Radiological assessment of apex formation following use of hydroxyapatite

Abstract

The treatment of pulp in teeth with incomplete apex formation is still a clinical challenge. In addition to the most widely used medication for this purpose, calcium hydroxide, other materials have also been tested. Following the use of synthetic biomaterials for restoring bone tissue, and considering their recognized biocompatibility and bioconductivity, our intention was to explore the possibility of using synthetic biomaterials in the endodontic treatment of permanent teeth with incomplete apex formation. The aim of this study was to observe the effectiveness of hydroxyapatite in apexogenesis of young permanent teeth. In this study a 100 µm synthetic hydroxyapatite material, Beohap (HAP) powder, was applied to 24 teeth in 3 dogs of 5.5 months of age, after incomplete root development was established on radiographs. The treated teeth were radiographed monthly and the radiographs compared with those of the corresponding teeth on the other side of the jaw until completion of apex growth. The tested teeth were divided into three groups according to the method of treatment: the first was direct pulp capping, the second was amputation of the pulp at the enamelcement junction and the third was high amputation at the radiographically identified point of root growth. On the basis of radiographic analysis, apex formation was successful in all test groups, with no significant differences between the three groups and the controls (Fisher's and χ 2 test). Deformities of the root apex were observed in two teeth (25%) in the third group.

Tretman pulpe u vreme kada još uvek traje rast i razvoj korena predstavlja i dalje klinički izazov. Pored kalcijum hidroksida, najčešće i najduže upotrebljavanog medikamenta u ovakvim slučajevima, svakodnevno se testiraju i mnogi drugi materijali. Nakon što su se sintetski biomaterijali pokazali uspešnim u restauraciji koštnog tkiva uz njihovu priznatu biokompatibilnost i biokonduktivnost, naša namera je bila da istražimo mogućnost primene hidroksiapatita kao sintetskog biomaterijala u endodontskom tretmanu zuba sa nezavršenim rastom korena. U ovom istraživanju primenjen je Beohap, sintetski hidroksiapatit, prosečne veličine čestica =100 µm, aplikovan na 24 zuba sa nezavršenim rastom korena kod tri psa uzrasta 5,5 meseci. Uzrorci su kontrolisani radiografski i poređeni sa kontralateralnim netretiranim zubima do završetka rasta korena. Tretirani zubi su podeljeni u tri grupe: u prvoj je urađeno direktno prekrivanje pulpe, u drugoj je pulpa uklonjena do cementno-gleđne granice, a u trećoj je pulpa uklonjena do radiografski vidljivog vrha korena. Na osnovu analize rendgen filmova utvrđeno je da je formiranje vrha korena bilo završeno u sve tri grupe bez statističkih značajnosti razlika (Fisher's i χ 2 testovi) Deformiteti vrha korena uočeni su u 2 uzorka u trećoj grupi (25%).