Apexification is a procedure a dentist or endodontist performs to close the end of an open tooth root. It's often required for treating permanent teeth with incompletely formed roots that require root canal therapy. This straightforward procedure can usually be completed in a few hours by a dentist or by a root canal specialist called an endodontist.
The Apex of a Tooth
Apexification is named after the part of the tooth it treats: the apex. The American Dental Association defines apex as the base of the tooth root. Your teeth roots extend under the gum and into the jawbone and contain the blood vessels and nerve fibers that keep the tooth alive.
In developing teeth, the apex is open and remains open while the tooth grows. It usually takes three years for the apex to fully close once the tooth erupts into the mouth, according to Scottish Dental Magazine. While this open apex is normal in a child's growing tooth, it provides access for bacteria to enter the nerve and other structures contained within the tooth's inner pulp. The Iranian Endodontic Journal points out that an open apex also presents a challenge when filling a tooth with root canal material since there is no natural stop to contain the filling.
Preparing for a Root Canal
Unfortunately, some teeth may need root canals before the apex fully closes. This can happen if a tooth is injured and dies before fully forming its roots, or if a cavity reaches the nerve of the tooth. The American Academy of Pediatric Dentistry suggests that the ideal outcome is to allow the tooth to continue to erupt and the bone surrounding it to continue to grow alongside the adjacent teeth. This requires treatment of the immature root. If your dentist decides the treatment of choice is a root canal, they will look at the anatomy of the root first. If the apex is open, and the tooth is or will become non-vital, apexification is usually necessary.
The Apexification Process
Root canals and apexifications are usually performed in the regular dental office under local anesthetic. Your dentist will clean out the root of the tooth and seal the end of the root canal with a chemical material. The Scottish Dental Magazine lists mineral trioxide aggregate and calcium hydroxide as two common sealing materials. Both substances form a hard layer over the apex called a calcific barrier. While some teeth may require further treatments, most easily form a calcified apex. This hardened plug is visible on X-rays after the apexification is performed.
After undergoing an apexification, your tooth will need follow-up treatment. Over at least a six-month period, your dentist may replace the filling material in the tooth depending on which material was used. They will also regularly take X-rays and test the tooth to make sure it can feel normal sensations like temperature and pressure. When the root apex is sealed, the root canal can be finished and a final restoration like a filling or crown can be placed on the tooth.
Very little home care is needed if you're recovering from a root canal or tooth apex procedure. Your dentist may ask you to be careful of biting your cheek and lip since your mouth will be numb for a few hours following the procedure. Be sure to follow your dentist's instructions for any home care, including brushing and flossing your new restoration.