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Effect of revascularisation and apexification procedures on biomechanical behaviour of immature maxillary central incisor teeth: a three-dimensional finite element analysis study

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Abstract

Objectives

This study aimed to assess the effects of revascularisation and apexification procedures on biomechanical behaviour of immature teeth using 3-dimensional finite element analysis (3D FEA).

Materials and methods

Five 3D FEA permanent maxillary incisor models were developed from CBCT scans and available literature data: Model MT: Mature tooth, Model IT: Immature tooth (Cvek’s stage 3), Model AT: Apexified tooth-mineral trioxide aggregate (MTA) apexification, Model RTB: Revascularised tooth with blood, and Model RTS: Revascularised tooth with supplementary scaffold. Using FEA, a masticatory load of 240N at 120° was simulated, and the Von Mises and maximum principal stresses within the models were evaluated. Failure index (FI) and weakening% were also calculated for each model.

Results

On dentinal stress analysis, model MT (96.16MPa) and IT (158.38MPa) had lowest and highest stress values, respectively. Among the experimental groups, model RTS (131.12MPa) had lower stresses than AT (136.33MPa) and RTB (133.7MPa), with no significant difference among the three. Peak dentinal stresses in all the models were observed in the cervical third of the root and near the apical opening in model IT. The extent of high dentinal stress area in model RTB and RTS was lesser than that of AT. The FI and weakening% values were highest for model AT followed by RTB and RTS, among the experimental groups. However, all these treatments strengthened an immature tooth by more than 20%.

Conclusions

AT, RTB, and RTS treatments lowered the stress values and risk of fracture in immature teeth with no significant difference among the three groups.

Clinical relevance

Stress distribution evaluation following revascularisation/apexification was essential, with potential to influence clinical decision-making. MTA apexification and revascularisation with blood clot/supplementary scaffold lowered the stresses in immature teeth, with no significant difference among the three.

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Funding

This study was funded by the Indian Council of Medical Research via the “MD/MS/DM/MCh/MDS support” grant.

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Authors and Affiliations

  1. Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, MAMC Complex, Bahadur Shah Zafar Marg, New Delhi, 110002, India

    Persis Anthrayose, Ruchika Roongta Nawal, Seema Yadav, Sangeeta Talwar & Sudha Yadav

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  1. Persis Anthrayose
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  2. Ruchika Roongta Nawal
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  3. Seema Yadav
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  4. Sangeeta Talwar
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  5. Sudha Yadav
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Contributions

All authors contributed to the study conception and design. Data collection, model, and result analysis were performed by Persis Anthrayose under the guidance of Ruchika Roongta Nawal, Seema Yadav, Sangeeta Talwar and Sudha Yadav. The first draft of the manuscript was written by Persis Anthrayose, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sangeeta Talwar.

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This article does not contain any procedures with human participants or animals performed by any of the authors. The study was approved by the Ethics Committee of Maulana Azad Institute of Dental Sciences (Ref No- MAIDS/ Ethical Committee/ 09,2018). All applicable international, national, and/or institutional guidelines were followed.

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Anthrayose, P., Nawal, R.R., Yadav, S. et al. Effect of revascularisation and apexification procedures on biomechanical behaviour of immature maxillary central incisor teeth: a three-dimensional finite element analysis study. Clin Oral Invest 25, 6671–6679 (2021). https://doi.org/10.1007/s00784-021-03953-1

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