Apexification (root end closure)
Apexification is a method of inducing root end closure of an incompletely formed nonvital permanent tooth by removing the coronal and nonvital radicular tissue just short of the root end and placing a biocompatible agent such as calcium hydroxide in the canals for 2-4 weeks to disinfect the canal space. Root end closure is accomplished with an apical barrier such as MTA.
In instances when complete closure cannot be accomplished by MTA, an absorbable collagen wound dressing (eg, Colla-Cote®) can be placed at the root end to allow MTA to be packed within the confines of the canal space. Gutta percha is used to fill the remaining canal space. If the canal walls are thin, the canal space can be filled with MTA or composite resin in-stead of gutta percha to strengthen the tooth against fracture.
• Indications: This procedure is indicated for nonvital permanent teeth with incompletely formed roots.
• Objectives: This procedure should induce root end closure (apexification) at the apices of immature roots or result in an apical barrier as confirmed by clinical and radiographic evaluation. Adverse post-treatment clinical signs or symptoms of sensitivity, pain, or swelling should not be evident. There should be no radiographic evidence of external root resorption, lateral root pathosis, root fracture, or breakdown of periradicular supporting tissues during or following therapy. The tooth should continue to erupt, and the alveolus should continue to grow in conjunction with the adjacent teeth.
