Radiographic appearance of apical closure in apexification: follow-up after 7-13 years

This was the radiographic evaluation of 15 maxillary incisors apexification treatment carried out on 7-9 years old patients with periapical pathology due to pulpal necrosis after dental trauma.

The treatment consisted of two phases. The aim of first phase was the formation of a calcified apical barrier through calcium hydroxide medications repeated twice with a three months interval. The aim of the second phase was the obturation of the root canal system once achieved a radiographic evidence of the formation of an apical barrier. The treated teeth were radiographed at six months and then periodically once a year for a period of 7 and 13 years.

The radiographic analysis allowed to underline three different kinds of apical formation: a physiological development of the apical portion with a final root length equal to the contralateral tooth; the formation of a cap tissue and an apical development with the final root length slightly shorter than the contralateral tooth; or the formation of different layers of mineralised tissue that aggregate together trough the years.

Apexification is not a static phenomenon and the apexified area undergoes through the years to a conspicuous readjustment involving bone, apical root tissues and root filling material.