APEXIFICATION

Abstract

INTRODUCTION

Conventional endodontic treatment of immature non vital teeth is impractical as chances of fracture of thin walls of root and inability to achieve proper apical seal will lead to failure. It is imperative to create an artificial apical barrier or induce the closure of apical foramen with calcified tissue [1]. Apexification is the method to induce apical closure to produce favorable condition for conventional root filling [2]. Endodontic infections are mixed infection of poly microbial etiology. Siqueira et al. found high level of Porphyromonas gingivalis by using polymerase chain reaction and checkerboard  technique [3]. Baumgartener et al. reported high prevalence of spirochetes in endodontic infections using different molecular methods [4]. Use of calcium hydroxide as intra canal medication resulted in reduction of most of species but some of the species such as Enterococcus faecalis were refractory to therapy [5]. Calcium hydroxide activity is related to close contact with lethal hydroxyl ions. Some bacteria can be lodged in dentinal tubules and evade the ions [6]. Apexification procedure requires chemico mechanical debridement of canal followed by placement of an intra canal medicament to stimulate apical bridge formation. Calcium hydroxide paste has become the material of choice to induce apexification [7]. It has anti bacterial activity due to its high alkaline nature and plays an important role in re mineralization process [8]. Apexification is not a static phenomenon and apexified area undergoes through the years to a conspicuous readjustments involving bone, apical root tissue and root filling material [9]. Many authors have recommended the use of intra canal medication with antimicrobial activity between therapy sessions to eliminate persistent microorganism in case of pulp necrosis [10]. This report presents a case in which single visit apexification was performed to induce apical closure to allow successful endodontic treatment in carious non vital immature right mandibular second premolar tooth.