What Is The Apexification?

Nothing can be as beautiful as natural teeth. It’s always a good idea to save your natural tooth. No matter how advanced the bridges and implants are, there can never be a replacement for your natural teeth. Sometimes children have suffered progressive cavities to create a situation where the tooth’s root is suffering from an infection.

If a root canal is done, the infected pulp in the affected tooth’s interior is carefully eliminated with the endodontic techniques. Infected areas of the tooth and its associated pulp are removed using the same tiny instruments involved in adult root canals. Since pulp has the blood vessels and nerve tissues that function inside normal teeth, infection within the interior often causes severe pain for kids with the inflamed tooth that a root canal can alleviate.  After this procedure, your tooth will be restored, and it will function just like any other tooth for the rest of your life.

What is apexification?

It is a procedure performed on an infected immature tooth to close the open apex to allow the teeth to heal. An open top can also occur on teeth whose roots have been eroded away by resorption. in such an occurrence, it may be difficult to seal the root canals using the routine methods. The objective of this treatment is to seal the root with an open apex by forming a hard tissue barrier. This prevents further inflammation and external infection of the roots. It also allows the root canal to be sealed traditionally. You can quickly detect the condition with an x-ray especially on kids between the ages of 7-12 years or on patients who have suffered teeth trauma. To seal the open apex of the root we use mineral trioxide aggregate (MTA). MTA forms a hard impermeable barrier at the apex of the root. Pulp regeneration is an alternative treatment to apexification that allows tooth grow to the normal root. To read more about this technique go to our latest article about pulp regeneration for kids.

Step by step process of apexification

1. You first have to gain access to the pulp chamber.
2. clean the root canals by irrigating and filing. When you repeatedly use sodium hypochlorite, it helps in the removal of the debris.
3.  You now have to seal the apex. On a clean glass slab, mix a paste of mineral trioxide aggregate. Place the mixture into the open apex using  MTA carriers. The primary objective is to seal the canal completely. You can use a radiograph to check the accuracy of this procedure.
4. Do a follow up after six months to check the radiograph evidence of apical healing.

The success rate of apexification is usually high however there are situations where the infection does not heal. In some cases, the resorption process continues. These isolated cases may require surgical intervention or the complete removal of the tooth.

Materials used during apexification

A lot of materials have been proposed for use during apical barrier formation like calcium hydroxide and mineral trioxide aggregate (MTA). MTA remains the widely accepted material for apexification and apexogenesis. There has been a high success rate with the use of mineral trioxide aggregate. Studies revealed that in instances where MTA was used, there was less inflammation and it was found out to be less toxic.

Benefits of apexification

The benefits of this procedure cannot be underestimated. Apart from saving your natural tooth from extraction, below are some of the benefits of apexification:

• It prevents external infection to the root – once the barrier is successfully placed, chances of germs and infections reaching the delicate canal is zero. This prevents further inflammation or hemorrhage.
• Your tooth maintains its natural appearance – your lifestyle remains pretty the same. You can comfortably chew food and keep your natural teeth for the rest of your life.
• Helps protect other teeth – it will contribute to saving the remaining teeth from wear and tear.

With the right and successful treatment, you can maintain your smile and continue eating the foods you love. Frequent visits to the doctor are also reduced, and the beauty is that that particular tooth can last a lifetime just like your other teeth.

What is Apexogenesis?

It is a procedure performed on an injured or immature tooth to stimulate root development or to close the open apex to allow the teeth to heal. Apexogenesis is more or less the same as apexification but involves the removal of the inflamed pulp and placing calcium hydroxide or mineral trioxide aggregate, MTA, on the remaining healthy pulp tissue. In this case, only the inflamed tissue is removed. Additional treatment is not necessary if the pulp heals. By preserving the healthy part of the dental part, the root can continue to form its final form. The advantage of the apexogenesis to apexification, if it is possible, is the higher success rate of the treatment in long-term. The open apex teeth are weaker than normal teeth and they might fracture.

When do we recommend apexogenesis?

1. To promote root end closure so that a natural apical is formed to prevent canal filling.
2. To help in the development of thicker root and decreasing the chances of root fracture.
3. To allow for continued root development and a more favorable crown to root ratio.
4. Helps in maintaining the vitality of the pulp.
The success of this process may take 1-2 years. The patient should be recalled in intervals of every three months from the time the procedure was performed. If the endodontist determines that the inflammation is irreversible and resorption is evident, then the pulp should be removed and the apexification procedure initiated.

Case Study MTA Apexification Technique

A 17-year-old female patient was referred to our office by her general dentist because of constant pain in her front teeth area and swelling around her gum. The patient didn’t have any systemic disease.   A dens invaginatus (dens in dente) was found on the maxillary lateral incisor and with periradicular radiolucency. The tooth didn’t respond to the cold test and it sensitive to percussion. The diagnosis was nonvital tooth with an apical periodontitis.

After anesthesia and rubber dam isolation, an access cavity was opened.  The tooth was cleaned and shaped. The canal was irrigated with 6% sodium hypochlorite, and 17% EDTA and thoroughly dried. The canal was filled with MTA and was temporarily closed with a moist cotton pellet and provisional filling material. The patient was referred to her general dentist for permanent restoration.

One year follow up clinical evaluation, and intra-oral radiograph confirmed the success of root canal treatment of tooth #7. The patient doesn’t experience any pain or discomfort in that area.

Recent rapid advances have opened the door to exciting new opportunities in the quest for treating immature teeth with pulpal necrosis.Omega Dental Specialists is here to answer any of your questions or concerns to give you peace of mind. Call us at (713) 322-7474.

Symptoms That Require a Root Canal in Children

Dental professionals in endodontics routinely provide root canal therapies in child patients and are well trained in working with younger patients who are worried about pain and discomfort. Each endodontist is careful to explain every step of the procedure and will use the numbing agents that will alleviate the child’s concerns about pain. The process of infection can spread outside of the roots involved to associated tissues in the jaw and can cause severe pain for the child, and the endodontist will reassure the young patient that this pain will be eliminated providing great relief.

Childhood Teeth with Pain Symptoms that Could Require Root Canal

• Sensitivity to cold that lingers
• Heat sensitivity
• Sweet intolerance and sensitivity
• Pain upon biting down
• Referred pain adjacent to the tooth, including the jaw, temple, ear or neck
• Unexplained toothaches
• Intermittent tooth pain sensation
• Throbbing, severe discomfort or pain
• Atmospheric pressure pain (airline flights or swimming activity)
• Pain when getting up from reclining
• General swelling in the jaw

When a crown is later placed upon the tooth, the child will happily be able to chew, dine and speak talk without the previous discomfort that was experienced. In the short to long-term, the child (and parents) will be grateful the experience is behind them and the child’s affected tooth was saved.

Methods to Reassure Your Child Before the Root Canal

How you communicate about the root canal can prove very helpful to the process and relieve your child’s worries:

• Tell your child that the process will relieve pain
• Avoid using descriptive words
• Be positive
• Emphasize the procedure’s benefits 
• Explain that dental techniques have improved greatly
• Use typical drugstore pain relief (Advil, Tylenol, etc.) after treatment to quell discomfort the child may experience after the procedure