Apexification and Apexogenesis

 

The completion of root development and closure of apex occurs up to 3 years after eruption of the teeth. 

Treatment of pulpal injury in young permanent teeth poses a special challenge to the pediatric dentist and calls for a specially tailored treatment plan. 

Depending on the  vitality of the affected pulp, two approaches are possible: 
Apexogenesis 
Apexification.

Apexogenesis (maturogenesis) – a vital pulp therapy procedure performed to encourage continued physiological development and formation of the root end. 

Apexification – is a method to induce a calcified barrier in a root with open apex or the continued apical development of an incomplete root in teeth with necrotic pulp. (AAE 2003).

Apexification is a method of inducing root end closure of an incompletely formed nonvital permanent tooth by removing the coronal and nonvital radicular tissue just short of the root end and placing in the canal a suitable biocompatible agent such as calcium hydroxide (several treatments with a fresh agent may be necessary) or MTA. (AAPD 2007).

TYPES OF OPEN APEX

1. Blunderbuss: 

It is derived from the Dutch word DONDERBUS, meaning thundergun which was an 18th century weapon with a wide and short barrel. 

It indicates divergent and flaring root canal walls in which apex is funnel shaped and typically wider than the coronal aspect of canal. 

2. Non Blunderbuss:

Root canals are parallel or slightly convergent.

CAUSES OF OPEN APEX

1. Incomplete development – Pulpal necrosis as a result of caries or trauma before root growth and development are complete (i.e. Cvek’s stage 1-4) 

2. Extensive apical root resorption due to trauma, periapical pathosis, orthodontic treatment.

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