R7d7rd7rd7rdt8ditcitd

1. APEXIFICATION
PREPARED BY : HAWZHEN FAKHER

2. CONTENTS
definition
objectives
indication
Procedure
contraindication

4. WHAT IS APEXIFICATION
✿ Is a process for induce development of root and closure of an open apex .
Why we do Apexification instead of root canal treatment????
- there is open apex
- thin dentin wall
- Blunderbuss canal
- dryness is difficult

5. INDICATION & CONTRAINDICATION
✿ Use for
1. Immature young necrotic permanent tooth
2. Incomplete root formation or open apex
✿ Not use for
1. Short root
2. Vital pulp
3. Compromised periodontium

6. The procedure has been demonstrated to be successful in repeated clinical trials
stimulating the process of root end development, which was interrupted by pulpal
necrosis, so that it continues to the point of apical closure.When the calcific “plug” is
observed in the apical portion ,routine endodontic procedures may be completed.

7. PROCEDURE
1. Anesthesia & Isolation & rubber dam
2. Access opening
3. Extirpate the canal and remnants by using reamer then do irrigation by Sodium
hydrochloride
4. Establish Working length avoid epithilial diaphragm injury

8. 5. After the remnants of the pulp have been removed by using barbed broaches and files
6. canal is flooded with hydrogen peroxide to aid in the removal of debris.
7. irrigation with sodium hypochlorite and saline & dry with paper point
8. A thick paste of calcium hydroxide transferred to the canal. excess material should not
be forced beyond the apex.
9. And put sealing material like zinc oxide eugenol

9. 9. Recall after 3 month if asymptomatic the canal is cleaned and again fill with
ca – hydroxide
10. Patient is again recalled and examined for radiographic evidence of root
formation 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 Treatment time from 6 weeks to 18 months

10. USING MINERAL TRIOXIDE (MTA)
1. After drying put ca- hydroxide for 1 week then remove it & remove all the remaining
tissue
2. Fill apical part 4 to 5 mm with MTA then put moisted pledget cotton wool sealed with
thermoplastisized gutta purca & zinc oxide eugenol
3. Take radiograph to evaluate the apical seal

11. 4. The following day remove gutta purca and the cotton fill it with definitive gutta purca
coronal to MTA and temporary restoration
5. After 6 month to 1 year follow up check clinically and radiographically

12. SUCCESSFUL TREATMENT RESULTS
✿ continued closure of the canal and apex to a normal appearance,
✿ a dome shaped apical closure with the canal retaining blunderbuss appearance
✿ no apparent radiographic change but a positive stop in the apical area
✿ and a positive stop and radiographic evidence of a barrier coronal to the anatomic apex of the
tooth.

13. FINAL OBTURATION DONE ONLY IF
✿ Absence of any symptom
✿ Absence of fistula & sinus
✿ Presence of firm stopper clinically and radiographically

14. THANK YOU