Apexification

with MTA
Definition
Method of treatment for immature permanent teeth in which root
growth and development ceased due to pulp necrosis by creating an
artificial apical plug with MTA

Indication
 Non-vital immature teeth caused by traumatic injury, deep carious
lesion, and anatomic variations (such as dens invaginatus)
Clinical Procedures
Clean root canal system and dress with calcium hydroxide paste for at least 1 week
(same procedures as apexification using calcium hydroxide)

Second visit:
• Rubber dam isolation
• Irrigate and dry canal
• Mix MTA immediately before its use with ratio  powder : sterile water (3:1)
• Carry mixed MTA in a small amalgam carrier or MTA applicator
• Lightly condense the MTA with a plugger or back end of paper points
• Compact MTA and create 4-5 mm apical plug into the canal (about 1 mm short of
the radiographic apex) and check radiographically (Figure 1)
Clinical Procedures (2)
• Place a moist cotton pellet in the root canal and wait for 20-30 min or until next
visit
• After a few days, tooth is reentered and the hardness of the MTA is examined
with an endodontic instrument
o In case that the MTA is not set  placement should be repeated
• After setting, obturate the root canal using thermoplasticised gutta percha and
sealer or another obturation technique
• Restore the tooth with bonded composite resin extending into the canal space (in
an attempt to strengthen the root)
o In short roots the composite resin can be placed in direct contact with the
MTA plug
Figure 1. MTA plug placement 4-5
mm apical plug into the canal
Figure 2. Permanent restoration with bonding of
glass fibers in light curing resin matrix
(everStickTM, GC Corporation, Tokyo, Japan)
performed in direct contact with the set MTA
plug
 Advantages
 Reduced number of visits for patients
 Good biocompatibility
 Prevents microleakage
 Induction of odontoblasts, cementoblasts
and hard tissue barrier
 Capacity to set in a moist environment
 Radiopacity that is slightly greater than  Potential for fracture of thin roots could
dentine
 Low solubility
 Setting time of 3–4 h
 A pH of 12.5 after setting 
antimicrobial properties
 Compressive strength after setting = 70
Mpa
 Ability to create an apical stop  allows
tooth to be filled immediately
be reduced as a bonded core can be placed
immediately within the root canal
DisAdvant ● Does not account for complete root development along the
entire root length
ages ● Discolouration of the crown  poor aesthetic in the long
term
● Contributes to increased brittleness of dentine and decrease
in the fracture resistance of the tooth
References
1. Fuks AB, Peretz B (2016). Pediatric Endodontics. Switzerland: Springer International
Publishing.
2. Duggal, M., Tong, H. J., Al-Ansary, M., Twati, W., Day, P. F., & Nazzal, H. (2017).
Interventions for the endodontic management of non-vital traumatised immature
permanent anterior teeth in children and adolescents: a systematic review of the evidence
and guidelines of the European Academy of Paediatric Dentistry. European archives of
paediatric dentistry : official journal of the European Academy of Paediatric Dentistry,
3, 139–151.
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