Endodontics
Course Review
Enoch Ng, DDS 2014
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Apexification
o
Induce calcified barrier in root with open apex for tooth with necrotic pulp
o
Often blunting of root end with little/no length increase
o
Clean/shape tooth and remove debris to create favourable environment for forming barrier
Use CaOH to induce hard tissue to help prevent overfill
o
Indications
Necrotic tooth with open apex
Compliant patient willing to return for multiple appointments
Restorable tooth
o
Technique
Rubber dam, local anesthesia
Access – large to accommodate larger instruments
Length determination from radiographs
Irrigation with NaOCl
Ca(OH)
2
delivered to working length
Lasting provisional with excellent seal
Recall patient every 3 months to wash out Ca(OH)
2
and inspect calcified barrier
Treatment may take 9-24 months
Obturate with gutta percha, permanent coronal restoration
o
Apical barrier
Blockage of apical foramen, may be an induced hard tissue or artificial material
May use single visit and create barrier with MTA
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Revascularization
o
Promote revascularization of immature permanent tooth with infected necrotic pulp and apical
periodontitis or abscess – remove pathosis and induce angiogenesis in canal
o
Minimal/no mechanical instrumentation
o
Copious antiseptic irrigation of canals with disinfection by triple antibiotic
Has been shown radiographically to induce increased canal wall thickening via hard tissue and
continued root development
o
Indications
Same as apexification