Calcium hydroxide apexification and Mineral Trioxide Aggregate (MTA) apexification are classical treatments for necrotic immature permanent teeth. protocol with its variations, and their clinical application. strong class=”kwd-title” Keywords: Immature permanent tooth, necrotic pulp, regenerative endodontics, revascularization, revitalization 1. Introduction Since the 1960s, the procedure indicated to treat immature permanent teeth with loss of vitality was apexification [1,2], a technique that aims to obtain a calcified apical barrier that permits the canal to be filled in a conventional way afterward [3], observe Figure 1. Open in a separate window Physique 1 (A) Pre-operative radiograph of a young necrotic upper left central incisor with periapical lesion; (B) radiograph after two months medication with calcium hydroxide; (C) radiograph after six months medication with calcium hydroxide; (D) working length determination; (E) post-operative radiograph; (F) four-years control radiograph. This technique has been demonstrated to be predictable and successful; however, some complications remain [4]. The traditional apexification technique used calcium hydroxide, Ca(OH)2, a strong base with a high pH (approximately 12), that was originally used in endodontics as a direct pulp-capping agent in 1928 [5]. Ca(OH)2 is usually formed by a powder that when in contact with an aqueous fluid dissociates into calcium and hydroxyl ions. This reaction induces a hard-tissue deposition and high antimicrobial activity [6]. The reaction of periapical tissues to this material is similar to that of pulp tissue [7]. It produces superficial necrosis and subjacent mineralization due to the matrix production due to low-grade irritation in the necrosis. Calcium mineral ions are drawn to that collagenous matrix and initiate calcification [8]. The mineralization of the apical hurdle is marketed by high pH as well as the lack of microorganisms. Calcium mineral hydroxide provides antibacterial properties: It produces hydroxyl ions DGKD that are extremely oxidant and reactive and harm bacteria in various ways. The calcium mineral ion rather, can stimulate enzyme pyrophosphatase, facilitating fix mechanisms [9]. This process consists in starting an usage of the pulp, washing the canal using irrigation agencies and manual data files (generally somewhat shorter towards the apex), and applying a calcium mineral hydroxide paste that’s replaced to market a faster recovery response periodically; the first substitute is advised after LP-533401 enzyme inhibitor 4C6 weeks, then LP-533401 enzyme inhibitor every 2C3 weeks until the operator feels a barrier when probing the apex with an endodontic file. After this, it is advised to wait another 3 months to finalize the procedure [10]. After the mineralized barrier completion, the tooth canal is definitely filled with gutta-percha and sealer [9]. Unfortunately, this procedure presents some disadvantages, such as being a long treatment, taking between 6 to 24 months to complete, where the patient needs to attend multiple occasions to assess progression and evaluate the need to switch the medication. The advantages of changing the intra-canal dressing in between classes are high pH maintenance, LP-533401 enzyme inhibitor continuous delivery of OH? ions to the periapical area, the possibility of renewing temporary cavity filling avoiding infiltrations, and to clinically assess the barrier formation. It also allows one to change part of the dressing that has been washed out down the large apex, to keep up patience compliance, and to make sure complete contact LP-533401 enzyme inhibitor between the calcium hydroxide and the apical cells. Not changing the intracanal medication may lead to the same effect but at a later time and with a higher.