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The restorative management of deep carious lesions and the preservation of pulp vitality of immature teeth present real challenges for dental practitioners. New tricalcium silicate cements are of interest in the treatment of such cases. This case describes the immediate management and the follow-up of an extensive carious lesion on an immature second right mandibular premolar. Following anesthesia and rubber dam isolation, the carious lesion was removed and a partial pulpotomy was performed. After obtaining hemostasis, the exposed pulp was covered with a tricalcium silicate cement (Biodentine, Septodont) and a glass ionomer cement (Fuji IX extra, GC Corp.) restoration was placed over the tricalcium silicate cement. A review appointment was arranged after seven days, where the tooth was asymptomatic with the patient reporting no pain during the intervening period. At both 3 and 6 mon follow up, it was noted that the tooth was vital, with normal responses to thermal tests. Radiographic examination of the tooth indicated dentin-bridge formation in the pulp chamber and the continuous root formation. This case report demonstrates a fast tissue response both at the pulpal and root dentin level. The use of tricalcium silicate cement should be considered as a conservative intervention in the treatment of symptomatic immature teeth.

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The purpose of this study was to determine the effect of post types and sizes on fracture resistance in immature tooth model with various restorative techniques. Bovine incisors were sectioned 8 mm above and 12 mm below the cementoenamel junction to simulate immature tooth model. To compare various post-and-core restorations, canals were restored with gutta-percha and resin core, or reinforced dentin wall with dual-cured resin composite, followed by placement of D.T. LIGHT-POST, ParaPost XT, and various sizes of EverStick Post individually. All of specimens were stored in the distilled water for 72 hours and underwent 6,000 thermal cycles. After simulation of periodontal ligament structure with polyether impression material, compressive load was applied at 45 degrees to the long axis of the specimen until fracture was occurred.

Experimental groups reinforced with post and composite resin were shown significantly higher fracture strength than gutta-percha group without post placement (p < 0.05). Most specimens fractured limited to cervical third of roots. Post types did not influence on fracture resistance and fracture level significantly when cement space was filled with dual-cured resin composite. In addition, no statistically significant differences were seen between customized and standardized glass fiber posts, which cement spaces were filled with resin cement or composite resin individually. Therefore, root reinforcement procedures as above in immature teeth improved fracture resistance regardless of post types and sizes.

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