Apexification: a review

Abstract

This paper reviews the rationale and techniques for treatment of the non-vital immature tooth. The importance of careful case assessment and accurate pulpal diagnosis in the treatment of immature teeth with pulpal injury cannot be overemphasized. The treatment of choice for necrotic teeth is apexification, which is induction of apical closure to produce more favorable conditions for conventional root canal filling. The most commonly advocated medicament is calcium hydroxide, although recently considerable interest has been expressed in the use of mineral trioxide aggregate. Introduction of techniques for one-visit apexification provide an alternative treatment option in these cases. Success rates for calcium hydroxide apexification are high although risks such as reinfection and tooth fracture exist. Prospective clinical trials comparing this and one-visit apexification techniques are required.

Intracanal dressing paste composed by calcium hydroxide, chlorhexidine and zinc oxide for the treatment of immature and mature traumatized teeth

“…Considering these aspects, a more predictable treatment (apexification) was the Intracanal dressing paste composed by calcium hydroxide, chlorhexidine and zinc oxide for the treatment of immature and mature traumatized teeth treatment of choice in the present study. Apexification usually involves refreshing the calcium hydroxide paste every three months, requiring multiple visits with heavy demands on patients and operators, inevitable clinical costs, and the increased risk of tooth fracture, since the use of calcium hydroxide requires many dressing changes until a calcified barrier isformed 12,22 . This study demonstrated an alternative to periodic changes of intracanal medication in apexification, using a paste composed by calcium hydroxide, chlorhexidine and zinc oxide.…”

Apexification of Immature Teeth Using Novel Apical Matrices and MTA Barrier: Report of Two Cases

“…Although earlier studies recommended the use of a Ca(OH)2 prior to MTA placement, recent studies report that the initial use of Ca(OH)2 paste was not necessary for apexification to occur, and it has shown to be strongly related to the extrusion of MTA and formation of barriers beyond the limits of the root canal walls. 3 The major problem in cases of a wide open apex is the need to limit the material to the perforation, thus avoiding the extrusion of a large amount of material into the periodontal tissue [18,19]. A large volume of the extruded material may set before it disintegrates and get resorbed.…”

“…Recently MTA has also been emerged strongly as artificial rootend closure material in open apices. Both materials were found to stimulate the formation of mineralized tissue, thereby providing an adequate seal in the apical region [17] MTA, a bio-compatible material, can be used to create a physical barrier that also helps in formation of bone and periodontium around its interface [1][2][3][4][5]. Although earlier studies recommended the use of a Ca(OH)2 prior to MTA placement, recent studies report that the initial use of Ca(OH)2 paste was not necessary for apexification to occur, and it has shown to be strongly related to the extrusion of MTA and formation of barriers beyond the limits of the root canal walls.…”

“…Calcium hydroxide (CH) has been the material of choice for apexification [3]. Calcific barrier formation is induced with repeated changes of material over the course of 5-20 months [4] averaging 12.9 months [5].…”

Regenerative endodontics – biologically‐based treatment for immature permanent teeth: a case report and review of the literature

“…11 There was a requirement for multiple visits and a lengthy time period (average 12 months) before a root filling could be completed. 12 More recently, an alternative 'apexification' protocol involved placement of mineral trioxide aggregate (MTA) which acts as an artificial barrier on which a hard tissue barrier forms. 13 An advantage of this technique is it is generally completed in one or two 446 ª 2010 Australian Dental Association…”