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Apexification: Getting to the Root of Your Dental Issues

Apexification is a procedure that closes 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. If you or someone you know is undergoing an apexification, here is some helpful information to know before you head to your appointment.

The Apex of a Tooth

Apexification is named after the part of the tooth it treats, the apex, also known as the base of the tooth root. The roots of your teeth extend under the gum and into the jawbone. They 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. According to Scottish Dental Magazine, it usually takes three years for the apex to close once the tooth appears in the mouth fully. While this open apex is expected in a child's growing tooth, it provides bacteria access to enter the nerve and other structures within the tooth's inner pulp. Additionally, an open apex can present a challenge when filling a tooth with root canal material since there is no natural barrier to contain the filling.

Preparing for a Root Canal

Unfortunately, some teeth might need root canals before the apex fully closes as a child. This situation can happen if a tooth is injured and dies before fully forming its roots or if a cavity reaches the tooth's nerve. The American Academy of Pediatric Dentistry suggests that the ideal outcome is to allow a child's tooth to continue to erupt and the bone surrounding it to continue to grow alongside the adjacent teeth, which requires treatment of the immature root. If you and your child's dentist decide the best treatment is a root canal, the dentist will look at the root's anatomy 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 apexification procedures are usually performed in a regular dental office under local anesthetic. The apexification process is usually uncomplicated: Your dentist will clean out the root of the tooth and seal the root canal's end with a chemical material. Two common sealing materials are mineral trioxide aggregate and calcium hydroxide. Both substances form a hardened layer over the apex, called a calcific barrier. While some teeth might require further treatments, most easily create a calcified apex. This hardened plug is visible on X-rays after the apexification occurs.

Follow-Up Care

About six months after your apexification procedure, you will usually need follow-up treatment for your dentist to replace the tooth's filling material. They will also regularly take X-rays and test the tooth to make sure it can feel normal sensations, such as temperature and pressure. After sealing the root apex, the dentist can finish the root canal and place a final restoration, such as a filling or crown, on the tooth.

Very little home care is needed if you're recovering from a root canal or tooth apex procedure. Since your mouth might be numb for a few hours following the procedure, your dentist might warn you about biting your cheek and lip. Be sure to follow your dentist's instructions for any home care, including brushing and flossing your new restoration.

Apexification is not as big and complicated as its name might sound. It's a fairly common procedure, so there is no reason to fear. With the help of your dentist or endodontist, apexification can help give you back the confident and healthy smile you love.

This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.

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