Apexificiation Flashcards
What is the process that takes an open apex on a NECROTIC IMMATURE root and closes it?
Apexification
What are 3 methods used to close the open apex on a necrotic immature root: apexification?
- Ca(OH)2
- MTA
- Triple Antibiotic
The Ca(OH)2 method for apexification seeks to do what on the open apex of a necrotic immature root?
Stimulate formation of a calcified barrier across the apex of an immature tooth
The MTA method for apexification does what on the open apex of a necrotic immature root?
Seek to revascularize or regenerate pulp
Apexification done via Ca(OH)2 placed then changed periodically for up to 2 years, then eventually obturated with Gutta percha had what benefit?
Predicatble
What were 2 disadvantages of the apexification done via Ca(OH)2?
- Required multiple appointments so patient compliance was an issue
- Increased susceptibility to cervical fracture
Apexification using MTA is called what?
Apical barrier technique
Does the apical berrier technique for apexification where MTA is placed in the open apex of a necrotic immature tooth promote thickening of root wall or continued development of the root?
No
What are the levels of materials from apex to crown for the artificial barrier technique with MTA?
- MTA (Apex and into canal)
- Gutta Percha (Canal)
- Glass ionomer (canal and access)
- Composite (final restoration coronally)
What apexification method seeks to re-establish environment in which root apex may continue to form both in root length and root wall thickness?
Revascularization/regeneration via Triple antibiotic paste and blood clot stimulation
What ist he first step after instrumentation for revascularization/regeneration?
Disinfect root with sodium hypochlorite or chlorhexidine
After the root has been disinfected, what is placed in the canal for revascularization / regeneration?
Disinfect root with sodium hypochlorite or chlorhexidine
After the root has been disinfected, what is placed in the canal for revascularization / regeneration?
- Triple Antibiotic Paste
- Ciprofloxacin
- Metronidazole
- Minocycline
After the Triple Antibiotic paste is placed, what is done and why for revascularization / regeneration?
Stimulation of blood clot at apex to serve as scaffold for regeneration of apical tissue
Once Triple Antibiotic paste is in and blood clot has been stimulated, what is placed on top of the clot for revascularization / regeneration?
MTA
What is placed on the MTA that is placed on top of the clot for revascularization / regeneration?
Glass ionomer and composite
One the case Dr Replogle posted for Vital Pulp therapy that was treated via revascularization / regeneration, how many appointments did hte procedure take?
First Appointment: antibiotic paste placed, covered with cotton pellet and cavit
Second Appointment: reaccess, irrigate, place Callotape scaffold after stimulating blood clot, cover with MTA, cotton pellet, cavit
Third Appointment: reaccess, ensure MTA set, final restoration
What are the challenges with immature non-vital tooth?
Thin, weak, root wall
Large apex hard to completely obdurate
What was the intracanal medicament used after irrigation with NaOCl on immature non-vital tooth?
Ca(OH)2 creamy for more than 7 days
What was the success rate for a Ca(OH)2 apexification if no apical hard tissue barrier was generated?
Less than 50%
What was the success rate for a Ca(OH)2 apexification if a hard tissue barrier was generated?
About 90%
For the Ca(OH)2 apexification, what was the consistency of the final Ca(OH)2 that was placed?
Stiff long term Ca(OH)2
What is the expected percentage of immature non-vital teeth fracturing if nothing is done to strengthen the root wall?
About 30% expected to fracture
What are 3 disadvantages of the traditional (Ca(OH)2) apexification method?
- Long treatment procedure (decreased patient compliance)
- Long-term Ca(OH)2 weakens tooth
- Chance of tooth fracture
