Kimberly McLachlan, DMD, MSED, MBA
290 N. El Camino Real
Encinitas, CA 92024
Encinitas, Carlsbad & Del Mar, CA
Children's permanent or adult teeth that are not fully developed at the time of the injury many need special attention. In an immature adult tooth, the tip of the root, called the apex, is open and the root canal walls are thin. AS the tooth develops, the apex closes and the canal walls thicken. An injured immature tooth may need one of the following two procedures to improve the chances of saving the tooth. One procedure, called apexogenesis, encourages the root to continue developing as it helps to heal the pulp. The injured soft tissue is covered with a medication to encourage further root growth. The apex continues to close, and the walls of the root canal thicken. If the pulp heals, no additional endodontic treatment may be necessary. The more mature the root becomes, the better the changes that the tooth can be saved. However, apexogenesis is not always successful. A different procedure, called apexification may need to be performed. During apexification, the unhealthy pulp tissue is removed. The endodontist places a medication into the root to help a hard tissue to form near the apes, or root tip. This had tissue provides a barrier for the permanent root canal filling. In spite of appropriate treatment, the root canal walls of a tooth treated by apexification will not continue to develop and thicken, making the tooth susceptible to crown or root fractures. Proper restoration will minimize this possibility and maximize protection of your tooth. After apexification is complete, a root canal will be done on the tooth. Over time, due to the law of averages, this tooth will be retreated many times in your child's lifetime. Nothing lasts forever, and since your child is having these procedures at an early age, they will need to be redone at additional cost to you.
An immature permanent tooth that has been dislodged may require minimal or no treatment other than follow-up until it has matured. If the tooth is severely dislodged, orthodontic or surgical repositioning and stabilization may be necessary.
If an immature permanent tooth that has been out of the mouth for less than one hour, the tooth should be placed back in its socket, stabilized and watched closely by your dentist or endodontist for three to four weeks. Suring this time, your dentist will look for changes in tooth, color, pain, swelling or loosening of the tooth. If any of these problems arise, an apexification procedure followed by a permanent root canal filling may be needed. If the immature permanent tooth has been out of the mouth and dry for more than one hour, the tooth may be put back in the socket filled with a medication and re-evaluated in six to eight weeks. The long-term health of this tooth is generally poor, so your dentist or endodontist may discuss other treatment options with you.
The nature of the injury, the length of time from injury to treatment, how your tooth was cared for after the injury and your body's response all affects the long-term health of the tooth. Timely treatment is particularly important with the dislodged or avulsed tooth to prevent resorption. Resorption occurs when your body, through its own defense mechanisms, begins to reject your own hard tooth structure in response to traumatic injury. You should return to your dentist or endodontist to have the tooth examined at regular intervals following the injury to ensure that resorption is not occurring and that surrounding tissues and teeth continue to heal.
In 6 months and a year an x-ray will be taken to watch the progression of healing. Every reasonable effort will be made to ensure that your condition is treated properly, although it is not possible to guarantee perfect results.