Apexification can be defined as a procedure used to treat a specific root canal problem.

The root canal system is the natural cavity within the center of the tooth that contains the dental pulp and extends from the crown of the tooth to the end of the root (the apex).  Teeth always have at least one root, and each root always has at least one root canal.

The root canals of most teeth are tapered from the crown to the root end, and can be treated with conventional methods.  However, some teeth have an opening at the bottom of the root canal that has not closed, called an open apex.  It is most commonly found in teeth that are not fully developed (usually in children) but can also be found in mature teeth whose roots have eroded.  Apexification is a treatment used to create a calcified/solid barrier (the recalcification) at the tooth root’s open apex.

There are several reasons this root canal problem can occur:

  • An injury has moved a tooth out of place
  • A tooth has been chipped or cracked
  • A tooth has been knocked our completely

If these occur, it is recommended to see an endodontist immediately for emergency care.  Even if the injury does not cause severe pain, it can lead to a serious infection or issues with the surrounding healthy teeth, and that can lead to expensive and complex treatment down the road.

Front tooth injury is most common in children, and if the nerve becomes non-vital (dead) the natural root development stops.  The tooth then requires a root canal to prevent problems like pain and dental abscesses from developing.  When tooth roots are not fully formed in young children, they are weaker and can fracture easily.  It is difficult to do root canal treatment in a tooth that is not yet fully formed because the filling cannot be placed when the end of the root is open.  Then apexification to seal the opening must be done.

An alternative treatment under study (showing excellent results), to accommodate healing by stopping infection and closing the root end, involves ‘revascularisation’ (recovery of the blood supply to the tooth), accomplished by the use of a triple antibiotic paste that allows ‘natural’ root growth to restart, and also strengthens the walls of the root. Treatment can often be completed in just two visits.

During treatment the dentist or endodontist will:

  • Remove the root pulp and clean and shape the root canal.
    • Insert a medication (usually calcium hydroxide) and seal the cavity with temporary filling.
    • Replenish the medication at intervals of 2 to 4 months until a solid barrier is formed at the end of the root.

There is a newer one-step procedure using a material called mineral trioxide aggregate (MTA).  An even newer treatment is with Biodentine, a bioactive and biocompatible calcium-based cement — part of a new approach seeking to simplify clinical procedures.  However, even though the treatment may be completed in one visit, it will still be necessary for the patient to return to the dentist for final tooth restoration.

There is no way to determine in advance the number of visits and extent of treatment because it varies with each case.  Once a barrier has formed at the root end, the patient can then return to the dentist for final tooth restoration, i.e. filling, crown, etc.

When there is an open apex, it is critically important that it be treated promptly in order to protect the tooth roots and save the tooth.  Deterioration can happen rapidly.  The apexification is usually, but not always successful, and if the barrier does not form properly, or the process of resorption continues, the endodontist may recommend a surgical procedure or tooth extraction.

Just as in other fields, in the last 15 years, there has been an explosion in the development of new technologies, instruments, and materials for nonsurgical and surgical endodontics. These developments have improved the precision with which endodontics is performed.  Clinicians can now complete procedures that were once considered impossible or that could be performed only by talent or with luck.  The most important of these advancements has been the introduction and widespread adoption of the operating microscope (OM).

OMs have been used for decades in other medical disciplines: ophthalmology, neurosurgery, reconstructive surgery, otorhinolaryngology, and vascular surgery. Its introduction into dentistry in the last 15 years, particularly in endodontics, has revolutionized how endodontics is practiced worldwide.   Before the OM, if a problem was encountered (a ledge, a perforation, a blockage, a broken instrument) it was only ‘‘felt,’’ meaning most endodontic procedures occurred in a visual void, which placed a premium on the doctor’s tactile dexterity, mental imaging, and perseverance.  Now every challenge existing in the straight portion of the root canal system, even if located in the most apical (deepest) part of the root, can be easily seen and competently managed under the OM, and that’s very good news for patients needing this treatment.

If you are interested in apexification / recalcification in Costa Rica, fill out the “Find a Dentist” form on this page.  One of our patient advocates will reply to your needs.