Calcium hydroxide apexification of a large apical lesion

Abstract EN

Apexification is the standard procedure for the management of immature non-vital teeth.

This report presents a case of a traumatic injury to a maxillary central incisor that lead to total pulp necrosis and a large periapical lesion.

Calcium hydroxide apexification was used successfully in the treatment of this case. Key Words : Calcium hydroxide, apexification Introduction: Endodontic treatment of necrotic teeth with open apices is a challenge.

When teeth with incomplete root formation suffer pulp necrosis the formation of dentine stops and root development ceases.

Consequently the canal remains large with thin and fragile walls and the apex remains open.

Until recently, surgical intervention was considered to be necessary for treating endodontic periapical lesions particularly when they were large. Endodontic treatment of these teeth is often complicated because the larger apical versus smaller coronal canal diameter makes debridement difficult and the lack of an apical stop, such as the apical constricture of a mature root, makes obturation impossible; also the thin root canal walls are more prone to fracture / 1'2) It is imperative to create an artificial apical barrier or to induce the closure of the apical foramen with apexification, the process of creating an environment within the root canal and periradicular tissues after pulp death that allows a calcified barrier to form across the open apex (3' 6).

The creation of the proper environment to form a calcified barrier involves: cleaning and shaping the tooth in order to remove debris and bacteria, followed by placement of a paste to the apex.

Calcium hydroxide was found to be the material of choice for apical barrier formation and healing.(2, 4)