Apexification: follow-up after 6-12 years

Area of Science:

• Dentistry
• Endodontics
• Regenerative Dentistry

Background:

• Immature permanent anterior teeth with open apices present a challenge in endodontic treatment.
• Apexification aims to induce root end closure, enabling conventional root canal filling.
• Calcium hydroxide has been a widely used intracanal medicament for apexification.

Purpose of the Study:

• To evaluate the long-term clinical and radiographic outcomes of apexification using calcium hydroxide (Ca(OH)2) as a root canal dressing.
• To assess the stability and consolidation of the dentinal bridge formation over an extended follow-up period.

Main Methods:

• Thirty immature permanent anterior teeth with open apices were treated with Ca(OH)2 as an intracanal dressing.
• Clinical and radiographic assessments were performed at follow-up intervals, with a mean observation period exceeding 6 years (up to 12 years).
• Evaluation focused on the status of the dentinal bridge, periapical radiolucency, and clinical signs of success or failure.

Main Results:

• A significant proportion of teeth (15/30) demonstrated stable dentinal bridge formation.
• Further consolidation of the dentinal bridge was observed in 10 out of 30 teeth.
• A decrease in bridge consolidation was noted in 3 teeth, with one showing reappeared periapical radiolucency.
• Two teeth with questionable consolidation were clinically asymptomatic.
• Two teeth were extracted due to discolouration during the observation period.

Conclusions:

• Calcium hydroxide as a root canal dressing is effective in achieving long-term apexification in immature permanent anterior teeth.
• The treatment demonstrates a high success rate in promoting dentinal bridge formation and maintaining periapical health.
• While generally successful, long-term monitoring is essential to detect potential complications like discolouration or incomplete root end closure.