Dr.

Sharaz Ahmed
Operative Dentistry

A vital pulp therapy procedure performed to

encourage physiological development and
formation of the root end.
OR

The stimulation to make the end of a tooth

root close in a traumatized tooth with healthy
pulp.

The goal of apexogenesis is the

preservation of vital pulp tissue so that
continued root development with apical
closure may occur.
Carious exposure or trauma to immature
permanent teeth in which root canal therapy
cant be done.

Apexogenesis is a procedure that addresses the

shortcomings involved with capping the inflamed
dental pulp of an incompletely developed tooth.
Most or all of the coronal pulp is removed, often to
the level of the canal orifices, and calcium hydroxide
paste is placed.
An aseptic technique combining the use of the rubber
dam and sterile burs is strongly recommended.

Abrasive diamond bur at high speed with

adequate water-cooling.
Following coronal pulp amputation, the
pulp chamber is rinsed with sterile saline.
The excess liquid should then be carefully
removed via vacuum or sterile cotton
pellets.
Once the pulpal bleeding is controlled,
calcium hydroxide paste is placed over the
amputation site.

A restorative base material should be placed over the

calcium hydroxide and then allowed to set
completely.
A coronal restoration should then be placed that will
ensure the maximum long-term seal.
The patient should be re-evaluated every three
months for the first year, and then every 6 months
for 2 to 4 years to determine if successful root
formation is taking place.

Pulp necrosis
Root resorption
Periradicular pathosis

Apexification is a method of inducing a

calcified barrier at the apex of a nonvital
tooth with incomplete root formation.

If apexification is successful, a hard

substance histologically described variously
as bone, dentin, cementum, or osteodentin
will develop against which obturation of root
canal can be done.
Materials used for apexification are
Calcium hydroxide
Mineralo trioxide aggregates (MTA)

The tooth is isolated with rubber dam, and access

is gained into the pulp chamber.
2. Using large reamers & files, remove the debris from
the coronal half of the pulp & establish the file
length radiographically.
3. Clean the canal, irrigate it & then dry it with a paper
point.
4. Calcium hydroxide powder mix with salin to form
paste or commercially availabe paste fill the canals
upto working length.excess calcium hydroxide is
removed from the pulp chamber and then sealed
with intermediate restorative material.
5. Recall after 3 months and take a radiograph to
determine whether calcific barier has developed if
1.

6.On a 6 month recall, you should see radiographic

evidence of an apical closure.
7.When you have accomplished apical closure, the root
canal filling is completed.

MTA is now the material of choice for

induction of an apical barier because of
better ability to seal and good
biocompatibility
Apexification can be possible in single visit
with MTA

Anesthesia and isolation, appropriate access cavity

Removal of necrotic pulp; barbed broach or H files
Workinglength determination 2mm short of apex then
cleaning, shaping and copious irrigation and then dry the
canals.
MTA is mixed according to manufacturer instructions then
introduced into the canal with MTA carrier checked with
radiographs.
Pluggers are used to condense MTA into an apical 3-4 mm
barrier.
A moist cotton pellet is place and left to ensure setting
Recall after 48 hrs for obturating the remaining part of the
root canal and placement of permanent restoration.