Apexification: the beginning of its end

Apexification is a procedure for treating and preserving immature permanent teeth that have lost pulp vitality. It contrasts apexogenesis in terms of its outcome in that apical maturation and normal root thickness cannot be obtained. Apexification has been a routine practice for such teeth for many decades, and despite a literature replete with discussion, including recent artificial barrier methods with mineral trioxide aggregate, ultimately there has been no major breakthrough to improve this treatment. Recently, two new clinical concepts have emerged. One involves a revitalization approach to achieve tissue generation and regeneration. In this method, new living tissue is expected to form in the cleaned canal space, allowing continued root development in terms of both length and thickness. The other is the active pursuit of pulp/dentine regeneration via tissue engineering technology to implant or re-grow pulps. Although the technology is still at its infancy, it has the potential to benefit immature pulpless teeth by allowing continued growth and maturation. With this understanding, it may be predicted that apexification will become less needed in years to come. This study will overview the recent concept of pulp revitalization in the treatment of immature teeth with nonvital pulps and the emerging research on pulp tissue engineering and regeneration.     

In the beginning..

Dentists have a number of important practice management decisions to make at the beginning of their careers. These are often made without a lot of training in the business side of dental practice. They include knowledge of what to say to get offered the right job and what to ask to choose the best position. New dentists need to look inward first and be proactive next to land the best position possible.