Apexification is a method of inducing the development of root apex in an immature pulpless tooth by formation of osteocementum or other bone like tissue. Only the root apex is affected by apexification procedure. Generally, the apex assumes a blunt form. Lateral wall thickness and overall root length will not increase.It differs from apexogenesis, the physiologic process of root development.

Below are given the indications of Apexification, objectives of Apexification & Materials used for Apexification.

Indications for Apexification

1.   It is indicated in cases where there is no normal pulp tissue  i.e ,where the pulp has undergone irreversible pulpal necrosis.

2.   It is indicated for non-vital permanent teeth with incompletely formed roots.

3.   Normal root development takes place rarely.

Contraindications for Apexification

1.   All vertical and unfavourable horizontal root fractures

2.   Resorptions

3.   Short roots

4.   Periodontally broken down tooth

5.   Vital pulp

Factors Affecting Apexification

1.   Age of the patient

2.   Root development

3.   Location of apex

4.   Apical diameter

5.   Temporary restorations

Objectives of Apexification

1.   Apexification procedure should induce root end closure at the apices of immature roots, as evidenced by periodic radiographic evaluation.

2.   Post treatment, adverse clinical signs or symptoms such as a prolonged sensitivity, pain, or swelling should not be evident.

3.   There should be no evidence of abnormal canal calcification or internal or external root resorption, lateral root pathosis, or breakdown of periradicular supporting tissues during or following treatment of Apexification.

Materials  Required for Apexification

A number of materials and procedures have been recommended for apexification procedure:

1.   Antiseptic & antibiotic paste

2.   Zinc oxide & metacresylacetate-camphorated para-chlorophenol

3.   Tricalcium  phosphate

4.   Collagen-calcium phosphate gel

5.   Resorbable tricalcium phosphate

6.   Bone growth factors

7.   Ceramic

8.   Calcium hydroxide

Successful apexification has been shown to occur without any canal filling material at all, as long as removal of the necrotic pulp tissue is complete!

Thorough debridement and sealing of the root canal appear to be the most important factors for the  success.

Indications for Apexification

It is indicated in cases where there is no normal pulp tissue i.e, where the pulp has undergone irreversible pulpal necrosis.

It is indicated for non-vital permanent teeth with incompletely formed roots.

Types of closure

which can occur during Apexification

1. Root-end development in normal pattern

2. Apex closes but is wider at the apical end

3. Development of calcific bridge just coronal to apex

4. Formation of thin barrier at or close to the apex


The prognosis for a tooth that has undergone apexification is guarded.

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