Dentaltown August 2019 - 85

the scaffold. A composite restoration was eventually placed and the patient
was monitored at regular intervals (Fig. 13).
Over the next two or three years, the periapical pathosis healed, which
is the first goal for regeneration. However, the second goal of further root
development-root wall thickening and closure-did not occur; rather, a
radiopaque, hard tissue formation developed both in the apical third of the
canal and toward the apical opening (Fig. 14).
In 2019, at a regular recall visit, a sinus tract was once again present in the apical
area. The sinus tract traced to the apex of UR1, where periapical pathosis had recurred
(Figs. 15 and 16). No recurrent decay was observed, and no history of further
trauma was reported. Treatment options were discussed, and re-treatment
with the goal of apexification with a resin buildup was recommended and
decided upon. Ree and Schwartz reported a 96% healing rate with this
method in immature incisors over a 5- to 15-year time period.6
At the initial visit, the intact composite and Biodentine, which was
discolored and soft, were removed, and the canal was irrigated with diluted
sodium hypochlorite. The osteoid material was removed with Munce
burs and the canal packed with calcium hydroxide for two months (Fig.
17). At the second visit, the sinus tract had healed and the patient remained
asymptomatic. The canal was irrigated with diluted sodium hypochlorite and
dried. A collagen barrier was placed and MTA apexification was completed
(Fig. 18). A small layer of thermoplasticized gutta percha was placed with
sealer as a barrier over the MTA, and a fiber post/resin buildup was completed.
Fig. 13

Fig. 14

Fig. 15

Fig. 16

Fig. 17

Fig. 18

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Dentaltown August 2019

Table of Contents for the Digital Edition of Dentaltown August 2019

Dentaltown August 2019 - Intro
Dentaltown August 2019 - Cover1
Dentaltown August 2019 - Cover2
Dentaltown August 2019 - 1
Dentaltown August 2019 - 2
Dentaltown August 2019 - 3
Dentaltown August 2019 - 4
Dentaltown August 2019 - 5
Dentaltown August 2019 - 6
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Dentaltown August 2019 - Cover3
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