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xD3 Endo Midterm > Apexificiation > Flashcards

Apexificiation Flashcards

1
Q

What is the process that takes an open apex on a NECROTIC IMMATURE root and closes it?

A

Apexification

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2
Q

What are 3 methods used to close the open apex on a necrotic immature root: apexification?

A
  1. Ca(OH)2
  2. MTA
  3. Triple Antibiotic
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3
Q

The Ca(OH)2 method for apexification seeks to do what on the open apex of a necrotic immature root?

A

Stimulate formation of a calcified barrier across the apex of an immature tooth

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4
Q

The MTA method for apexification does what on the open apex of a necrotic immature root?

A

Seek to revascularize or regenerate pulp

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5
Q

Apexification done via Ca(OH)2 placed then changed periodically for up to 2 years, then eventually obturated with Gutta percha had what benefit?

A

Predicatble

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6
Q

What were 2 disadvantages of the apexification done via Ca(OH)2?

A
  1. Required multiple appointments so patient compliance was an issue
  2. Increased susceptibility to cervical fracture
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7
Q

Apexification using MTA is called what?

A

Apical barrier technique

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8
Q

Does the apical berrier technique for apexification where MTA is placed in the open apex of a necrotic immature tooth promote thickening of root wall or continued development of the root?

A

No

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9
Q

What are the levels of materials from apex to crown for the artificial barrier technique with MTA?

A
  1. MTA (Apex and into canal)
  2. Gutta Percha (Canal)
  3. Glass ionomer (canal and access)
  4. Composite (final restoration coronally)
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10
Q

What apexification method seeks to re-establish environment in which root apex may continue to form both in root length and root wall thickness?

A

Revascularization/regeneration via Triple antibiotic paste and blood clot stimulation

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11
Q

What ist he first step after instrumentation for revascularization/regeneration?

A

Disinfect root with sodium hypochlorite or chlorhexidine

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12
Q

After the root has been disinfected, what is placed in the canal for revascularization / regeneration?

A

Disinfect root with sodium hypochlorite or chlorhexidine

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13
Q

After the root has been disinfected, what is placed in the canal for revascularization / regeneration?

A
  1. Triple Antibiotic Paste
  2. Ciprofloxacin
  3. Metronidazole
  4. Minocycline
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14
Q

After the Triple Antibiotic paste is placed, what is done and why for revascularization / regeneration?

A

Stimulation of blood clot at apex to serve as scaffold for regeneration of apical tissue

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15
Q

Once Triple Antibiotic paste is in and blood clot has been stimulated, what is placed on top of the clot for revascularization / regeneration?

A

MTA

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16
Q

What is placed on the MTA that is placed on top of the clot for revascularization / regeneration?

A

Glass ionomer and composite

17
Q

One the case Dr Replogle posted for Vital Pulp therapy that was treated via revascularization / regeneration, how many appointments did hte procedure take?

A

First Appointment: antibiotic paste placed, covered with cotton pellet and cavit
Second Appointment: reaccess, irrigate, place Callotape scaffold after stimulating blood clot, cover with MTA, cotton pellet, cavit
Third Appointment: reaccess, ensure MTA set, final restoration

18
Q

What are the challenges with immature non-vital tooth?

A

Thin, weak, root wall

Large apex hard to completely obdurate

19
Q

What was the intracanal medicament used after irrigation with NaOCl on immature non-vital tooth?

A

Ca(OH)2 creamy for more than 7 days

20
Q

What was the success rate for a Ca(OH)2 apexification if no apical hard tissue barrier was generated?

A

Less than 50%

21
Q

What was the success rate for a Ca(OH)2 apexification if a hard tissue barrier was generated?

A

About 90%

22
Q

For the Ca(OH)2 apexification, what was the consistency of the final Ca(OH)2 that was placed?

A

Stiff long term Ca(OH)2

23
Q

What is the expected percentage of immature non-vital teeth fracturing if nothing is done to strengthen the root wall?

A

About 30% expected to fracture

24
Q

What are 3 disadvantages of the traditional (Ca(OH)2) apexification method?

A
  1. Long treatment procedure (decreased patient compliance)
  2. Long-term Ca(OH)2 weakens tooth
  3. Chance of tooth fracture
25
Q

What is an alternative treatment for immature non-vital tooth besides the traditional (Ca(OH)2) apexification?

A

MTA apical barrier technique

26
Q

Is the MTA apical barrier technique one step?

A

No, requires disinfection and cervical root strengthening

27
Q

What is the principle factor for failure of revascularization?

A

Bacterial contamination

28
Q

What is the difference in bacterial load for an avulsed / replanted immature tooth vs an infected immature tooth?

A

Avulsed has no canal bacteria

Immature canal has canal bacteria

29
Q

What type of scaffold is present in an avulsed / replanted immature tooth vs infected immature tooth?

A

Avulsed has a necrotic pulp scaffold

Immature infected has no scaffold

30
Q

What is another potential bacterial entrance difference between avulsed / replanted immature tooth vs infected immature tooth?

A

Avulsed has no coronal access

Infected has a coronal access

31
Q

What are the concentrations of metronidazole, ciprofloxacin, and minocycline in the triple antibiotic paste for revascularization / regeneration?

A

20 mg each

32
Q

What is the advantage of triple antibiotic paste over Ca(OH)2?

A

Triple antibiotic paste does not necrose vital tissue apically as Ca(OH)2 will

33
Q

What has been show to be important in promoting revascularization in disinfected canals?

A

Blood clot

34
Q

What is another factor important in the success of revascularization / regeneration after disinfection and scaffold have been placed?

A

Bacteria tight seal

35
Q

What is indicated if revascularization fails in a non-vital immature tooth?

A

MTA Apical Barrier

xD3 Endo Midterm (7 decks)

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