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Introduction
Apexogenesis
a) Definition
b) Objective
c) Indirect pulp capping
d) Direct pulp capping
e) Apical closure
pulpotomy
- Calcium hydroxide
pulpotomy
- MTA pulpotomy
Apexification
INTRODUCTION
OPEN APEX:
Problems
- Canals have larger apical diameter
Solution - Surgery?
Drawbacks:
1. Inadequate crown:root ratio
2. Physically and psychologically traumatic
to the patient
3. Young patients are not very cooperative.
4. Apical walls are thin and could shatter
when touched by a rotating bur
5. Thin walls would make condensation of a
retrograde filling difficult
6. Surgery would remove the root sheath
and prevent any possibility of further root
development. (Morse et al)
APEXOGENESIS ( VITAL
PULP THERAPY)
Definition:
The physiologic root end
development and formation.
American Association of Endodontists
2. Vital Pulp therapy: Treatment of
a vital pulp in an immature tooth to
permit continued dentin formation
and apical closure - Walton and
Torabinejad
1.
Objective:
Maintain the vitality of radicular pulp
Achieved through:
1. Indirect pulp capping
2. Direct pulp capping
3. Apical closure pulpotomy
Rationale:
Objective:
Indication:
Contraindication:
Carious exposures in an immature
tooth as the extent of inflammation
and contamination cannot be
determined clinically. (Seltzer and
Bender)
Materials Used:
1.Calcium hydroxide
2.MTA
Indication:
1.An immature permanent tooth with an
Types:
1.Partial pulpotomy ( shallow, low-
Calcium hydroxide
pulpotomy
Partial pulpotomy:
Advantages:
1. Minor injury to the pulp and undisturbed
MTA Pulpotomy
Disadvantage:
Expensive
Long setting time, requiring an
Treatment failure
Cessation of root growth
Development of signs and symptoms or
periapical lesion.
Calcific metamorphosis (i.e. calcific
obliteration) of canal or internal
resorption
Goals:
1. Sustaining a viable Hertwigs epithelial
root sheath
2. Maintaining pulpal vitality
3. Promoting root end closure
4. Generating a dentinal bridge at the site
of pulpotomy
Restoration:
Institute root canal therapy after
apexogenesis (Cvek, Webber,
Seltzer and Bender)
Prognosis:
Pulp capping 72-88%
Partial pulpotomy 94-96%
Cervical pulpotomy 72-79%
APEXIFICATION
Non-surgical approaches (discussed by
Morse):
Blunt end or rolled cone (customized cone)
Short fill technique (by Moodnick)
Instrumentation only
No treatment
Induction of periapical bleeding with
Definition:
Method of inducing apical closure by the
formation of osteocementum or a similar
hard tissue or the continued apical
development of the root of an incompletely
formed tooth in which the pulp is no longer
vital. American Association of
Endodontics
Root end closure technique (Torabinejad)
The process of creating an environment
within the root canal and periapical tissues
after pulp death that allows a calcific barrier
to form across the open apex
Indication :
Restorable immature tooth with pulp
necrosis.
Contraindications :
1. All vertical and unfavorable horizontal
root fractures.
2. Replacement resorption
3. Very short roots
4. Periodontal breakdown
5. Vital pulps
Root development
Location of apex
Patient
Cleaning and debridement of canal
Apical diameter
Interim restoration
Materials Used:
1. Calcium hydroxide (Material of choice)
2. Tricalcium phosphate
3. Collagen calcium phosphate
4. Osteogenic protein- 1
5. Bone growth factors
6. Mineral trioxide aggregate
EPT
CONCLUSION