Are Bioceramics the Dernier Cri in the Management of Stage 4 Developed Root? A Finite Element Analysis.

Aim: To compare the stress distribution of four modalities of reinforcing the radicular space of a pulpless central incisor exhibiting stage 4 root development.
Materials and Methods: The model of a pulpless immature central incisor with a stage 4 of root development supporting periodontium was generated based on the properties. The longitudinal growth of the root was completed. Four such models were developed. Then, the radicular space was rehabilitated as follows: Model 1: Ceramicrete; Model 2: Biomimetic Mineralization; Model 3: Biodentine; Model 4: Bioaggregate. They were subjected to three different loading conditions. One was to mimic the mastication by applying a load of 70 N applied at 45° angle. Second loading condition was a vertical load of 100 N to mimic bruxism. The third loading condition was to mirror the impact of a frontal trauma. A load of 100 N was applied labially.
Results: It was observed that during mastication, Model 2 has exhibited the lowest concentration of von Mises stresses, followed by Model 3 and then Model 4 followed by Model 1; this could be because the modulus of elasticity of Model 2 is comparable to that of Dentin. During bruxism and horizontal impact, the maximal stress concentration was found in Model 4, Model 3, Model 2, followed by Model 1.
Conclusion: The closer the elasticity of modulus of the primary endodontic replacement monoblock was to that of dentin, the lower were the stresses generated. However, as the increase in stress values was minimal between groups, these obturating materials can be viable reinforcement materials for the rehabilitation of cases of stage 4 developing root. Biomimetic mineralization strategies can be a viable treatment option for managing cases of the open apex.
Clinical Relevance: Biomimetic mineralization strategies and bioceramics can be used for obturation of root canals with open apex, instead of utilizing these bioceramics as apical plugs.