Apexogenesis
The clinical procedure
It is treatment aimed to preserve pulp tissue at the apex of root canal so as the root formation can be completed.
Deep resection of the pulp tissue is usually undertaken in single-rooted anterior teeth, with a small endodontic spoon excavator. Bleeding is usually controlled with saline-soaked cotton Pellets.
The pulp wound is then covered with a dressing material before securely restoring the crown.
Radiographic and clinical follow-up is mandatory, Also, if apexogenesis is successful and root-end formation is complete, the tooth could be re-entered if desired for conventional root canal treatment.
Apexification
It is the process where a permanent tooth that has lost the capacity for further root development as it is nonvital and immature, is induced to form a calcified barrier at the root terminus without inducing further root development.
Root canal filling or restorative material can be compacted with length control against this material.
Unlike the pulp capping, pulpotomy, and apexogenesis procedures described previously, apexification will at best result in the closure of the root end and cannot be expected to cause further root development in terms of length or wall thickness.
It is thus considered as a treatment of the last choice in immature teeth that have lost pulp vitality.
For now, root-end closure techniques, both those involving the generation of a biologic calcific barrier and those involving artificial root-end closure with a material such as MTA, still have a place in practice and will be considered.
To determine long term success
Comparison of root formation with contralateral teeth should always be considered.
Apexification Technique
- The tooth is opened.
- The canal is cleaned and disinfected after applying a rubber dam.
- Canal length is established by radiographs.
- Irrigation with antimicrobial solvent is important for the debridement.
- After complete débridement, the canal is dried and medicated with Ca(OH)2 paste.
- The tooth is then sealed coronally, and the patient is recalled at 3-monthly intervals for the follow-up.
