Teeth are held into place with roots embedded into bony sockets. Apexes are the lowest part of the root that serves as an entry route for the nerves and tissue that make up the pulp inside the root canal. Problems with an apex or apexes can cause lingering infections, impede proper tooth development, and threaten the life of the tooth.

There are a few different dental procedures that can treat root apex problems in children up to young adults. Your or your child's dentist or endodontist will make the treatment decision based on the nature of your specific problem. 

Apicoectomy

Dental infections happen when harmful bacteria accumulates in the mouth due to genetic predisposition and/or poor oral hygiene. An infection within the tooth's root canal can be eradicated with a root canal therapy procedure, which removes all of the pulp and seals the canal shut to prevent reinfection. Sometimes that root canal therapy doesn't reach all of the infection – namely, infectious material buried in the apex.

If you or your child have already had one root canal procedure but still seem to have a dental infection, the dentist might recommend an apicoectomy. The procedure involves the dentist accessing the apex through your gums and jawbone in order to clean out the infection and remove the apex to prevent reentry.

Apexogenesis

An open apex can occur in developing immature teeth, in teeth that have experienced trauma, or in teeth experiencing resorption, which involves the tooth absorbing its own minerals. The open apex provides a quick route for infections and can lead to improper root development in a growing tooth.

Apexogenesis is one of the procedures a dentist can use to treat an open apex. The procedure begins like standard root canal therapy with the dentist cleaning out the pulp. A medicated material is then injected into the canal to hold its shape while also preventing infection from entering through the open apex. The filling will be replaced periodically to ensure that the canal remains properly shaped as the walls grow thicker.

Holding the canal in position can help the apex start to heal shut on its own and healthy pulp will start to enter the canal. Once the apex has shut, the medicated material is removed and replaced with the bio-cement and dental crown used to finish off a root canal.

Apexification

Apexification works similarly to apexogenesis except the apex itself needs bolstering while the root canal's pulp is too damaged to save. A medicated material is injected into the apex to help keep the tip healthy so that it can grow stronger and close.

When the apexification is successful, the root canal is filled with bio-cement and the tooth is sealed with a dental cap. Note that the tooth will be vulnerable to breakage during most of the process because the root canal is empty and the tooth is essentially hollow. 

Share