Apexification
For immature permanent teeth with open apices and pulp necrosis, infection is controlled and an apical barrier is induced to preserve the tooth.
Apexification is used for immature permanent teeth with pulp necrosis and an open apex. By controlling root canal infection and using calcium hydroxide or bioceramic materials, it induces formation of a hard-tissue barrier at the apex. The goal is to make the open apex sealable so root canal filling can be completed and the tooth preserved. Because the root canal walls are thin and fracture resistance is poor, hard biting should be avoided during and after treatment, and protective restoration should be provided according to the tooth defect.
Quick Reference
Treatment
1 hours – 2 hours
Observation
0 mins – 1 days
Est. Cost
$200 – $300
Department
Pediatric Dentistry
Who Is This For
Is Apexification Right for You?
Good Candidates
- Immature permanent teeth where pulp disease has involved the root pulp
- Immature permanent teeth with complete pulp necrosis or periapical periodontitis
May Not Be Suitable
- Reversible pulpitis where pulp function can recover
- Infection limited to coronal pulp without root pulp involvement
- Root development less than 1/2 complete or extensive periapical bone destruction
- Permanent teeth with fully developed roots
Step-by-Step Process
How Apexification Works
Root Canal Preparation
Conventional access opening is performed. The canal is repeatedly irrigated with saline or sodium hypochlorite solution to remove infected necrotic pulp tissue, followed by instrumental canal preparation.
Root Canal Disinfection
After drying the canal, a mild intracanal disinfectant such as calcium hydroxide paste is sealed inside. Whether to use other antimicrobial agents, the dressing-change interval, and medication duration are decided by the dentist based on exudate, symptoms, and imaging changes.
Medication Induction
Calcium hydroxide or bioceramic induction material is placed layer by layer inside the canal, filling the canal so it contacts apical tissues, stimulating apical stem cells to redevelop and promote apical barrier formation.
Temporary Filling
The cavity is sealed with temporary material to prevent microleakage, followed by observation and follow-up.
Regular Follow-up and Permanent Filling
X-rays are reviewed every 3-6 months. When X-rays show apex formation or calcified deposition closing the root end and the tooth has no clinical symptoms, conventional permanent root canal filling is performed.
The first stage requires multiple visits for dressing changes, usually once every 1-3 months, until apical inflammation is controlled and there is no obvious exudate. The second stage completes permanent filling after the apex becomes sealable. The total course is generally 6-24 months, depending on individual variation.
Cost Information
Cost Estimate for Apexification
Estimated Price Range
$200 – $300
What's Included
Anesthesia, material fees such as traditional calcium hydroxide or bioactive ceramics, and procedure fees such as microscope-assisted treatment, apexification, and simple filling.
Before Your Visit
What to Prepare
Required Tests & Examinations
If you already have recent valid test results, bring the reports. If not, these assessments can usually be completed in China before the procedure.
X-ray to rule out periapical lesions and root resorption and to assess root development
Dental specialty examination and pulp vitality testing to determine pulp status
Detailed medical history
Documents & Materials to Bring
Required to Bring
Recent dental imaging, such as periapical radiograph or CBCT if available
Previous dental treatment records
Record of dental trauma, fractured dens evaginatus, or previous infection course if applicable
Medication allergy history
General medical history information
Companion & Support
An adult companion is recommended for postoperative pickup and observation. For general anesthesia, sedation, larger procedures, child patients, or patients with limited mobility, arrange accompaniment according to hospital requirements.
After Treatment
Recovery & Follow-Up
Mild soreness or swelling sensation may occur for 1-2 days after surgery and is normal.
Two hours after surgery, warm or cool liquid food may be eaten. Avoid chewing hard objects on the affected side for 2 weeks.
Maintain oral hygiene. For child patients, parents should supervise oral hygiene and use fluoride toothpaste to prevent secondary caries.
If clinical symptoms persist or worsen, return promptly to rule out infection.
Follow-Up Schedule
During induction, X-rays are reviewed every 3-6 months until apex formation or root-end closure. After permanent root canal filling, follow the routine root canal treatment follow-up schedule.
Related Conditions
Conditions This Procedure Treats
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Frequently Asked Questions
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