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Year : 2014  |  Volume : 5  |  Issue : 1  |  Page : 11-13

Possible use of calcifying nanoparticles in immature root apex treatment

1 Ministry of Health, Endodontic Postgraduate Student, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Saudi Arabia
2 Oral and Maxillofacial Pathology, Research Center, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Saudi Arabia

Date of Web Publication3-Mar-2014

Correspondence Address:
Mohammed S Alenazy
Riyadh Colleges of Dentistry and Pharmacy, P.O. Box 21437, Riyadh - 11475
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2155-8213.128106

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Introduction: There are reports in the literature, which describe different techniques and materials in the challenging management of thin dentin walls and immature root apex. It has been suggested that calcifying nanoparticles (CNPs) could be used in the management of these conditions. The Hypothesis: Compositionally modified CNPs made into a paste could become efficacious in managing thin dentin walls and immature root apex. Calcium and phosphate ions when mixed with CNPs could form a synthetic nanopaste that clinicians could use to manage thin dentin walls and to get a biological seal for immature root apex. Evaluation of the Hypothesis: CNPs can replicate and could facilitate the aggregations of calcium hydroxyapatite to produce a self-surrounding shell. These characteristics of CNPs could be used through their biomineralization process as initial nidus of calcification for further calcification progression to achieve total biological apical seal. If the hypothesis could be supported by biomineralization behavior of the paste (CNPs, Ca2 + , and PO4 ), a new therapeutic agent would have been added to the armamentarium of endodontists. There is need for more in vivo and in vitro investigations of modified nanopaste to manage these conditions.

Keywords: Biological seal, immature apex, nanobacteria, nanopaste

How to cite this article:
Alenazy MS, Mosadomi HA. Possible use of calcifying nanoparticles in immature root apex treatment. Dent Hypotheses 2014;5:11-3

How to cite this URL:
Alenazy MS, Mosadomi HA. Possible use of calcifying nanoparticles in immature root apex treatment. Dent Hypotheses [serial online] 2014 [cited 2023 Feb 6];5:11-3. Available from:

  Introduction Top

Immature apex and thin dentin walls are challenging cases to manage in nonvital endodontic practice especially in young permanent tooth. Previously the lines of treatment of nonvital teeth with immature apex and/or thin dentin are restricted to filling paste, customized fitted gutta-percha, and apical surgery. [1] Limited success of these procedures has led to enhanced interests in "apexogenesis", completing apical development phenomenon, or "apexification" forming a hard apical barrier. [2]

The use of various materials had been recommended for producing hard apical root barrier. In both situations, calcium hydroxide was the most common material used in apexification treatment for immature nonvital teeth and/or thin wall dentin. Although calcium hydroxide has many disadvantages, several studies reported the success of this traditional method of using this material. [3],[4],[5]

The alternative method of the calcium hydroxide apexification is the one-visit method of forming an artificial apical barrier. Parirokh and Torabinejad revealed that mineral trioxide aggregate (MTA) has been recommended for various endodontic procedures. [6] This approach has been described as the nonsurgical filling of a biocompatible material condensed into the apical third of the root canal. Therefore, creating an immediate apical barrier facilitates the root canal filling in one visit. [7] The superiority of this method is less treatment time, and the formation of a satisfactory apical seal barrier. [8]

Several materials used in apexification technique include tricalcium phosphate, [9] calcium hydroxide, [10] freeze-dried bone, [11] freeze-dried dentin, [12] and calcium phosphate. [13] Ham et al., explained that blood clot formation through a controlled overinstrumentation in the periapical area is the initiator of an apical development that close the root apex "revascularization". Consequently the use of a nanotechnology material could improve the management of nonvital immature apex and thin wall dentin, than the methods presently available and then leads to closure of root apex. [14]

  The Hypothesis Top

Jing et al., hypothesized the therapeutic use of calcifying nanoparticles (CNPs) in enamel tooth repair in vitro. Other researchers proposed a gelatinous synthetic agent to be applied on cracked tooth surface. The action of this material is to limit further propagation of the crack deeper into the dentin. [15] The hypothesis could be made that the synthesis of a nanopaste containing modified CNPs compacted at the root end of immature apex and/or thin wall dentin will produce a biological seal and repair the root apex end. The procedure appears more preferable than an artificial barrier because the result is more biological.

  Evaluation of the Hypothesis Top

CNPs or nanobacteria have been found in different parts and fluids of human saliva, tooth surface, plaque, calculus, and pulp stones. They have several morphological shapes and their diameter sizes range from 80 to 500 nm. [16],[17] CNPs have the ability to replicate as well as to facilitate aggregation of calcium hydroxyapatite as shell surrounding the CNPs. [18] These characteristics of CNPs could be used through their biomineralization process potential as initial core of calcification for further calcification progression. [19] It is documented that essential components of biomineralization are calcium and phosphate ions. [20] There is evidence that CNPs initiates their mineralization mechanism when calcium concentration and phosphorus concentration reach 2.5 and 1.0 mM, respectively. [21]

The theoretical treatment modality is controlled overinstrumentation to the apical part to create a bleeding area which will allow the formation of blood clot that will serve as a temporary blockage of the canal which prevents escape of the applied nanopaste. This means that a nanopaste of CNPs, Ca2 + and PO4 will be applied after the formation of blood clot inside the canal. At the same time the clot will also serve as a matrix and provide growth factors and nutrition sources for CNPs. The possible drawbacks of nanopaste and the theoretical treatment modality are the ability to control the mineralization degree and CNPs activity.

In conclusion, if this hypothesis supports the behavior of the paste (CNPs, Ca2 + and PO4 ), then a new biomaterial would have been added to the therapeutic choices of endodontic management of nonvital immature apex and or thin wall dentin. However, more in vivo and in vitro investigation of modified nanopaste are needed.

  References Top

1.Rafter M. Apexification: A review. Dent Traumatol 2005;21:1-8.  Back to cited text no. 1
2.Frank AL. Therapy for the divergent pulpless tooth by continued apical formation. J Am Dent Assoc 1966;72:87-93.  Back to cited text no. 2
3.Kerekes K, Heide S, Jacobsen I. Follow-up examination of endodontic treatment in traumatized juvenile incisors. J Endod 1980;6:744-8.  Back to cited text no. 3
4.Cvek M. Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with gutta-percha. A retrospective clinical study. Endod Dent Traumatol 1992;8:45-55.  Back to cited text no. 4
5.Ghose LJ, Baghdady VS, Hikmat YM. Apexification of immature apices of pulpless permanent anterior teeth with calcium hydroxide. J Endod 1987;13:285-90.  Back to cited text no. 5
6.Parirokh M, Torabinejad M. Mineral trioxide aggregate: A comprehensive literature review - Part III: Clinical applications, drawbacks, and mechanism of action. J Endod 2010;36:400-13.  Back to cited text no. 6
7.Morse DR, O'Larnic J, Yesilsoy C. Apexification: Review of the literature. Quintessence Int 1990;21:589-98.  Back to cited text no. 7
8.Rudagi KB, Rudagi B. One-step apexification in immature tooth using grey mineral trioxide aggregate as an apical barrier and autologus platelet rich fibrin membrane as an internal matrix. J Conserv Dent 2012;15:196-9.  Back to cited text no. 8
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9.Coviello J, Brilliant JD. A preliminary clinical study on the use of tricalcium phosphate as an apical barrier. J Endod 1979;5:6-13.  Back to cited text no. 9
10.Schumacher JW, Rutledge RE. An alternative to apexification. J Endod 1993;19:529-31.  Back to cited text no. 10
11.Rossmeisl R, Reader A, Melfi R, Marquard J. A study of freeze-dried (lyophilized) cortical bone used as an apical barrier in adult monkey teeth. J Endod 1982;8:219-26.  Back to cited text no. 11
12.Rossmeisl R, Reader A, Melfi R, Marquard J. A study of freeze-dried (lyophilized) dentin used as an apical barrier in adult monkey teeth. Oral Surg Oral Med Oral Pathol 1982;53:303-10.  Back to cited text no. 12
13.Nevins A, Finkelstein F, Laporta R, Borden BG. Induction of hard tissue into pulpless open-apex teeth using collagen-calcium phosphate gel. J Endod 1978;4:76-81.  Back to cited text no. 13
14.Ham JW, Patterson SS, Mitchell DF. Induced apical closure of immature pulpless teeth in monkeys. Oral Surg Oral Med Oral Pathol 1972;33:438-49.  Back to cited text no. 14
15.Lin Y, Zheng R, He H, Du H, Lin Y. Application of biomimetic mineralization: A prophylactic therapy for cracked teeth? Med Hypotheses 2009;73:493-4.  Back to cited text no. 15
16.Kajander EO. Nanobacteria - propagating calcifying nanoparticles. Lett Appl Microbiol 2006;42:549-52.  Back to cited text no. 16
17.Kutikhin AG, Brusina EB, Yuzhalin AE. The role of calcifying nanoparticles in biology and medicine. Int J Nanomedicine 2012;7:339-50.  Back to cited text no. 17
18.Kajander EO, N Ciftcioglu. Nanobacteria: An alternative mechanism for pathogenic intra- and extracellular calcification and stone formation. Proc Natl Acad Sci U S A 1998;95:8274-9.  Back to cited text no. 18
19.Martel J, Young JD. Purported nanobacteria in human blood as calcium carbonate nanoparticles. Proc Natl Acad Sci U S A 2008;105:5549-54.  Back to cited text no. 19
20.Liu X, Monger HC, Whitford WG. Calcium carbonate in termite galleries biomineralization or upward transport? Biogeochem 2007;82:241-50.  Back to cited text no. 20
21.Juhasz JA, Best SM, Auffret AD, Bonfield W. Biological control of apatite growth in simulated body fluid and human blood serum. J Mater Sci Mater Med 2008;19:1823-9.  Back to cited text no. 21


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