The calcium hydroxide is placed in the root canal to stimulate a hard tissue cementoid or osteoid barrier across the wide-open apex prior to placement of a permanent root filling. The barrier formation prevents overextension of root filling material into the surrounding peri-apical tissues. Studies have demonstrated that repeated dressing changes initially at 1 month, and then 3-month intervals thereafter can result in barrier formation anywhere from 4 to 9 months. The calcium hydroxide acts as a mild inflammatory stimulant that initially causes necrosis of the tissue surface with calcification over time. Calcium hydroxide is antibacterial due to its inherent high pH

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Murugesan Gawthaman, E-mail: moc. This article has been cited by other articles in PMC. Abstract The completion of root development and closure of the apex occurs up to 3 years after the eruption of the tooth. The treatment of pulpal injury during this period provides a significant challenge for the clinician. The importance of careful case assessment and accurate pulpal diagnosis in the treatment of immature teeth with pulpal injury cannot be overemphasized.

The treatment of choice for necrotic teeth is apexification, which is induction of apical closure to produce more favorable conditions for conventional root canal filling. The most commonly advocated medicament is calcium hydroxide, although recently considerable interest has been expressed in the use of mineral trioxide aggregate MTA.

We report a case series wherein calcium hydroxide and MTA were used successfully for one step apexification in teeth with open apex. These injuries often result in pulpal inflammation or necrosis and subsequent incomplete development of dentinal wall and root apices. Apicoectomy further reduces the root length resulting in a very unfavorable crown root ratio. The use of calcium hydroxide was first introduced by Kaiser in who proposed that this material mixed with camphorated parachlorophenol CMCP would induce the formation of a calcified barrier across the apex.

Calcium hydroxide can be mixed with a number of different substances camphorated mono chlorophenol, distilled water, saline, anesthetic solutions, chlorhexidene and cresatin to induce apical closure.

It has been used in both surgical and non-surgical applications. There was a history of trauma to the same tooth due to fall about 4 days back. Periapical radiograph showed incomplete root formation with wide open apices for the same tooth [ Figure 1 ]. Apexification with calcium hydroxide dressing was planned. In the first visit, an access cavity was prepared with a straight line entry into the root canal.

The working length was established within one mm of the radiographic apex by using size 30 Hedstrom file. Next, pulp extirpation and complete debridement of the canal was done using H file number 40 followed by copious irrigation with normal saline. After drying of the canal using paper points, calcium hydroxide powder was mixed with normal saline and this mixture was placed into the canal and pushed to the short of apex using plugger. Access opening was restored with glass ionomer cement [ Figure 2 ].

Patient was called after 3 months. After 3 months when patient came back, a periapical radiograph was taken, which showed complete formation of the root apex in maxillary right central incisor, without any signs and symptoms and periapical radiolucency. In the next visit, complete obturation was carried out with GP using lateral condensation technique [ Figure 4 ] followed by composite restoration.


Apexification, apexogenesis and regenerative endodontic procedures: a review of the literature.

Salkis Pulp capping of carious exposures: Dentine bridge formation at the site of pulpal exposure was also rfview in both cases. Maturogenesis of a cariously exposed immature permanent tooth using MTA for direct pulp capping: The pulp provides a matrix for binding of its cells and provides support allowing communication between the cells. According to Trope, 4 the area and depth of inflammation in cariously exposed pulps are very unpredictable, and pulp capping at the superficial exposure site can result in failure. At a four-year recall visit, the radiograph revealed closure of the apices of the mesial and distal roots and an increase in the thickness of the dentine bridge formation Figure 3c.


Apexogenesis, Apexification, Revascularization and Endodontic Regeneration


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