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Apexification.ppt
- 1. Pulpotomy
- 2. Apexogensis
- 3. Apexification Management of non-vital immature permanent teeth
- 5. Apexification • Induction of formation of a calcific barrier across an open apex • Involve removal of necrotic pulp followed by debridement of the canal and placement of medicaments to induce the formation of calcific barrier at root tip.
- 6. Calcific hard tissue barrier • A mineralized cementum like hard tissue formed at the apex of tooth. • If the some remnants of pulp remain at apical part than more dentine like tissue is formed
- 8. Indications • Immature permanent teeth with necrosed or irreversibly damaged pulp. • Failure of root formation following vital pulp therapy (pulpotomy)
- 11. Rationale • For performing the successful root canal treatment the apical barrier/stop is needed to prevent the ingression of material used in RCT in peri-radicular area which can harm the peri-radicular tissues.
- 16. Technique • Access cavity (opening of pulp chamber) • Canal debridement • Root length determination • Canal medicaments • Intermediate restoration • Monitoring the apical barrier formation • Root canal filling (obturation) • Definitive restoration
- 19. • Calcium hydroxide produces a multilayered sterile necrosis permitting subjacent mineralization • Antimicrobial • High pH favors hard tissue formation • Stimulating growth factors
- 20. Follow-up • Recall at 6-months interval for 2-4 years • Clinical and radiographic examination on each visit • Checking clinically of apical barrier formation with paper point.
- 24. 12 month calcium hydroxide therapy
- 26. Causes of failure • Bacterial microleakage through defected coronal restoration • Incomplete root debridement • Fracture of root • Large apical pathology
- 27. Alternative to apexification • Formation of an artificial barrier with MTA • Performing the conventional RCT in case of almost complete apex • Endodontic surgery • Regenerative endodontic (canal revascularization)
- 28. Artificial Apical Barrier with MTA
- 32. Artificial apical barrier with MTA
- 38. Difference in apexogensis and apexification Apexogensis • Pulp is vital/healthy • only coronal pulp is removed and radicular pulp remain intact • A hard setting calcium hydroxide applied over pulp tissue • A normal physiological root development takes place completing the root length • complete RCT not necessary Apexification • pulp is necrosed • entire necrotic pulp tissues are removed (coronal & radicular) • A non-setting calcium hydroxide used to fill the entire canal • A calcific barrier formed with arrested root length • complete RCT necessary