Trishna PokhrelToday in this article we will explore about apexogenesis and apexification and various aspects to it.
APEXOGENESIS:
Apexogenesis is defined as the treatment of the vital pulp by capping or pulpotomy in order to permit continued growth of the root and closure of the open apex.
Rationale:
Maintenance of integrity of the radicular pulp tissue to allow for continued root growth.
Indications:
- Indicated for traumatized or pulpally involved vital permanent tooth when root apex is incompletely formed.
- No history of spontaneous pain.
- No sensitivity on percussion.
- No hemorrhage.
- Normal radiographic appearance.
Contraindications:
- Evidence that radicular pulp has undergone degenerative change.
- Purulent drainage.
- History of prolonged pain.
- Necrotic debris in canal.
- Periapical raiolucency.
Procedure:
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Anesthetize and isolate the tooth using rubberdam. ↓ Remove all the carious structure and open the pulp chamber. ↓ Removes the coronal pulp tissue, care should be taken to prevent damage to radicular pulp. ↓ Clean all the residual debris using saline and control hemorrhage using moist cotton pellet at the exposure site. ↓ Placed the Ca(OH)2 paste over the pulp stumps, followed by temporary restoration. ↓ Follow-up radiographs are taken periodically to check root development. ↓ Once root development is achieved, the conventional root canal treatement can be done. |
Apexification:
It is the method of inducing development of the root apex of an immature pulpless tooth by formation of oseocementum / bone like tissue.
Indication:
- For non-vital permanent teeth with open apex. (Blunderbuss canals)
Objective:
- To induce closure of open apical third of root canal or formation of an apical calcific barrier where obturation can be achieved.
Materials Used:
- Zinc oxide eugenol.
- Metacresylacetate - Camphorated parachlorophenol.
- Tricalcium phosphate + tricalcium phosphate.
- Resorbable tricalcium phosphate.
- Collagen - Calcium phosphate gel
- Calcium hydroxide
- Mineral trioxide aggregate.
Procedure:
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Most often tooth is non-vital and pulp is necrosed. So no need of local anesthesia, rubber dam can be given for isolation. ↓ Make an access opening deroot coronal pulp. ↓ Remove debris and necrotic pulp tissue from the canal using broaches. ↓ Irrigation is performed with saline ↓ Working length is determined. ↓ Circumferential enlargement done by the file and irrigation is done by the file and irrigation is done with saline to remove infected dentin from the canal walls. ↓ Canal dried with paper points. ↓ Injectable calcium hydroxide is injected inside the canal. ↓ Entrance filling done with a cement with good sealing ability (GIC) ↓ Radiograph taken to check intracanal calcium hydroxide. ↓ Periodic recall is scheduled( 2 weeks, 3 months and 6 months) |
IOPA shows 2 situations:
- Either apex is not closed, then recall patient again after 6 months.
OR
- Apex is closed, then take out calcium hydroxide, irrigate by normal saline, Obturate canals with gutta-percha points and give final restoration.