Apexification

indirect pulp capping
calcium hydroxide
MTA

1. APEXIFICATION Method to induce a calcific barrier across an open apex of an immature pulpless tooth. Objective: To induce either closure of open apical third of root canal or formation of apical calcific barrier against obturation

2. MATERIALS USED FOR APEXIFICATION Collagen calcium phosphate gel Tricalcium phosphate Calcium hydroxide MTA

3. APEXIFICATION WITH CALCIUM HYDROXIDE

4. APEXIFICATION WITH CALCIUM HYDROXIDE

5. APEXIFICATION WITH CALCIUM HYDROXIDE

6. APEXIFICATION WITH CALCIUM HYDROXIDE

7. APEXIFICATION WITH MTA

8. APEXIFICATION WITH MTA

9. MTA MINERAL TRIOXDE AGGREGATE

10. MTA Mohammad Torabinejad (1993) Composition: Tricalcium silicate Dicalcium silicate Tricalcium aluminate Tetracalcium aluminoferrite Bismuth oxides Traces of free crystalline silica Traces of calcium oxide magnesium oxide potassium and sodium sulfate compounds

11. MTA Available in two forms Gray and white MTA Difference between two is lack of iron in tetracalcium aluminoferrite in white MTA.

12. MTA Advantage: Biocompatible Acceptable biological performance Superior structural integrity of dentinal bridging Resist future bacterial penetration Antimicrobial property Hydrophillic Alkaline ph – induce dentinogenesis Less microleakage

13. MTA Application: Root end fillings Perforation repair Pulp capping Pulpotomy Apexification

14. MTA Setting reaction: On hydration MTA result in formation of crystalline gel of hydrated components of MTA with trace formation of CH. It hardens in 3hours time

15. IPC INDIRECT PULP CAPPING

16. INDIRECT PULP CAPPING Procedure wherein the deepest layer of remaining affected carious dentin is covered with layer of biocompatible material in order to prevent pulpal exposure and further trauma to pulp

17. INDIRECT PULP CAPPING Objective: To preserve vitality of pulp by completing removing carious infected dentin

18. INDIRECT PULP CAPPING Diagnostic data: History: tolerable, dull pain with mild discomfort associated with eating, thermal stimulation. Clinical examination: large carious lesion without any frank pulpal exposure Positive response to electric test, thermal test, test cavity Normal to percussion

19. INDIRECT PULP CAPPING Diagnostic data: c) Radiographic examination: large carious lesion Involves 3/4 th thickness of dentin Lamina dura is intact

20. INDIRECT PULP CAPPING Clinical Procedure: 1 st appointment:

21. INDIRECT PULP CAPPING

22. INDIRECT PULP CAPPING (2 nd appointment)

23. INDIRECT PULP CAPPING (2 nd appointment)

24. INDIRECT PULP CAPPING Reason for 2 steps: Avoids unintentional pulpal exposure which might deteriorate pulpal prognosis. Gain information about changes in caries activity

25. INDIRECT PULP CAPPING Treatment outcome: Remaining Dentin Thickness: 2.0-0.5 mm- good prognosis as secretion of reactionary dentin is more 0.5-0.25 mm- prognosis decreases as reduce number of odontoblastic activity. b) Choice of IPC agents: Calcium hydroxide MTA Biodentin