Content area
Full Text
Abstract
When there is pulpal involvement of permanent teeth with incompletely formed roots, techniques for the induction of apical closure should be completed before endodontic therapy is begun. Apexification is a method of inducing a calcified barrier at the apex of a nonvital tooth with incomplete root formation. Apexogenesis refers to a vital pulp therapy procedure performed to encourage physiological development and formation of the root end.
PULPAL INVOLVEMENT of permanent teeth with incomplete root formation requires preparatory treatment prior to the initiation of conventional endodontics. Apical closure is complete two to three years after eruption of the permanent tooth. The open divergent apex presents the challenge of producing an apical stop or constriction for placement of a hermetically sealed root canal filling. Prior to apexification and apexogenesis techniques, the treatment of choice was completion of endodontic therapy, followed by apical surgery with a retrograde filling. This method of treatment offers a poor long-term prognosis because of the incomplete formation of length and cross-sectional mass of the root, coupled with the difficulty of preparing a seat for the apical filling material. Apexification Defined Apexification is a method of inducing a calcified barrier at the apex of a nonvital tooth with incomplete root formation.3 This technique was described by Alfred Frank in 1966 as an alternative to surgical treatment of nonvital teeth with immature root development. The histologic features of a calcified cap (not true root development) induced by a calcium hydroxide-camphorated monochlorophenol paste in root canals in monkey teeth have been described by Torneck, Smith and Girndall. Frank and Goldman have reported clinical success in obtaining apical end closure with calcium hydroxide pastes.' In 1964, Kaiser presented for the first time reports of root induction in nonvital permanent teeth following insertion of a Ca(OH)2-CMCP paste into thoroughly debrided root canals.2
When...