Single-visit apexification with Biodentine and platelet-rich
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This article, published in the journal Endodontology describes single-visit apexification using Biodentine, a new calcium silicate-based material as an apical barrier along with platelet-rich fibrin as internal matrix.

A 19-year-old male patient reported with a chief complaint of discolored and fractured upper front left tooth. Patient gave a history of trauma 4 years back. Intraoral clinical examination revealed discoloration and Ellis Class IV fracture with relation to #21.

Following rubber dam placement, access opening was done and working length was determined radiographically 1 mm short of radiographic apex. Cleaning and shaping was performed with K-files using conventional preparation technique. Root canal irrigation was performed with 3% sodium hypochlorite (NaOCl) between change of instruments followed by 17% ethelynediaminetetraacetic acid (EDTA) and saline. Root canal was then dried with sterile paper points.

Calcium hydroxide was placed in the root canal, and the access cavity was sealed with cotton pellet and Cavit G. After 4 weeks in the subsequent appointment, under isolation, calcium hydroxide dressing was removed by H file and irrigating with alternating solutions of 3% NaOCl and 17% EDTA. A final irrigation with sterile saline was done. The root canal was then dried with sterile paper points.

Simultaneously, PRF membrane was prepared. A 10 ml sample of whole blood was drawn and transferred into a 10 ml sterile glass test tube without anticoagulant and was immediately centrifuged at 3000 revolutions per minute for 10 min. The resultant product consisted of three layers: topmost layer consisting of acellular platelet poor plasma, PRF clot in the middle, and red blood cells at the bottom.

The freshly prepared PRF membrane was placed into the root canal and gently compacted using hand pluggers to achieve a matrix at the level of the apex. The mixed Biodentine was carried into the canal with the help of amalgam carrier and was condensed against the PRF matrix using hand pluggers. Several increments were required to form an apical plug of 4 mm thickness, which was confirmed radiographically. After 12 min, the hardness of the Biodentine was checked using a plugger to confirm its set.

The canal was backfilled with thermoplastized gutta-percha with AH Plus resin sealer. The tooth was immediately restored with a composite restoration, and in subsequent visits, metal ceramic crown was placed. Six-month follow-up revealed the patient remained asymptomatic with restored esthetics and functions.

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