Continued Root Development Following iRoot BP Plus Apical Barrier Placement 3-4mm Short of Apex in Immature Permanent Teeth: A Retrospective Case Series Study

Continued Root Development Following iRoot BP Plus Apical Barrier Placement 3-4mm Short of Apex in Immature Permanent Teeth: A Retrospective Case Series Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Continued Root Development Following iRoot BP Plus Apical Barrier Placement 3-4mm Short of Apex in Immature Permanent Teeth: A Retrospective Case Series Study Wenqi Zheng, Yibing Wang, Xiangzi Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8631088/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The apical barrier technique using bioceramic materials is established for treating immature permanent teeth with pulp necrosis. This study reports an unexpected observation: continued root development when iRoot BP Plus was inadvertently placed 3-4mm short of the radiographic apex. This retrospective case series analyzed four immature permanent teeth where iRoot BP Plus apical barrier was placed 3-4mm short of the apex due to technical factors, between October 2020 and December 2022, with follow-up periods of 22–48 months (mean: 32.5 months). All patients were male, aged 8–12 years. Affected teeth included mandibular second premolars and maxillary central incisor. Clinical diagnoses included acute pulpitis (n = 1) and apical periodontitis (n = 3). Treatment involved chemomechanical debridement, calcium hydroxide intracanal medication, followed by iRoot BP Plus placement which was positioned 3-4mm from the radiographic apex. Despite suboptimal material placement, all cases (100%) achieved periapical healing. Remarkably, three cases (75%) demonstrated continued root development with progressive apical closure beyond the bioceramic material, while one case showed periapical healing without significant root development. These unexpected findings suggest that placing iRoot BP Plus 3-4mm short of the apex may preserve the apical papilla and its stem cells (SCAPs), allowing continued physiological root development. This observation warrants prospective investigation as a potential intentional treatment modification. Apical barrier technique iRoot BP Plus Bioceramic Immature permanent teeth Continued root development Stem cells from the apical papilla Short placement Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8631088","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":596640467,"identity":"c0a15c31-d166-4271-8211-e2f5a61e9a44","order_by":0,"name":"Wenqi Zheng","email":"","orcid":"","institution":"Affiliated Hospital of Yanbian University(Yanbian HospitaD)","correspondingAuthor":false,"prefix":"","firstName":"Wenqi","middleName":"","lastName":"Zheng","suffix":""},{"id":596640468,"identity":"0d6e028d-1107-41c3-b2e0-15b515e8b2f1","order_by":1,"name":"Yibing Wang","email":"","orcid":"","institution":"Affiliated Hospital of Yanbian University(Yanbian HospitaD)","correspondingAuthor":false,"prefix":"","firstName":"Yibing","middleName":"","lastName":"Wang","suffix":""},{"id":596640469,"identity":"101963ee-2265-4a1c-bc80-a0cf70eed9b6","order_by":2,"name":"Xiangzi Zhang","email":"data:image/png;base64,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","orcid":"","institution":"Affiliated Hospital of Yanbian University(Yanbian HospitaD)","correspondingAuthor":true,"prefix":"","firstName":"Xiangzi","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2026-01-18 12:08:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8631088/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8631088/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109183959,"identity":"696fe67b-7c32-458e-9023-cefd8586c699","added_by":"auto","created_at":"2026-05-13 10:44:26","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":595368,"visible":true,"origin":"","legend":"","description":"","filename":"iRootBPPlusBMCREVISED3.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8631088/v1_covered_9a9a67d9-9422-42e0-8efc-b0acd64d8899.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Continued Root Development Following iRoot BP Plus Apical Barrier Placement 3-4mm Short of Apex in Immature Permanent Teeth: A Retrospective Case Series Study","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Apical barrier technique, iRoot BP Plus, Bioceramic, Immature permanent teeth, Continued root development, Stem cells from the apical papilla, Short placement","lastPublishedDoi":"10.21203/rs.3.rs-8631088/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8631088/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe apical barrier technique using bioceramic materials is established for treating immature permanent teeth with pulp necrosis. This study reports an unexpected observation: continued root development when iRoot BP Plus was inadvertently placed 3-4mm short of the radiographic apex. This retrospective case series analyzed four immature permanent teeth where iRoot BP Plus apical barrier was placed 3-4mm short of the apex due to technical factors, between October 2020 and December 2022, with follow-up periods of 22\u0026ndash;48 months (mean: 32.5 months). All patients were male, aged 8\u0026ndash;12 years. Affected teeth included mandibular second premolars and maxillary central incisor. Clinical diagnoses included acute pulpitis (n\u0026thinsp;=\u0026thinsp;1) and apical periodontitis (n\u0026thinsp;=\u0026thinsp;3). Treatment involved chemomechanical debridement, calcium hydroxide intracanal medication, followed by iRoot BP Plus placement which was positioned 3-4mm from the radiographic apex. Despite suboptimal material placement, all cases (100%) achieved periapical healing. Remarkably, three cases (75%) demonstrated continued root development with progressive apical closure beyond the bioceramic material, while one case showed periapical healing without significant root development. These unexpected findings suggest that placing iRoot BP Plus 3-4mm short of the apex may preserve the apical papilla and its stem cells (SCAPs), allowing continued physiological root development. 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