712H
Fig. 12.20 Pulp amputation (apexogenesis procedure) of a permanent incisor. (a)
Complicated fracture of an immature incisor with microbial invasion of the coronal
pulp. The pulp has been exposed to the mouth for more than 24 h. (b) Access to the
coronal pulp and amputation of coronal pulp tissue with a diamond bur running at
high speed with constant water cooling. (c) Dressing the pulpal wound to promote
calcific repair. Non-setting calcium hydroxide cement is flowed on to the pulp, then
overlaid with a hard cement, and the tooth restored with composite resin. (d) The
same tooth after 12 months showing calcific barrier formation. The calcific barrier
was directly inspected in this case, (not always required), and a new layer of setting
calcium hydroxide cement placed on the barrier before definitive restoration. The
remaining pulp has stayed healthy and deposited dentine to complete root formation.