12- necrotic teeth with immature apex

Characteristics of immature teeth

Thin dentinal walls

Susceptible to fracture during apexification

Short roots 

Unfavourable corono-radicular ratio

No apical stop for obturation

What is the initial vs after 48 hrs after traumatic injury?

Proliferation- 2mm depth of pulpal inflammation

Increased chance of bacterial contamination- zone of inflammation progresses apically 

Objective of endodontic procedures in teeth with open apex?

Create anatomical barrier 

What’s apexification and when is it mainly used?

Forms calcified barrier (apical stop) in tooth with open apex

Technique mainly used in non vital anterior teeth due to trauma or deep caries or anatomical variations (dens invaginatus)

What are the objectives and indications of pulpal revascularistation?

Recover pulp vitality so it continues root development

Incomplete root and pulp necrosis

Indications vs contraindications of apexification?

Immature teeth with pulp necrosis

All vertical and most horizontal root fractures, Very short roots 

How can you conduct apexification with calcium hydroxide?

Slide 9- condense- key points disinfect, wash out calcium hydroxide after 3 months, probe for a stop at the apex, wait anywhere from 3-18 months with CaOH

How can you conduct apexification with MTA?

Push calcium sulphate through apex for barrier- packs MTA

Leave MTA with wet pellet for 6 hrs to dry- then fill- can use thermoplastic technique 

Biological bases of pulpal revascularisation 

Slide 29 

What does the antibiotic paste placed in revascularistaion paste contain?

Double or triple

Triple- metronidazole, ciprofloxacin, minocycline

What anaesthesia is used in revascularisation process?

Local- 3% mepivacaine without vasoconstrictor

Need to allow bleeding to stimulate stem cells

1st session revascularisation 

Aq CaOH placed only ½ of root 

2nd appointment revascularisation? Summary on 44

Absolute isolation 

Canal system access

Remove temp medication with 17% edta

Dry canal with dry points 

Induce bleeding- over instrument with k25 file- blood clot forms which provides scaffold 

Place rype 1 collagen sponge 

What is a scaffold and its function and its types?

Slide 39 

What is hyaluronic acid and what is it used as?

Polysaccharide found in extracellular matrices- scaffold in tissue engineering- chemically modified so can be semi/synthetic

Primary scaffold

Supplement to the blood clot

Carrier for growth factors

What is apexogenesis and its indications?

Treat vital pulp of immature tooth- CaOH paste to dress wound 

Immature tooth with icomplate or oft and damage to coronal pulp 

Crown with possibility of restoration 

Contraindications of apexogenesis?

Avulsed, reimplanted or very dislocated teeth

Horizontal root fracture

Very decayed