Apexification is the method of inducing the development of root apex in an immature pulpless tooth by formation of osteocementum or other bone like tissue. In this article there is a brief discussion on the apexification treatment evaluation. Let us examine them.
Apexification treatment evaluation:
The first evaluation of the apexification procedure may be done after 3 months. Radiographs may show hard tissue deposition, but such evidence is not considered reliable. It is necessary to test the quality of the apical barrier with a size 35 file. If the file easily penetrated, so too will the obturation material. It will therefore be necessary to continue the apexification by reapplying calcium hydroxide.
If the 3 months radiograph shows little or no apical changes, reschedule the patient for another 3 months recall. There is no need to change the calcium hydroxide if it appears to occupy the root canal space adequately, and if the coronal temporary seal appears satisfactory.
Shalini Gupta et al in 1999 reported a continuing root formation in a carious non-vital and immature mandibular second premolar after a single visit calcium hydroxide apexification treatment. An apical hard tissue barrier was formed, accompanied by a separate, mesioapically growing root, in 7 months post treatment.
Treatment was concluded with gutta percha root canal restoration. The success of this single visit apexification treatment supports the contention that frequent changing of the calcium hydroxide dressing is not always required to induce an apical closure.
The follow-up evaluation is repeated every 3 months until successful apical bridging has occurred. This may take as little as 3 months or as long as a year or more, depending on the degree o apical destruction and the ability of the apical tissue to repair.
Obturation of the root canal:
Because the root canal wall does not change during apexification, the shape of the canal will remain the same after the apical barrier has formed, namely a reverse taper. These canals are probably best suited for obturation by a thermoplasticized technique.
Recall and follow-up:
A routine recall evaluation should be performed to determine the outcome of the root canal procedure. Teeth treated in this manner are more likely to develop root fractures due to the thin root canal walls. Therefore, the more developed the teeth before apexification, the better their prognosis.
Alternative to conventional apexification:
- A primary objective in endodontic therapy is the complete obturation of the root canal space. A good apical stop is an essential factor in achieving this goal. It effectively confines the filling material to the canal space and allows the application of adequate condensation forces to yield an acceptably dense filling.
- Immature pulpless teeth present special problems in adherence to these objectives. These teeth have parallel or divergent walls in the apical third which make a normal development of an apical third which make a normal development of an apical stop impossible. This leads to an inability to confine the filling material to the canal space.
- Mineral trioxide aggregate or MTA, is a new material developed for endodontics that appears to be a significant improvement over other materials for procedures in bone. It is the first restorative material that consistently allows for the overgrowth of cementatum, and it may facilitate the regeneration of the periodontal ligament.
Schwartz et al (1999) reported the use of MTA as
- 1. First appointment: Calcium hydroxide was used and the tooth was temporized.
- 2. Second appointment: (3 weeks later): The tooth still had a sinus tract.
- 3. Third appointment: The sinus was healed. A thick mix of MTA and saline was introduced into the canal, and left to set overnight. The next day the tooth was obturated with gutta pecha. The tooth was found to be asymptomatic with normal periapical structure at 9 and 20 months recall.
The above article discusses briefly about the apexification treatment evaluation.
