Injury during the growth years
A fall, a sports accident or a knock to a front tooth in children aged 7 to 14 — the pulp dies before the root has finished growing.
05 — Sealing an open apex
Apexification
in Kiel.
When a permanent tooth dies before root development is complete — usually after an accident in childhood or adolescence. Modern MTA apexification seals the open root apex in one to two appointments.
What is it?
Sealing the root
at an open apex.
In young permanent teeth, root development is only complete at around the age of 14. If the pulp dies before then — usually after an injury (a fall, a sports accident) or deep decay — this creates a problem: the root apex is still wide open and cannot be sealed tightly with conventional root filling materials.
The solution: we build an apical plug of MTA (mineral trioxide aggregate) or of a bioceramic material. This dense “floor” is placed in one to two appointments — the rest of the canal is then filled conventionally with gutta-percha.
The technique is a modern alternative to the traditional calcium hydroxide method, which used to take 6 to 18 months and weakened the root over time.
When is it needed?
Typical
situations.
Apexification is indicated whenever a permanent tooth with incomplete root development has a pulp that is no longer alive.
Deep decay
In very deep decay in teeth that are not yet fully developed, the pulp can be damaged beyond repair.
A late diagnosis
When a tooth that died years earlier is only noticed late — the root stopped at the stage of development it had reached back then.
Our approach
An MTA plug
instead of months of treatment.
The traditional calcium hydroxide method (from the 1990s) is outdated today. Modern bioceramic materials have transformed this treatment.
An MTA plug in one to two appointments
Mineral trioxide aggregate — biocompatible, and it sets in a moist environment. The plug is placed at the open root apex with microscope precision.
Gentle canal preparation
With thin root walls we clean particularly carefully — preserving every bit of remaining root structure is the top priority.
Guided by the microscope
Every layer of the MTA plug is checked at 25× magnification. Plug thickness: about 3–4 mm.
CBCT imaging where useful
After an injury, CBCT reveals hidden root fractures, the extent of any lesion at the root tip and the exact anatomy.
The process
Treatment
in six steps.
01
Diagnosis
Clinical examination and X-ray — after an injury also CBCT, to assess the root structures.
02
Anaesthesia and rubber dam
Pain-free treatment in a dry working field — particularly important when working with MTA.
03
Cleaning the canal
Gentle preparation, thorough irrigation with sodium hypochlorite and, if needed, a calcium hydroxide dressing for 1–4 weeks to disinfect the canal.
04
Placing the MTA plug
3–4 mm of MTA is placed at the root tip and compacted under the microscope — the dense “floor” for the root filling.
05
Filling the rest of the canal
Once the MTA has set, the canal is filled conventionally with gutta-percha and sealer.
06
A stable restoration and follow-up
The tooth is restored with a build-up filling. Follow-up after 6 and 12 months — healing around the root tip is usually visible by then.
80–95%
Success rate
MTA apexification with healing around the root tip within 6–12 months.
1–2
Appointments
Instead of the 6–18 months required by the older calcium hydroxide method.
3–4mm
An MTA plug
Placed with microscope precision — the dense seal at the root tip.
Costs
What does
the treatment cost?
Apexification is a specialised treatment that requires microscope work and high-quality bioceramic materials. It is usually charged as a private (self-pay) treatment.
For younger patients and after an injury the investment is worthwhile: the child’s own tooth can be kept for decades — an implant would only be possible once growth is complete.
Guide prices
- Apexification with an MTA plug: approx. €600–1,000
- With a medicated dressing (several appointments): approx. €700–1,200
- CBCT (after an injury): approx. €100–250
We go through the total cost openly before treatment begins. You receive a written cost estimate.
Frequently asked questions
Answers
about apexification.
What patients and parents ask us most often.
What is apexification?
Apexification means sealing a root canal that has an open (not yet fully formed) root apex. It becomes necessary when the pulp of a permanent tooth has died before root development is complete — usually after an injury in childhood or adolescence.
Why not the traditional calcium hydroxide method?
The traditional technique, with calcium hydroxide dressings over many months, weakens the root and takes 6–18 months. Studies show an increased risk of root fracture after prolonged Ca(OH)₂ treatment.
Modern MTA apexification completes the seal in one to two appointments, without weakening the root. It is the method of choice today.
When is apexogenesis the better option?
If the pulp is still alive (for example after a recent injury), apexogenesis is the better choice. The living pulp tissue is preserved and the root can continue to mature. Apexification is only used when the pulp is no longer alive .
How high is the success rate?
MTA apexification achieves success rates of 80–95%. Healing around the root tip is usually visible on X-ray after 6–12 months.
Can the tooth be kept for good?
Yes — with successful apexification and a stable restoration, the tooth can last a lifetime. Teeth treated with apexification have thinner root walls and can be more prone to fracture, so a careful restoration (often a crown) matters.
What does the treatment cost?
Costs are usually between 600 and 1,200 euros. We provide a clear written cost estimate before treatment begins.
More treatments
Related
treatments.
After an injury, several treatments are often combined.
Keeping the pulp alive
apexogenesis
When the pulp is still alive — letting the root finish growing.
Find out more PrimaryRoot canal treatment
The standard treatment once root development is complete.
Find out more DiagnosisCBCT — 3D imaging
After an injury, a precise picture of the root structures.
Find out more AppearanceInternal bleaching
For discolouration after an injury — lightening the darkened tooth.
Find out moreBook
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