Among the leading causes of root canal treatment failure is the presence of a large periapical lesion with slow healing kinetics. General dental practitioners are forced to extract a large number of teeth due to limitations in treatment armamentarium and poor prognosis after multiple visit root canal procedures. A bad reputation of the dental practitioner results if too many of his/her treatments are going towards failure.
In such cases, conventionally complex surgical procedures were taken under consideration. Most of the dental professionals advise surgical endodontic treatment plans to their patients to prevent them from multiple visits and poor results in a tooth with large periapical lesion which has lesser chances of getting healed through non-surgical root canal treatment. Surgical endodontics is a good option in many cases but it needs patient compliance and consent and many patients undergo panic with the name of the procedure. Further explanation of the procedure prevents them from giving informed consent in this regard.
Recent developments in the field of dental sciences have made it quite possible to treat such teeth without the need of surgical treatment procedures with good healing kinetics and better results. The Apexum device has been developed for carrying out periapical debridment through a root canal access. The Apexum procedure is designed to be applied only after completion of cleaning, shaping and disinfection of the root canal. The obturation of the root canals is done after this procedure.
The Apexum concept involves the widening of the apical foramen to create an opening or passage beyond the apex of the tooth. An artificial apical stop and constriction is established about 1 mm short of the original apex through instrumentation carried out by a larger file. The Apexum device consists of two miniature instruments used to debride the periapical tissues through the root canal access.
The coarse Apexum ablator is a device devised from a pre bent memory shape NiTi wire encased in a NiTi tube serving as its sheath which is inserted up to the artificial apical stop. At this point, the inner wire in it is pushed gently through the apex and into the peripaical lesion where it regains its pre bent shape. The device is then attached to a low-speed hand piece and rotated at a slower speed carrying out the coarse mincing of periapical tissues after which this is removed.
The fine Apexum ablator is then inserted in the same manner and rotated at a higher speed turning the minced tissues into a thin suspension. This thin suspension is then washed out through the coronal opening with the help of irrigating syringe using sterile saline solution. This Apexum device is a supplementary treatment in order to achieve a faster healing rate and better prognosis.
This era is regarded as the era of advancements and innovations. The need of the time is to keep oneself up to date and include latest devices and procedures in the dental office armamentarium.