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25 Cards in this Set
- Front
- Back
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Define: regenerative endodontics
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Revascularization/regeneration procedure for necrotic teeth using antibiotic paste in root canal system to create environment for angiogenesis.
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Define: Apexification
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method used to induce apical closure (osteocementum) in an incompletely formed non-vital tooth
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Define: Apexogenesis
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vital pulp therapy of an incompletely formed tooth to allow root to mature and close naturally
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Objective of apexification tx?
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- stimulate the formation of a hard tissue barrier/calcified tissue at the apex
- fill the root canal system in 3 dimensions - keep the filling material in the root canal system |
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What endo and/or perio diagnosis can you expect prior to apexification?
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endo: pulp necrosis
perio: sometimes PA lesion present so dx would be Asymptomatic/symptomatic apical periodontitis; Chronic apical abscess |
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Apexification: Access
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- straight line access to apical 3rd
- removal of all remaining radiculal pulp, incl. removal of pulp horns |
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Apexification: instrumentation
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Use a larger file (support in place if needed with cotton pellet),
- do not increase 3 sizes up (apical stop is not necessary) - Apex locators will NOT work here |
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Apexification: drying canal
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paper points can be used upside down
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Apexification: placement of calcium hydroxide
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Ca(OH)2 placement – place paste (water/glycerin based) with lentulospiral
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Apexification: traditional method
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- takes mth-years
- Re-evaluate 6wks – 3mths – 6 mnths -Lengthen period if not washed out - Radiograph q6mo (may be misleading because B-L dimension last to converge) - Therefore, also check dynamically w/ #40 to see if hard tissue formation at apex has occured |
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Apexification: contemporary method
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– short period of time to disinfect before placing a barrier (ie. MTA)
- After several weeks, bring the pt back to create an apical plug with MTA “immediate apexification” - Obturate w/ GP & restore with composite to pvt fracture |
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Traditional apexification: recall and maintenance
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• Recall – 6 wks → 3 mo → 6 mo to maintain Ca(OH)2 and assess barrier
- hard tissue barried must form prior to removal of Ca(OH)2 |
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How to seal following apexification
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- Cotton pellet + hard setting temp material
- (Cavit is a good seal but need something with great compressive strength as well) - cavit can be used in double seal tecnique: cotton/cavit/hard setting temp |
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Precaution when using CaOH?
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may get into patients eyes, use saftey glasses! (CaOH2 has pH of 12.9)
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Traditional apexification: final obtruation
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- large GP cone (upside down, roll multiple cone, thermoplasticized GP, etc.)
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What are the uses for Ca(OH)2?
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1. vital pulp therapy
- direct pulp cap - indirect pulp cap - pulpotomy (permanent teeth) 2. open apex - apexification 3. Intracanal dressing |
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So.. what is apexogenesis?
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VITAL pulp therapy of an incompletely formed tooth to allow root to mature and close naturally
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Apexogenesis: Diagnosis
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Vital pulp
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Apexogenesis: access
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only to level of vital tissue, do NOT file to WL (can do w/o LA)
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What follows access preparation?
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Amputate coronal pulp to level of healthy pulp (or chamber, in multirooted teeth)
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What to used to control hemorrhage?
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- pressure with NAOCl soaked cotton balls
- CaOH2 powder, then rinse away - MTA |
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Describe the placement of medicatment
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- Ca(OH)2
- Dycal over remaining pulp stumps - IRM as a base and temp filling material - MTA to cap remaining pulp |
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Apexogensis: Seal
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- place permanent restoration over IRM/GIC base
- usually done at first visit |
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Apexogenesis: Recall
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- 6 mo, 1 yr, 2 yr to observe pulp vitality and apex closure
- Endo tx (if necessary) – necrosis, PA involvement, or symptoms |
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What is the main determinant in healing of exposed pulp?
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microbial flora
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