Apexogenesis, Apexification, and Regeneration Flashcards
apexogenesis main concept with it
maintain the pulp vitality
goal of apexogenesis
preservation of vital pulp tissue so that continued root development with apical closure may occur
when can you do apexogensis
addressing the shortcomings involved with capping the inflamed detnal pulp of an INCOMPLETELY DEVELOPES
what are two components you consider with these therapies
- PULP VITALITY
- AGE OF PATIENTS
- same clinical picture
choice of tx with necrotic 10 years old vs necrotic and 25 years old
- 10 years – regeneration
2. 25 years – apexification
apexification procedure aims to do what
form a plug at the apex
- induce a hard tisssue barrier in a tooth with an open apex
- or the continued apical developmment of an incomplete root in teeth with apical periodontisis
pulp reaction to caries
poor tolerance to injury
large volume of tissue with a small volume of blood supply
terminal circulation (collateral vessels?)
confined in calcified tissue
carries progressiuon what radiograph ? what is the bacterial penetration
BITEWING
bacterial penetration that is less than .75 mm away from the pulp
carries progressiuon what radiograph ? what is the bacterial penetration
BITEWING
bacterial penetration that is less than .75 mm away from the pulp
vital pulp therapy example
apexogenesis
clincial procedure of apexogenesis is basically a
a deep pulpotomy
how do you apexogeneis (3)
- direct pulp capping
- indirect pulp capping
- pulpotomy
indirect
still some dentin between pulp and p
direct
right into the pulp
pulpotomy
resecting coronal part
indications for vital pulp therapy
- truamatic injuries
mm for indirect vs direct pulp cap
less than 2mm – can do a DIRECT PULP CAP
material of choice for pulpotomoy
MTA (or a bioceramic)
follow up after pulp capping and pulpotomy
should be seen periodically for the next 2-4 years
evidence that an apexogenesis was successful?
continued root formation/ development (length and wall thickness) and calcific batterir formation in response to the dressing
apexification is what?
root-ended closure, whereby a NON-VITAL, IMMATURE, PERMANENT tooth has LOST the ability for further root development is induced to form a calcified barrier at the root terminus
what will apexification NOT cause
will NOT CAUSE further root development in terms of length or wall thickness
apexification acts as a?
barrier so your root canal filling can be compacted with length control
- considered a last resort treatment
why apexificatoin instead of conventional RCT?
- open apex
- blunderbuss canals
- thin and fragile canal walls
- absolute dryness of canals diffult to achieve
Advantages of MTA/ bioceram with apexification
- reduction in tx time
- biocompatible material
- osteo-inductive properties
- moisture compatibility
- No CaOH disadvantages
Advantages of MTA/ bioceram with apexification
- reduction in tx time
- biocompatible material
- osteo-inductive properties
- moisture compatibility
- No CaOH disadvantages
regeneration advantages
- root elongation
- thickening of roots
- formaiton of morphologic apex
flow chart that reaches regeneration
pulp exposure – non-vital pulp– open apex (immature) –young patient – regeneration
rely on what in regeneration
apical stem cells
apical dental papilla
if successful what does regeneration allow for
continued root development, thicker dentin walls, longer root length, and a closed apex, thus reducing the risk of fracture, in immature and structurally vulnerable teeth
biological principles of regeneration (3 aspects that are required)
- scaffold
- progenitor or stem cells
- growth factors
what differentiation do you need
stem cells capable of differentiating into an odontblast
adult stem cells are what type?
describe
multipotent
- divide and create another cell like itself, also a cell more differentitated than itself
ability to divide into other cell types is more limited
adult stem cells are what type?
describe
multipotent
- divide and create another cell like itself, also a cell more differentitated than itself
ability to divide into other cell types is more limited
scaffold describe and give examples
provides support for cell organization, proliferation, differentiation and vascularization
mostly utalized scaffolds are dentin or blood clot
others
- platalet rich plasma
- biodegradable or permanent or syntehtic scaffolds
can you intrsument a regeneration case?
NO – you will get rid of the growth factors!
previously instrumented is no good for regeneration
can you intrsument a regeneration case?
NO – you will get rid of the growth factors!
previously instrumented is no good for regeneration
age range for regeneration recommended by ADA
6-18 years old
step 1 for regeneration
everything youd do for access and irrigate with diluted hypochloride
1.2-2.25?
what happens if leave calcium hydroxide in tooth for 4 weeks
it can weaken the dentin
how long doyou leave calcium hydroxide in teh tooth for
2-3 weeks
do you use epinephrine in regeneratin? why?
NO
- rely on scaffolding and need the bleeding so we do not want to lose the scaffolding
LA use for regeneration
mepivicaine 3%
step 2 do you use sodium hypochloride?
NO – only EDTA
step 2 do you use sodium hypochloride?
NO – only EDTA
three goals for regenration? set by?
general
primary
secondary
tertiary
primary goal of regenration
elimination of symptoms and evidence of bony healing
secondary goal
increased root wall thickness and/or increased root length
tertiarty goal
positive response to vitality testing
ultimate goal of regeneration*
histologic confirmation of functional dental pulp (with an intact odontoblastic layer)
