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Apexification and Apexogenesis

The presentation features the pulp reparative and regenerative procedures which can be carried out in immature teeth. It involves development of mature tooth from an immature one by root formation and root fixation as a preparatory phase for root canal treatment.

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Apexification and Apexogenesis

  1. 1. APEXOGENESIS AND APEXIFICATION BY:- PRINCESONI MAUSAMICHAUDHARY B.D.S.FINALYEAR(2015-16) DEPARTMENT OF PEDODONTICS GOVT. COLLEGE OF DENTISTRY, INDORE
  2. 2. APEXOGENESIS • Physiologic process • Formation of apex in young, vital, immature, permanent teeth with appropriate pulp therapy
  3. 3. RATIONALE • Root end Development occurs in a tooth with a normal pulp and minimal inflammation • Pulp of immature teeth has significant reparative potential • Pulp revascularisation and repair occurs more efficiently in tooth with an open apex • Poor long term prognosis of an endodontically treated immature teeth Relatively thin dentine in obturated canals of Immature roots and open apex are prone to fracture
  4. 4. GOALS • Sustaining a viable Hertwig’s sheath to stimulate continues development of root • To attain favourable crown:root ratio • To attain root end closure • To preserve pulp vitality to secure further root development and maturation • Generating dentinal bridge at the site of pulpotomy
  5. 5. INDICATIONS • Fractured tooth with pulpal exposure
  6. 6. INDICATIONS • Carious exposure
  7. 7. INDICATIONS • Traumatic luxation
  8. 8. INVOLVES • Direct pulp capping When pulp chamber is exposed
  9. 9. INVOLVES • Indirect pulp capping When a thin dentin layer is present between pulp and cavity
  10. 10. INVOLVES • Pulpotomy Extirpation of pulp is restricted strictly to the coronal portion of pulp chamber
  11. 11. MATERIALS USED • MTA (Mineral trioxide aggregrate)
  12. 12. MATERIALS USED • Calcium hydroxide
  13. 13. MATERIALS USED • Formocresol (as an alternative to calcium hydroxide)
  14. 14. PROCEDURE • Anesthesia application and rubber dam isolation • The instrument of choice for tissue removal is an abrasive diamond bur at slow speed with adequate water-cooling • Access is gained into the pulp chamber and infected dentin partly removed • Peripheral carious lesion removed with a spoon excavator
  15. 15. PROCEDURE • Anesthesia application and rubber dam isolation • The instrument of choice for tissue removal is an abrasive diamond bur at slow speed with adequate water-cooling • Access is gained into the pulp chamber and infected dentin partly removed • Peripheral carious lesion removed with a spoon excavator
  16. 16. PROCEDURE • Anesthesia application and rubber dam isolation • The instrument of choice for tissue removal is an abrasive diamond bur at slow speed with adequate water-cooling • Access is gained into the pulp chamber and infected dentin partly removed • Peripheral carious lesion removed with a spoon excavator
  17. 17. PROCEDURE • Anesthesia application and rubber dam isolation • The instrument of choice for tissue removal is an abrasive diamond bur at slow speed with adequate water-cooling • Access is gained into the pulp chamber and infected dentin partly removed • Peripheral carious lesion removed with a spoon excavator
  18. 18. • Following coronal pulp amputation, the pulp chamber is rinsed with sterile saline or sterile water to remove all debris • The excess liquid should then be carefully removed via vacuum or sterile cotton pellets. • Air should not be blown on the exposed pulp, as this may cause desiccation and additional tissue damage. PROCEDURE(CONT.)
  19. 19. • Once the pulpal bleeding is controlled, calcium hydroxide paste is placed over the amputation site • Care must be taken to avoid placing the calcium hydroxide on a blood clot and the entire pulp surface must be covered • Once this is accomplished, a restorative base material should be placed over the calcium hydroxide and then allowed to set completely • A coronal restoration should then be placed that will ensure the maximum long-term seal PROCEDURE(CONT.)
  20. 20. • Once the pulpal bleeding is controlled, calcium hydroxide paste is placed over the amputation site • Care must be taken to avoid placing the calcium hydroxide on a blood clot and the entire pulp surface must be covered • Once this is accomplished, a restorative base material should be placed over the calcium hydroxide and then allowed to set completely • A coronal restoration should then be placed that will ensure the maximum long-term seal PROCEDURE(CONT.)
  21. 21. • Once the pulpal bleeding is controlled, calcium hydroxide paste is placed over the amputation site • Care must be taken to avoid placing the calcium hydroxide on a blood clot and the entire pulp surface must be covered • Once this is accomplished, a restorative base material should be placed over the calcium hydroxide and then allowed to set completely • A coronal restoration should then be placed that will ensure the maximum long-term seal PROCEDURE(CONT.)
  22. 22. • Once the pulpal bleeding is controlled, calcium hydroxide paste is placed over the amputation site • Care must be taken to avoid placing the calcium hydroxide on a blood clot and the entire pulp surface must be covered • Once this is accomplished, a restorative base material should be placed over the calcium hydroxide and then allowed to set completely • A coronal restoration should then be placed that will ensure the maximum long-term seal PROCEDURE(CONT.)
  23. 23. PROCEDURE(CONT.) • The patient should be re-evaluated every three months for the first year, and then every 6 months for 2 to 4 years to determine if successful root formation is taking place and that there are no signs of pulp necrosis, root resorption or periradicular pathosis
  24. 24. Open apex Root formation complete
  25. 25. CONTRAINDICATIONS • Severe crown-root fracture which requires intra-radicular retention for restoration
  26. 26. CONTRAINDICATIONS • Tooth with unfavourable horizontal root fracture i.e. close to gingival margin
  27. 27. CONTRAINDICATIONS • Necrotic or non vital pulp
  28. 28. CONTRAINDICATIONS • Unrestorable carious tooth
  29. 29. APEXIFICATION The process of inducing a calcific barrier across an open apex of an immature, pulpless tooth Definition:-
  30. 30. OBJECTIVE To induce root end closure to form a complete calcific barrier at the apex with no apparent pathosis
  31. 31. INDICATIONS • Young immature,permanent non-vital teeth • Open apex • Blunderbuss canals • Thin and fragile canal walls • Absolute dryness of canal difficult to achieve Why apexification preferred over RCT
  32. 32. MATERIALS USED • MTA (mineral trioxide aggregrate) • Collagen calcium phosphate gel • Calcium hydroxide • Osteogenic protein I and II
  33. 33. PROCEDURE • Anaesthetize the tooth and isolate with rubber dam • Gain straight line access to canal orifice • Extirpate the pulp tissue remnants from the canal and irrigate it with sodium hypochlorite
  34. 34. • Establish the working length of canal 2mm short of the radiographic apex of tooth • Dry the canal with paper points • Placement of appropriate material for apexification • Material condensed with finger pluggers • Effective temporary seal between visits is critical. Zinc oxide Eugenol cement or resin modified glass-inomer cement is used • Second visit at 3 months for monitoring the tooth, if symptomatic; canal is cleaned and again filled with calcium hydroxide PROCEDURE(CONT.)
  35. 35. • Establish the working length of canal 2mm short of the radiographic apex of tooth • Dry the canal with paper points • Placement of appropriate material for apexification • Material condensed with finger pluggers • Effective temporary seal between visits is critical. Zinc oxide Eugenol cement or resin modified glass-inomer cement is used • Second visit at 3 months for monitoring the tooth, if symptomatic; canal is cleaned and again filled with calcium hydroxide PROCEDURE(CONT.)
  36. 36. • Establish the working length of canal 2mm short of the radiographic apex of tooth • Dry the canal with paper points • Placement of appropriate material for apexification • Material condensed with finger pluggers • Effective temporary seal between visits is critical. Zinc oxide Eugenol cement or resin modified glass-inomer cement is used • Second visit at 3 months for monitoring the tooth, if symptomatic; canal is cleaned and again filled with calcium hydroxide PROCEDURE(CONT.)
  37. 37. • Establish the working length of canal 2mm short of the radiographic apex of tooth • Dry the canal with paper points • Placement of appropriate material for apexification • Material condensed with finger pluggers • Effective temporary seal between visits is critical. Zinc oxide Eugenol cement or resin modified glass-inomer cement is used • Second visit at 3 months for monitoring the tooth, if symptomatic; canal is cleaned and again filled with calcium hydroxide PROCEDURE(CONT.)
  38. 38. • Establish the working length of canal 2mm short of the radiographic apex of tooth • Dry the canal with paper points • Placement of appropriate material for apexification • Material condensed with finger pluggers • Effective temporary seal between visits is critical. Zinc oxide Eugenol cement or resin modified glass-inomer cement is used • Second visit at 3 months for monitoring the tooth, if symptomatic; canal is cleaned and again filled with calcium hydroxide PROCEDURE(CONT.)
  39. 39. PROCEDURE(CONT.) • Patient is examined for radiographic evidence of calcific barrier at or near root apex • Confirm the progress of apexification by passing an instrument through the apex after removal of calcium hydroxide • Repeat the process if no satisfactory result found • If apical barrier present, obturation is done
  40. 40. PROCEDURE(CONT.) • Patient is examined for radiographic evidence of calcific barrier at or near root apex • Confirm the progress of apexification by passing an instrument through the apex after removal of calcium hydroxide • Repeat the process if no satisfactory result found • If apical barrier present, obturation is done
  41. 41. PROCEDURE(CONT.) • Patient is examined for radiographic evidence of calcific barrier at or near root apex • Confirm the progress of apexification by passing an instrument through the apex after removal of calcium hydroxide • Repeat the process if no satisfactory result found • If apical barrier present, obturation is done
  42. 42. open apex fixation of root end
  43. 43. CONTRAINDICATIONS • Very short roots
  44. 44. CONTRAINDICATIONS • Vital pulp
  45. 45. CONTRAINDICATIONS • Compromised periodontium

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