Management and outcomes of apexification procedures in traumatized immature teeth

Abstract

The oral health of pediatric patients is a significant concern, with dental injuries being a common occurrence in this vulnerable population. Traumatic injuries to immature teeth, characterized by incomplete root development and open apices, present unique challenges that require specialized clinical management. Understanding the anatomy and developmental characteristics of immature teeth is crucial for effective management. Historically, apexification procedures relied on calcium hydroxide, but advancements in dental pulp biology led to regenerative endodontics, a transformative approach that preserves pulp vitality while promoting apical closure. Contemporary techniques include calcium hydroxide apexification, mineral trioxide aggregate (MTA) apexification, and regenerative endodontics, each with its advantages and considerations. Patient selection, radiographic assessment, choice of biocompatible materials, and post-operative care are key components of contemporary apexification protocols. Advanced imaging modalities like cone-beam computed tomography (CBCT) enhance diagnostic accuracy. Challenges in apexification procedures include infection control, the risk of root fractures, and dealing with resorption phenomena. Moreover, pediatric patients require special attention to address compliance and psychological factors. The long-term outcomes of apexification procedures extend beyond clinical and radiographic parameters and encompass growth and development as well as the quality of life of pediatric patients. Preservation of arch integrity, prevention of malocclusion, and maintaining oral health-related quality of life are vital considerations.