PMC8248255_01
Preoperative cone-beam computed tomography (a) Sagittal view of tooth 11 showing a wide-open apex of diameter 3.22 mm. (b) Axial view of teeth 11 and 21. (c) Coronal view of teeth 11 and 21.
DRJ-18-28-g001.jpg
PMC8248255_01_DRJ-18-28-g001.jpg
F1
Radiographic examination revealed an open apex in relation to teeth 11 and 21 without any signs of periapical pathology [Figure 1a-c].
(a) Preoperative radiograph showing teeth 11 and 21 with immature root apex. (b) Amniotic membrane being placed in the root canal of tooth 11 with the help of a tweezer. (c) Posttreatment Intra oral peri-apical Radiograph with amniotic membrane in the root canal space, mineral trioxide aggregate placed till the cementoenamel junction and resin-modified glass-ionomer cements restoration done on tooth 11.
DRJ-18-28-g002.jpg
PMC8248255_01_DRJ-18-28-g002.jpg
F2
On radiographic examination, widening of the apical periodontal ligament of 11 was noted, exhibiting a periapical index score of 2, thereby suggesting a diagnosis of pulpal necrosis and symptomatic apical periodontitis [Figure 2a]. Memorial Hospital, Mumbai, India) was cut into approximately 1 mm x 1 mm size, moistened with saline, folded with the help of a tweezer, and placed in the canal till 3-4 mm short of the orifice [Figure 2b]. Mineral trioxide aggregate (MTA-Angelus) was placed over the amniotic membrane till the orifice and glass ionomer cement restoration was done and postoperative radiograph was taken [Figure 2c].
Progressive root closure with respect to tooth 11 seen at (a) 3-month follow-up. (b) 6-month follow-up. (c) 9-month follow-up. (d) 12-month follow-up.
DRJ-18-28-g003.jpg
PMC8248255_01_DRJ-18-28-g003.jpg
F3
At the 3rd month recall visit, the patient was asymptomatic, and the radiographic evaluation revealed an increase in the root length with apex heading toward closure [Figure 3a] with a crown root ratio of 0.98 (Image J software). At the 6th month radiographic evaluation, root showed continued increase in the length with apex closed [Figure 3b]. At the 9th month follow-up, intraoral periapical radiograph taken showed complete closure of root apex [Figure 3c] with a crown root ratio of 0.86 (Image J software). The 12th month intraoral periapical radiograph showed a closed apex without any periapical abnormality in relation to 11; however, the tooth 21 showed an immature root apex [Figure 3d].
(a) Postoperative clinical photograph at 12 months. (b) Cone-beam computed tomography image showing complete apical closure of tooth 11 and a well-defined radiolucent lesion at the apex of tooth 21.
DRJ-18-28-g004.jpg
PMC8248255_01_DRJ-18-28-g004.jpg
F4
Clinically, the teeth 11 and 21 were asymptomatic and were not tender on percussion [Figure 4a]. Cone-beam computed tomography report revealed closed apex and no periapical pathology in tooth 11, whereas tooth 21 showed an open apex with a well-defined periapical radiolucency suggestive of a periapical cyst [Figure 4b].