APEXOGENESIS AND

APEXIFICATION

Dr.Sharaz Ahmed
Operative Dentistry
APEXOGENESIS
 APEXOGENESIS
 A vital pulp therapy procedure performed to
encourage physiological development and
formation of the root end.

OR

 The stimulation to make the end of a tooth

root close in a traumatized tooth with healthy
pulp.
 The goal of apexogenesis is the
preservation of vital pulp tissue so that
continued root development with apical
closure may occur.
 Carious exposure or trauma to immature

permanent teeth in which root canal therapy

cant be done.
 PROCEDURE
 Apexogenesis is a procedure that addresses the
shortcomings involved with capping the inflamed
dental pulp of an incompletely developed tooth.
 Most or all of the coronal pulp is removed, often to
the level of the canal orifices, and calcium hydroxide
paste is placed.
 An aseptic technique combining the use of the rubber
dam and sterile burs is strongly recommended.
 PROCEDURE(con’t)

 Abrasive diamond bur at high speed with

adequate water-cooling.
 Following coronal pulp amputation, the pulp
chamber is rinsed with sterile saline. The
excess liquid should then be carefully
removed via vacuum or sterile cotton pellets.
 Once the pulpal bleeding is controlled,

calcium hydroxide paste is placed over the

amputation site.
 PROCEDURE(con’t)
 A restorative base material should be placed over the
calcium hydroxide and then allowed to set
completely.
 A coronal restoration should then be placed that will
ensure the maximum long-term seal.
 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 place.
 Complication
 Pulp necrosis
 Root resorption
 Periradicular pathosis
 APEXIFICATION
 Apexification is a method of inducing a
calcified barrier at the apex of a nonvital
tooth with incomplete root formation.
 If apexification is successful, a hard
substance histologically described variously
as bone, dentin, cementum, or osteodentin
will develop against which obturation of root
canal can be done.
 Materials used for apexification are
◦ Calcium hydroxide
◦ Mineralo trioxide aggregates (MTA)
 Multiple-step Apexification

1. The tooth is isolated with rubber dam, and access

is gained into the pulp chamber.
2. Using large reamers & files, remove the debris from
the coronal half of the pulp & establish the file
length radiographically.
3. Clean the canal, irrigate it & then dry it with a
paper point.
4. Calcium hydroxide powder mix with salin to form
paste or commercially availabe paste fill the canals
upto working length.excess calcium hydroxide is
removed from the pulp chamber and then sealed
with intermediate restorative material.
5. Recall after 3 months and take a radiograph to
 PROCEDURE(CON’T)
6.On a 6 month recall, you should see radiographic
evidence of an apical closure.
7.When you have accomplished apical closure, the root
canal filling is completed.
 
 Single-step Apexification
 MTA is now the material of choice for
induction of an apical barier because of
better ability to seal and good
biocompatibility
 Apexification can be possible in single visit

with MTA
 procedure
 Anesthesia and isolatio, appropriate access cavity
 Removal of necrotic pulp; barbed broach or H files
 Workinglength determination 2mm short of apex then
cleaning, shaping and copious irrigation and then dry the
canals.
 MTA is mixed according to manufacturer instructions then
introduced into the canal with MTA carrier checked with
radiographs.
 Pluggers are used to condense MTA into an apical 3-4 mm
barrier.
 A moist cotton pellet is place and left to ensure setting
 Recall after 48 hrs for obturating the remaining part of the
root canal and placement of permanent restoration.
Apexification pre-treatment  showing
open apex.