Python Notes for mca i year students osmania university.docx
Apexification
1. APEXIFICATION
Method to induce a calcific barrier across an
open apex of an immature pulpless tooth.
Objective:
To induce either closure of open apical
third of root canal or formation of apical
calcific barrier against obturation
2. MATERIALS USED FOR APEXIFICATION
Collagen calcium phosphate gel
Tricalcium phosphate
Calcium hydroxide
MTA
3. APEXIFICATION WITH CALCIUM
HYDROXIDE
Preoperative radiograph taken to find
apparent length of tooth
Tooth anesthetized, rubber dam
isolation
Access opening done
Irrigation done with sterile
water/saline
Working length determination is done
using a radiograph
4. APEXIFICATION WITH CALCIUM
HYDROXIDE
Working length 2 mm short of tooth length
to prevent injury to apical tissue and thin
walls in apical third
After cleaning and shaping the root canal
is dried using blunt absorbent paper points
Calcium hydroxide mixed with sterile water
to thick consistency on sterile glass slab
By means of thick blunt finger plugger the
paste is forced into root canal
5. APEXIFICATION WITH CALCIUM
HYDROXIDE
dry pellet is forced into root canal with
blunt finger plugger until entire root
canal is filled with Ca(OH)2
Seal access cavity with intermediate
restorative material
Recall patient in 3 months to determine
whether a calcific barrier has developed
at or near root apex (radiographically)
6. APEXIFICATION WITH CALCIUM
HYDROXIDE
If not a fresh supply of calcium hydroxide
is applied into root canal and patient recall
every 3 months until one sees
radiographic evidence of apical barrier
Old CH is removed using large files and
copious irrigation with saline
Root canal obturated after completion of
apexification
7. APEXIFICATION WITH MTA
After proper isolation and anesthesia
access cavity is prepared to allow
debridement of necrotic pulp tissue
Working length kept 2 mm short of working
length and gentle circular filing is done
Irrigation with sodium hypochlorite
Paper points to dry the canals
8. APEXIFICATION WITH MTA
MTA is mixed according to manufactures
instruction and introduced into canal using
MTA carrier
MTA is condensed into apical 3-4mm
Moist cotton pellet is placed on top of MTA
to ensure setting and temporary
restoration is placed
Patient recalled after 48hours for
obturation and permanent restoration.
11. MTA
Mohammad Torabinejad (1993)
Composition:
• Tricalcium silicate
• Dicalcium silicate
• Tricalcium aluminate
• Tetracalcium aluminoferrite
• Bismuth oxides
• Traces of free crystalline silica
• Traces of calcium oxide magnesium oxide potassium
and sodium sulfate compounds
12. MTA
Available in two forms
Gray and white MTA
Difference between two is lack of iron in
tetracalcium aluminoferrite in white MTA.
13. MTA
Advantage:
Biocompatible
Acceptable biological performance
Superior structural integrity of dentinal bridging
Resist future bacterial penetration
Antimicrobial property
Hydrophillic
Alkaline ph – induce dentinogenesis
Less microleakage
14. MTA
Application:
Root end fillings
Perforation repair
Pulp capping
Pulpotomy
Apexification
15. MTA
Setting reaction:
On hydration
MTA result in formation
of crystalline gel of
hydrated components of
MTA with trace formation
of CH.
It hardens in 3hours time
17. INDIRECT PULP CAPPING
Procedure wherein the deepest layer of
remaining affected carious dentin is covered with
layer of biocompatible material in order to
prevent pulpal exposure and further trauma to
pulp
18. INDIRECT PULP CAPPING
Objective:
To preserve vitality of pulp by completing removing
carious infected dentin
19. INDIRECT PULP CAPPING
Diagnostic data:
a) History: tolerable, dull pain with mild discomfort
associated with eating, thermal stimulation.
b) Clinical examination:
a) large carious lesion without any frank pulpal exposure
b) Positive response to electric test, thermal test, test cavity
c) Normal to percussion
20. INDIRECT PULP CAPPING
Diagnostic data:
c) Radiographic examination:
large carious lesion
Involves 3/4th thickness of dentin
Lamina dura is intact
21. INDIRECT PULP CAPPING
Clinical Procedure:
1st appointment:
Local anesthesia and isolate with rubber
dam
Cavity outlined using high speed air turbine
handpiece
Slow speed handpiece with large #6/#8
round bur majority of softened infected
dentin is removed till firm resilient dentin is
felt
22. INDIRECT PULP CAPPING
Peripheral carious dentin can
be removed with spoon
shaped excavators
Site is covered with hard set
calcium hydroxide preparation
and sealed with overlying base
of ZOE
Sealed cavity is not disturbed
for 6-8weeks
23. INDIRECT PULP CAPPING
(2nd appointment)
Between 2 appointment history
must be negative and IRM should
be intact
Bitewing radiograph of treated
tooth is obtained
LA and rubber dam isolation
Careful removal of temporary
restoration and CH
24. INDIRECT PULP CAPPING
(2nd appointment)
Previously remaining soft deep
brownish red color affected dentin
changes to lighter brownish gray
color harder in nature
Cavity washed and dried very gentle
Entire floor is cover with hard set CH
When clinical and radiographic
finding is negative the final
restoration is placed
25. INDIRECT PULP CAPPING
Reason for 2 steps:
a) Avoids unintentional pulpal exposure which might
deteriorate pulpal prognosis.
b) Gain information about changes in caries activity
26. INDIRECT PULP CAPPING
Treatment outcome:
a) Remaining Dentin Thickness:
a) 2.0-0.5 mm- good prognosis as secretion of
reactionary dentin is more
b) 0.5-0.25 mm- prognosis decreases as reduce
number of odontoblastic activity.
b) Choice of IPC agents:
1. Calcium hydroxide
2. MTA
3. Biodentin