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    L3. Apexogenesis - Apexification

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    AGENG RAHMA HIJAHANIS ILMASTITI 1
    This document discusses apexogenesis and apexification procedures for immature permanent teeth with open apices. It defines apexogenesis as a vital pulp therapy procedure to encourage continued root development. The goal of apexification is to induce a calcified barrier at the open root end when the pulp is non-vital. For apexogenesis, direct pulp capping or pulpotomy using calcium hydroxide or MTA can preserve vitality and allow root maturation. For apexification when the pulp is non-vital, repeated applications of calcium hydroxide over months induces apical barrier formation to allow root canal filling.

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    L3. Apexogenesis - Apexification

    Uploaded by

    AGENG RAHMA HIJAHANIS ILMASTITI 1
    224 views44 pages
    This document discusses apexogenesis and apexification procedures for immature permanent teeth with open apices. It defines apexogenesis as a vital pulp therapy procedure to encourage continued root development. The goal of apexification is to induce a calcified barrier at the open root end when the pulp is non-vital. For apexogenesis, direct pulp capping or pulpotomy using calcium hydroxide or MTA can preserve vitality and allow root maturation. For apexification when the pulp is non-vital, repeated applications of calcium hydroxide over months induces apical barrier formation to allow root canal filling.

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    L3. Apexogenesis _ Apexification

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    This document discusses apexogenesis and apexification procedures for immature permanent teeth with open apices. It defines apexogenesis as a vital pulp therapy procedure to encourage continued root development. The goal of apexification is to induce a calcified barrier at the open root end when the pulp is non-vital. For apexogenesis, direct pulp capping or pulpotomy using calcium hydroxide or MTA can preserve vitality and allow root maturation. For apexification when the pulp is non-vital, repeated applications of calcium hydroxide over months induces apical barrier formation to allow root canal filling.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    224 views44 pages

    L3. Apexogenesis - Apexification

    Uploaded by

    AGENG RAHMA HIJAHANIS ILMASTITI 1
    This document discusses apexogenesis and apexification procedures for immature permanent teeth with open apices. It defines apexogenesis as a vital pulp therapy procedure to encourage continued root development. The goal of apexification is to induce a calcified barrier at the open root end when the pulp is non-vital. For apexogenesis, direct pulp capping or pulpotomy using calcium hydroxide or MTA can preserve vitality and allow root maturation. For apexification when the pulp is non-vital, repeated applications of calcium hydroxide over months induces apical barrier formation to allow root canal filling.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 44

    Blok Conservative Dentistry

    Kedokteran Gigi
    Universitas Jenderal Soedirman

    PERAWATAN APEKS TERBUKA


    (APEKSOGENESIS DAN APEKSIFIKASI)

    drg. Irfan Dwiandhono, Sp.KG, M.Biomed


    APEXOGENESIS
    • Definition :
    A vital pulp therapy procedure performed to
    encourage continued physiologic development
    and formation of the root end.

    • Objective :
    To maintain the vitality of the radicular pulp
    APEXOGENESIS
    • INDICATION :
    ✔ Pulp must be vital (Pulpitis reversible)
    ✔ Immature tooth
    ✔ Capable of sustaining continued
    development
    TREATMENT OF
    APEXOGENESIS
    • The choice of treatment depends on :
    ✔ The size of the exposure,
    ✔ The presence of hemorrhage
    ✔ The length of time since the injury

    • Pulp capping and pulpotomy are the measures


    that permit apexogenesis to take the place
    and may avoid the need for root canal therapy
    TREATMENT OF APEXOGENESIS
    • A small pulpal exposure 🡪 pulp capping

    • More extensive pulpal exposure (inflammation is


    limited to the most superficial 2 mm of the pulp) 🡪
    Partial pulpotomy / Cvek pulpotomy (Remove the
    inflamed tissue / only the superficial 2-4 mm of
    pulp, leaving the rest of the pulp intact)

    • Larger pulpal exposure 🡪 The pulp should be


    amputated at the level of the cervical constriction
    (conventional pulpotomy)
    MATERIAL USED FOR APEXOGENESIS
    1. Calcium hydroxide
    2. Mineral Trioxide Agregate
    DIRECT PULP CAPING
    DIRECT PULP CAPING
    • DEFINITION :
    A procedure in which the
    exposed vital pulp is
    covered with a protective
    dressing or base placed
    directly over the site of
    exposure in an attempt to
    preserve pulpal vitality
    INDICATION DIRECT PULP
    CAPPING
    • Asymptomatic (no spontaneous pain, normal
    response to thermal testing, and pulp is vital
    before the operative procedure)
    • Small exposure, less than 0,5 mm in diameter
    • Hemorrhage from the exposure site is easily
    controlled (within 10 minutes)
    • The exposure occurred is clean and
    uncontaminated (rubber dam isolation)
    • Atraumatic exposure and little desiccation of the
    tooth with no evidence of aspiration of blood into
    the dentin (dentin blushing)
    PULPOTOMY
    PULPOTOMY
    • DEFINITION :
    A procedure in which a
    portion of the exposed
    coronal vital pulp is surgically
    removed as a means of
    preserving the vitality and
    function of the remaining
    radicular portion
    OBJECTIVE PULPOTOMY
    • Preservation of vitality of the radicular pulp
    • Relief of pain in patients with acute pulpalgia
    and inflammatory changes in the tissue
    • Ensuring the continuation of normal
    apexogenesis in immature permanent teeth
    by retaining the vitality of the radicular pulp
    INDICATION PULPOTOMY
    • Mechanical or carious exposure in permanen
    teeth with incomplete root formation

    The pulpotomy procedure permits the


    completion of apexogenesis, the physiological
    maturation of the root. Even if only the apical 3
    or 4 mm of the pulp tissue is still vital, the root
    apex can complete development.
    TYPE OF PULPOTOMY
    Based on the amount of pulpal tissue removed :
    • Partial Pulpotomy (Cvek’s pulpotomy)
    A kind of pulpotomy in which only a portion of the
    coronal pulp is removed or removal of tissues until
    normal tissue that is free of inflammation is reached
    before placing medicament

    • Complete Pulpotomy (Cervical pulpotomy)


    It involves the complete removal of the coronal
    portion of the dental pulp, followed by placement of a
    suitable dressing or medicament that will promote
    healing and preserve the vitality of the tooth
    APEXIFICATION (Root-end closure)
    • DEFINITION :
    The process in which a non
    vital, immature, permanent
    tooth that has lost the
    capacity for further root
    development is induced to
    form a calcified barrier at the
    root terminus
    OBJECTIVE OF
    APEXIFICATION
    ✔The main objective of apexification is to
    achieve an apical stop for obturating material.
    ✔This apical stop can be obtained by :
    a. Inducing natural calcific barrier at apex or
    short of apex
    b. Forming an artificial barrier by placing a
    material at or near the apex
    c. Inducing the natural root lengthening by
    stimulating Hertwig’s epithelial root sheath
    INDICATION OF APEXIFICATION
    In young permanen teeth with
    blunderbuss canal having
    following symptoms :
    ✔ Symptoms of irreversible
    pulpitis
    ✔ Teeth with necrotic pulp
    ✔ Teeth with pulpoperiapical
    pathology showing swelling,
    tenderness or sinus
    MATERIAL USED FOR APEXIFICATION
    1. Calcium hydroxide
    2. Calcium hydroxide in combination with other
    drugs like :
    a. Camphorated paramonochlorophenol
    b. Cresanol
    c. Anesthetic solution
    d. Normal saline
    e. Ringer’s solution
    3. Zinc oxide paste
    MATERIAL USED FOR APEXIFICATION
    4. Antibiotic paste
    5. Tricalcium phosphate
    6. Collagen calciumphosphate gel
    7. Mineral trioxide aggregate
    8. Osteogenic protein I and II
    TECHNIQUES APEXIFICATION USE
    CALCIUM HYDROXYDE
    1. Anesthetize the tooth and
    isolate it use rubber dam
    2. Gain the straight line access to
    canal orifice
    3. Extirpite the pulp tissue
    remnants from the canal and
    irrigate it with sodium
    hypochlorite
    4. Establish the working length of
    canal. The final working length
    should be adjusted 2 mm short
    of the radiographic apex
    TECHNIQUES APEXIFICATION USE
    CALCIUM HYDROXYDE
    5. Complete cleaning and
    debridement of canal, irrigate, and
    then dry the canal. Not the shaping
    of the canal because the canal is
    already very wide 🡪 the fragile
    dentinal walls

    6. Place thick paste of calcium


    hydroxide in the canal using carrier.
    Place a dry cotton pellet over the
    material and seal it with temporary
    restorative material
    TECHNIQUES APEXIFICATION USE
    CALCIUM HYDROXYDE
    7. Second visit is done at the interval of 3 months
    for monitoring the tooth. If tooth is
    symptomatic, canal is cleaned and filled again
    use calcium hydroxide paste
    8. Patient again recalled until there is radiographic
    evidence of root formation
    9. Clinically check the progress of apexification by
    passing a small instrument through the apex
    after removal of calcium hydroxide
    10. Obturation using thermoplasticized technique
    TYPES OF CLOSURE WHICH CAN
    OCCUR DURING APEXIFICATION
    1. Root-end development in normal pattern (Fig. 33.31)
    2. Apex closes but wider at apical end (Fig. 33.32)
    3. Development of calcific bridge just coronal to apex (Fig. 33.33)
    4. Formation of thin barrier at or close to the apex (Fig. 33.34)
    TERIMAKASIH

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