When the pulp of an immature tooth is compromised as a result of caries or trauma, the goals of conventional root canal treatment are difficult to achieve since the roots have not yet fully formed and closed. In such cases, there are several treatment options available depending on the status of the pulp/nerve. Apexogenesis is the recommended treatment option when the pulp is vital and Apexification or Revascularization is the recommended treatment option when the pulp is non-vital.

Apexogenesis

Apexogenesis procedure allows for the natural physiologic process of root development. It preserves pulp vitality in a traumatized tooth so that the affected tooth can develop to its full growth potential. The cavity is removed and the traumatized/exposed pulpal tissue is covered with Mineral Trioxide Aggregate (MTA) to protect the vitality of the pulpal tissue and allows for continued maturation of the tooth. This continued maturation process enables the apex (tip) of the root to close as the child gets older. In turn, the walls of the root canal thicken and the tooth becomes stronger over time. With pulpal healing, no additional treatment will be necessary on the tooth. The more mature the root becomes, the greater its chances of survival long term.

Apexification

Apexification procedure allows for closure of the root apex, thus creating an apical stop for obturation. The unhealthy pulp is removed and a material such as MTA is placed apically to form an immediate barrier. As a result, obturation of the canal can be performed shortly afterward. The coronal aspect of the tooth is then restored permanently in order to maintain structural integrity and minimize risk of tooth fracture.

Revascularization

Revascularization is an endodontic treatment procedure that allows for continued root development in an immature necrotic tooth with an open apex. By inducing bleeding into the disinfected canal, a stable blood clot can be established that will not only serve as a scaffold but also provide factors that stimulate the growth and differentiation of stem cells. This process, known as pulp tissue engineering, allows for the re-establishment of pulp vitality and continued root development including: increase in thickness of the tooth root, increase in length of the tooth root, and closure of the apex (tip) of the root.