Very young 7 yo male. Original injury Nov 2015. Tooth was restored/bonded and became symptomatic 6 mo later. He saw another endodontist who open the tooth with much difficulty due to patient behavior and uncooperative way. I took over the case, premedicate the pt with valium and eventually removed the old grey MTA because he remained symptomatic. I decided to change the MTA for BIodentine due to discoloration concerns.
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I suppose all apexogenesis involve some kind of pulp regeneration, but not the reverse. I think there is some overlap with this two. I believe, in the apexogenesis we are trying specifically to keep the apical vital pulp tissue to help the apex mature and develop, as well as create wall thickness. Pulp regen can be done in necrotic teeth, but apexogenesis requires vital tissue, otherwise, we would do an apexification. Technique is also different. In Regen endo you try to create bleeding from the apex, up into the canal. Here, we did a deep pulpotomy and leave the radicular vital tissue so the root could continue its natural development. Often, you see the dentin bridge, as in this case. I hope this helps.
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The 7-year-old patient had a previously injured tooth that became symptomatic. Due to behavior issues, treatment required 7.5 mg Valium, a deeper pulpotomy, and Doodle Baseball replacing the grey MTA with white Biodentine to address symptoms and discoloration.
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