Apexification in endodontics PowerPoint presentation
- 2. APEXIFICATION CONTENTS INTRODUCTION DEFINITION INDICATION OBJECTIVE MATERIALS USED PROCEDURE FRANK’ S CRITERIA APEXIFICATION VS APEXOGENESIS CONCLUSION REFERENCE
- 3. APEXIFICATION DEFINITION DEFINED BY COHEN AS A METHOD TO INDUCE DEVELOPMENT OF THE ROOT APEX OF AN IMMATURE PULPLESS TOOTH BY FORMATION OF OSTEOCEMENTUM / BONE LIKE TISSUE. APICAL CLOSURE IS DONE BY FORMATION OF THE CALCIFIC BARRIER. THE APEX OF THE ROOT OF THE TOOTH IS LEFT TO HEAL OVER THE TIME . DONE IN YOUNG PATIENTS. “ROOT END CLOSURE’’ INTRODUCED BY TORABINEJAD IN 2002
- 5. 0BJECTIVE TO INDUCE EITHER CLOSURE OF OPEN APICAL THIRD OF ROOT CANAL OR THE FORMATION OF AN APICAL CACIFIC BARRIER AGAINST WHICH OBTURATION CAN BE ACHIEVED
- 6. INDICATION FOR NON VITAL PERMANENT TEETH WITH OPEN APEX (BLUNDERBUSS CANALS)
- 7. RATIONALE WHEN THE PULP OF AN IMMATURE TOOTH BECOMES DEAD EITHER DUE TO TRAUMA OR CARIES , ITS HERTWIGS EPITHELIAL SHEATH STOPS ITS FUNCTION OF ROOT FORMATION. THESE TEETH PRESENT WITH BLUNDERBUSS CANALS IN WHICH OBTURATION BY ORTHOGRADE METHOD IS NEARLY IMMPOSIBLE. BY THE INTRODUCTION OF SUITABLE MEDICAMENT, APICAL BARRIER IS PRODUCED AT THE SAME TIME LENGTH OF THE ROOT IS INCREASED AND CANAL IS THEN OBTURATED USING THERMOPLASTICIZED TECH.
- 8. TYPES OF APEX IN IMMATURE TEETH BLUNDERBUSS APEX NON BLUNDERBUSS DIVERGENT WALLS WITH FUNNEL SHAPED APICAL FORAMEN ALSO TERMED AS BLINDERBUSS APEX. THE TERM BLUNDERBUSS IMPLIES TO AN 18th CENTURY WEAPON WITH A SHORT AND WIDE BARREL. IT ORIGINATES FROM A DUTCH WORD ‘DONDERBUSS’ WHICH MEANS ‘THUNDER GUN’ PARALLEL OR CONVERGENT WALLS ALSO KNOWN AS NON BLUNDERBUSS APEX (CYLINDRICAL).
- 9. CAUSES OF OPEN APEX • CARIES • TRAUMA • DENTIN DYSPLASIA • ROOT RESORPTION • OVERINSTRUMENTATION • ROOT END RESECTION
- 10. MATERIALS USED: • MINERAL TRIOXIDE • CALCIUM HYDROXIDE • BIODENTINE • BIOCERAMICS
- 11. PREOPERATIVE ASSESSMENT (CLINICAL EVALUATION OF COLOUR, MOBILITY , TENDERNESS & SWELLING) PERIAPICAL RADIOGRAPH MUST BE EVALUATED WHEN ACUTE SIGNS & SYMPTOMS ARE ABSENT, . INSTRUMENTATION IS RECOMMENDED LA AND APPLICATION OF RUBBER DAM
- 12. ACCESS IS GAINED IN THE PULP CHAMBER BARBED BROACH USED TO REMOVE DEBRIS AND . NECROTIC PULP TISSUE FROM CANAL IRRIGATION IS PERFORMED WITH SALINE WORKING LENGTH IS DETERMINED CIRCUMFERENTIAL ENLARGEMENT IS DONE BY THE FILE & IRRIGATION IS DONE WITH SALINE TO REMOVE INFECTED DENTIN FROM THE CANAL WALLS
- 13. CANAL DRIED WITH PAPER POINTS CA(OH)2 POWDER IS USED TO FILL 2MM SHORT . OF THE RADIOGRAPHIC APEX REMAINING OF THE CANAL FILLED WITH CA(OH)2 . & SALINE BARIUM SULPHATE ADDED TO RADIO-OPACITY DRY PLEDGE OF CA(OH)2 IS THEN EJECTED INTO THE PULP CHAMBER & FORCED AGAINST THE PASTE AHEAD OF IT PLACE A TEMPORARY RESTORATION
- 14. SECOND VISIT: THIS IS AFTER 6-24 MONTHS TOOTH IS REENTERED AND APEXIFICATION IS VERIFIED IF IT IS COMPLETE THEN RCT IS DONE
- 17. FOLLOW UP APICAL DEVELOPMENT IS MONITERED BY COMPARISON OF PREOPERATIVE AND POSTOPERATIVE RADIOGRAPH FORMATION OF CALCIFIC BRIDGE CONTINUED APICAL DEVELOPMENT ABSENCE OF INTERNAL RESORPTION OR PERIAPICAL RADIOLUCENCY NOTE : IF ANY SIGNS OF PAIN, SWELLING, INFECTION IS SEEN DURING THIS PHASE THEN CANAL IS AGAIN THOROUGHLY CLEANED AND DISINFECTED AND FILLED WITH CALCIUM HRYDROXIDE PASTE. IF APICAL BARRIER IS NOT FORMED OR INADEQUATE THEN CALCIUM HYDROXIDE IS REPEATED AND PATIENT RECALLED UNTILL THE BARRIER FORMATION IS ACHIEVED.
- 18. APEXIFICATION USUALLY TAKES 6-24 MONTHS PATIENT IS RECALLED AT 3MONTHS INTERVAL UNTIL EVIDENCE OF APEXIFICATION BECOMES APPARENT ON RADIOGRAPHS RENTERING THE TOOTH FOLLOWED BY REMOVAL OF CALCIUM HYDROXIDE PASTE WITH SALINE AND EVALUATION OF BARRIER USING A SMALL INSTRUMENT OBTURATION IS DONE WITH GUTTA PERCHA BY USING EITHER THERMOPLASTICISED OR CUTOMISED GUTTA PERCHA FOLLOW UP VISIT TO CHECK CONTINUED APICAL DEVELOPMENT OF ROOT AT INTERVAL OF 6 MONTHS, 1 YEAR, 3YEARS CALCIUM HYDROXIDE APEXIFICATION :
- 19. USING MTA MTA PROCEDURE AFTER 1 TO 2 WEEKS ONCE THE TOOTH IS FREE OF SIGNS ANS SYMPTOMS TH MTA IS MIXED WITH DISTILLED WATER MTA IS THEN PLACED IN CANAL IN INCREMENTS WITH MTA CARRIER TAPPED IN PLACE WITH PLUGER 4-5 MM OF PLUG IS MADE APICALLY MTA IS VERIFIED RADIOGRAPHICALLY WET COTTON PELLET IS PLACED IN THE CANAL SO AS TO HELP WITH FASTER SETTING OF MTA ACESS CAVITY IS SEALED WITH TEMPORARY RESTORATION AFTER 24 PATIENT IS RECALLED AND TEMPORARY RESTORATION AND COTTON PELLET IS REMOVED, CANAL IS OBTURATED WITH GUTTA PERCHA AND SEALED WITH BONDED RESIN FOLLOW UP AFTER 3-6 MONTHS
- 20. FRANK’ S CRITERIA: APEX IS CLOSED ,THROUGH MINIMUM RECESSION OF THE CANAL CONTINUED CLOSURE OF CANAL AND APEX AT A NORMAL APPEARANCE. APEX IS CLOSED WITH NO CHANGE IN ROOT SPACE A DOME SHAPED APICAL CLOSURE WITH THE CANAL RETAINING A BLUNDERBUSS APPEARANCE . RADIOGRAPHICALLY APPARENT CALCIFIC BARRIER AT THE APEX NO APPARENT RADIOGRAPHIC CHANGES BUT A POSITIVE STOP IN APICAL AREA THERE IS NO RADIOGRAPHIC EVIDENCE OF APICAL CLOSURE, BUT UPON CLINICAL INSTRUMENTATION, THERE IS DEFINITE STOP AT THE APEX, INDICATING CALCIFIC REPAIR. A POSITIVE STOP AND RADIOGRAPHIC EVIDENCE OF A BARRIER CORONAL TO THE ANATOMIC APEX OF TOOTH.
- 22. TREATMENT OPTIONS NONVITAL IMMATURE PERMANENT TEETH CREATING APICAL STOP (APEXIFICATION) CREATING ROOT END CLOSURE (REGENERATIVE ENDODONTICS) GRADUAL TRADITIONAL IMMEDIATE APICAL BARRIER TECHNIQUE REVASCULARISATION (CELL HOMING) TISSUE ENGINEERING TECHNOLOGY (CELL TRANSPLANTATION)
- 24. APEXOGENESIS APEXIFICATION • TREATMENT OF VITAL PULP BY CAPPING OR PULPOTOMY IN ORDER TO PERMIT CONTINUED GROWTH OF THE ROOT AND CLOSURE OF ROOT APEX. • IT IS THE PHYSIOLOGICAL PROCESS OF REDEVELOPMENT IN VITAL INFECTED TOOTH. • NORMAL/PULP TISSUE WITH MINIMAL INFLAMMATION IS PRESENT : 1.DPC 2.PULPOTOMY • NORMAL ROOT END DEVELOPMENT TAKES PLACE. • DEFINED AS A METHOD OF INDUCE DEVELOPMENT OF THE ROOT APEX OF AN IMMATURE PULPLESS TOOTHBY FORMATION OF OSTEOCEMENTUM/BONE LIKE TISSUE. • IT IS THE METHOD OF INDUCING THE REGENERATIVE POTENTIAL IN A NON VITAL TOOTH. • INDICATED IN CASES WHERE THERE IS NO NORMAL PULP TISSUE I.E WHERE THE PULP HAS UNDERGONE IRREVERSIBLE NECROSIS. • NORMAL ROOT DEVELOPMENT TAKES PLACE RARELY. CALCIFIC BARRIER IS FORMED CLINICALLY, ON A RADIOGRAPH OR BOTH.
- 25. CONCLUSION: IT IS DONE FOR NONVITAL PERMANENT TOOTH. PREOPERATIVE ASSESSMENT IS VERY IMP FOR EVALUATION AND TREATMENT PLAN FRANKS CRITERIA FOR ASSESSMENT OF THE CANAL ,TO KNOW IF THE CALCIFIC BARRIER IS FORMED OR NOT. IDEAL MATERIAL SUITABLE FOR THE CONDITION OF THE PULP SHOULD BE TAKEN FOLLOWING THE PROCEDURE. PROPER CARE SHOULD BE TAKEN DURING THIS PROCEDURE .
- 26. MUHS QUESTIONS APEXOGENESIS VS APEXIFICATION
- 27. REFERENCE: NIKHIL MARWAH SHOBHA TANDON
- 28. THANK YOU