Apexogenesis involves pulp therapy procedures for immature permanent teeth with open apices to encourage continued root development. It aims to maintain pulp vitality and stimulate further root development and maturation. The procedures include indirect/direct pulp capping and pulpotomy, using materials like MTA or calcium hydroxide to cover the exposed pulp and encourage dentin bridge formation. Success is monitored by periodic radiographs to check for ongoing root formation and absence of pathology over several years.

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