apexogenesis

1. APEXOGENESIS
Rabina panta
1701938

2. INTRODUCTION
• Physiologic process
• Formation of apex in young, vital, immature permanent teeth
with appropriate pulp therapy

3. • Rootend Developmentoccurs in a tooth with a normal pulpand minimal
inflammation
• Pulp of immature teeth has significant reparativepotential
• Pulprevascularisation and repairoccurs moreefficiently in tooth
with an openapex
• Poor long term prognosisof an endodontically treated
immature teeth
Relativelythin dentine in obturated canalsof Immature rootsand open
apexareprone to fracture
RATIONALE

4. • Sustaining aviable Hertwig’ssheath tostimulate continues
development of root
• Toattain favourable crown:rootratio
• Toattain root endclosure
• Topreserve pulpvitality tosecure furtherroot development
and maturation
• Generating dentinal bridge at the site ofpulpotomy
GOALS

5. • Fractured tooth with pulpal exposure
INDICATIONS
• Carious exposure
• Traumatic luxation

6. • Severe crown-root fracture
which requires intra-radicular
retention forrestoration
CONTRAINDICATIONS
• Tooth with unfavourable
horizontal root fracture i.e.
close to gingival margin

7. • Necrotic or non vitalpulp
• Unrestorable carioustooth

8. • Direct pulp capping
When pulp chamber
is exposed
INVOLVES
• Indirect pulp capping When a thin dentin layer is present
between pulp and cavity
• Pulpotomy Extirpation of pulp is restricted
strictly to the coronal portion of
pulp chamber

9. • MTA (Mineral trioxide aggregrate)
MATERIALS USED
• Calcium hydroxide
• Formocresol (as an alternative to calcium hydroxide)

10. • Anesthesia application and rubberdam
isolation
• The instrument of choice for tissueremoval
is an abrasive diamond bur at slow speed
with adequatewater-cooling
PROCEDURE

11. • Access is gained into the pulpchamberand
infected dentin partlyremoved
• Peripheral carious lesion removed witha
spoon excavator

12. • 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 viavacuumorsterile cotton pellets.
• Air should not be blown on the exposed pulp,
as this may cause desiccation and additional
tissuedamage.

13. • Once the pulpal bleeding is controlled, calciumhydroxide
paste is placed overtheamputation site
• Care must be taken to avoid placing the calcium
hydroxideon a blood clotand theentire pulpsurface
must becovered
• Once this is accomplished, a restorative base material
should be placed over the calcium hydroxide and then
allowed to setcompletely

14. • A coronal restoration should then be placed thatwill
ensure the maximum long-termseal
• 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 placeand that thereare no signs of pulp necrosis, rootresorption or
periradicularpathosis

15. Open apex Root formation
complete