December 10, 2015
The degree of tooth development is a major consideration when dealing with young patients who exhibit infected or damaged pulp. Only two-thirds of the roots are developed when a tooth erupts. If there is any kind of damage to the pulp before full development, further root growth and formation of the dentin stops. As a result these under-developed roots will have a reverse or flaring taper and open apex. If this is left untreated the future root canal treatment will have a minimal success due to dificulties in sealing the apex of the root. Besides, thin dentin walls will raise the likelihood of tooth fracture. Apexogenesis and apexification are two procedures that are commonly used under these circumstances.
Apexogenesis is a dental procedure that is carried out in the case of reversible pulpitis, that is, when dental pulp is still vital or minimally inflamed. In simple words, it stimulates the process of physiological root end development. It is likely to be successful in children or young patients only as there is better blood supply to their teeth than that of adults. The aim is to keep the pulp alive and to encourage further root growth as well as apical closure. This is likely to improve the chances of saving the original tooth in the long run.
As saving the vital pulp is an essential goal of this procedure only the inflamed part of the pulp is extricated, leaving at least one-third of the dental pulp in place. Medication is applied which permits further growth and strengthening of the roots. Among the various methods used are indirect pulp treatment, direct capping and partial removal of pulp before sealing.
Apexification is done when there is irreversible pulpitis and the pulp is necrotic. This procedure is carried out to induce a barrier by encouraging the development of mineralized tissue at the open apex.This tissue may be osteodentin, osteocementum, bone or even a combination of all three. It can also be described as root-end closure.
Apexification is carried out by removing the necrotic pulp and covering it with medication that promotes growth of tissue that serves to close the apex. As the roots fail to develop further, the chances of fracture and tooth loss are increased. Therefore a restoration becomes necessary following apexification.
In both, apexogenesis and apexification, regular monitoring after every 3 months in the beginning is essential to check for success of the procedure. After the root is fully developed a conventional root canal treatment is required in order to seal the apex, main and lateral root canals.
Difference Between Apexogenesis and Apexification
Both these procedures are performed for young immature teeth. However, there is a major difference in the two. Apexogenesis aims to preserve pulp vitality and to promote the further development and strengthening of the roots. On the other hand, apexification is carried out when the pulp is necrotic and there is no possibility of further development of the root structure. It aims to close the open apex with the development of a calcific barrier. Therefore careful assessment of pulp vitality is necessary to choose the correct mode of treatment.