of Endodontists. Glossary of endodontitc
terms,7th edn. Chicago: American Association of Endodontists; 2003.
• 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.
• Pawar AM, Kokate SR, Shah RA. Management of a large periapical
lesion using Biodentine TM as retrograde restoration with eighteen
months evident follow up. J Conserv Dent 2013;16:573-5