Apexification and its Indication
- Apexification is indicated for immature permanent teeth with non-vital pulp and incomplete root formation.
- The objective of apexification is to induce mineralised tissue formation and achieve root end closure.
- Apical closure can take various forms and may or may not be accompanied by continued root development.
Materials Used in Apexification
- Mineral trioxide aggregate (MTA), bioceramics, and biodentine are commonly used materials in apexification.
- MTA is composed of tricalcium silicate, aluminate, and oxide, and has superior properties in terms of sealing ability and biocompatibility.
- Bioceramics offer similar or better properties than MTA, including biocompatibility, antimicrobial activity, and dentin biomineralization enhancement.
- Biodentine is a tricalcium silicate-based material that acts as a bioactive dentin substitute and promotes the formation of tertiary dentin.
Mineral Trioxide Aggregate (MTA)
- MTA is primarily composed of tricalcium silicate, aluminate, and oxide.
- It sets in the presence of moisture and has been used as a root-end filling material.
- MTA shows good healing with minimal inflammation and has properties such as sealing ability, antimicrobial activity, and dentin biomineralization enhancement.
- Potential drawbacks of MTA include the release of hazardous substances, potential discoloration, and handling inconvenience.
Bioceramics
- Bioceramics are composed of zirconium oxide, calcium silicates, calcium phosphate, and other agents.
- They offer properties similar to or better than MTA, including biocompatibility, sealing ability, antimicrobial activity, and dentin biomineralization enhancement.
- Bioceramics have better bonding ability in high-humidity environments and superior color stability compared to MTA.
Biodentine
- Biodentine is a tricalcium silicate-based material used as a dentin substitute and cement.
- It allows good marginal sealing without the need for dentin surface conditioning.
- Biodentine forms tag-like structures that penetrate dentin tubules and can be bonded with different adhesives.
- It is clinically indicated for various procedures, including permanent dentin substitute, direct and indirect pulp capping, and apexification.
Apexification is a method of dental treatment to induce a calcific barrier in a root with incomplete formation or open apex of a tooth with necrotic pulp. Pulpal involvement usually occurs as a consequence of trauma or caries involvement of young or immature permanent teeth. As a sequelae of untreated pulp involvement, loss of pulp vitality or necrotic pulp took place for the involved teeth.
The main purpose of apexification includes restoring the original physiologic structures and functions of the pulp-dentin complex of the teeth. In addition to that, the elimination of the pulp tissue within a tooth, the disinfection of root canal system by using irrigants such as sodium hypochlorite and ethylenediaminetetraacetic acid are the necessary steps to ensure that the purpose of apexification is being met.
The apexification procedure will normally requires several monthly appointments or follow-ups to observe any calcific changes induced at the apex of tooth concerned. In these visits, a material known as calcium hydroxide ( Ca(OH)2 ) will be placed inside the root canal systems to eliminate intracanal infection, stimulates calcification and achieves apical barrier seal at the apex of tooth root. The success rate of applying the traditionally used calcium hydroxide to induce calcific barrier is between 74%-100%. Nowadays, a newer material known as mineral trioxide aggregate (MTA) is widely used as well.
Some difficulties are said to be a major clinical challenge when carrying out apexification, including difficulty in achieving appropriate apical seal with an open apex. Besides that, the termination of development of dentinal walls after pulpal pathologies occur will result in roots with thin dentinal wall and thus, producing a higher risk of tooth fracture.
apex + -ification
apexification (plural apexifications)
