Novel Apexification Procedure as a Biotic Treatment Approach Using Amniotic Membrane Matrix and Biodentin Obturation for Immature Permanent Teeth: Case Series with Review of Literature

Abstract Introduction Regenerative therapy’s primary goal in endodontics is to revitalize the pulpo-dentinal system of immature permanent dental teeth in order to permanently seal the gaping apex of the tooth’s root end and complete the root’s growth. Apexification is a process employed in teeth with diseased pulps to preserve an apical development of a root that is still developing or to form a mineralized barrier in a root that has an open apex. Biodentine is an adaptable substance that can support thin dentinal walls and help achieve apical closure, enhancing overall prognosis and maintaining natural dentition. Amnion membrane contains growth factors that promote regeneration and epithelization. Methodology In this paper, cases of nonvital permanent tooth with an immature apex received treatment for the apexification process. Standard endodontic therapy was started after rubber dam isolation and under local anesthesia. Access cavities were prepared. ProTaper hand files up to size F3 were used for the cleaning and shaping process. For a duration of 2 weeks, two applications of calcium hydroxide dressing were applied to the root canals along with 3% sodium hypochlorite irrigation. At the subsequent appointment, the calcium hydroxide dressing was removed. The canals were dried using paper points, and then an amniotic membrane (Tata Memorial Hospital, Mumbai, India) plug was placed at the apex. The canal was filled with sterile cotton and temporized for 2 weeks. Following this, the entire root canal was obturated with Biodentin. Final restoration was done at subsequent visit with composite resin. Results Three cases with permanent immature teeth with open apices were treated in which all the protocols of the apexification procedure were followed. All the 3 cases treated showed signs of healing both clinically and radiographically. Conclusion Amniotic membrane is considered as one of the regenerative materials for the apexification procedure which helps in the closure of open apices within a span of 2 weeks. This membrane is considered as a viable option for the apexification of immature teeth without any adverse effects.