ABSTRACT
This paper briefly reviews the pros and cons of five methods used to treat a tooth with a necrotic pulp and an open apex (incompletely developed root), and presents representative treatments of open apex cases. These treatments include customized cone, short-fill, periapical surgery, apexification, and one-visit apexification.
Subject(s)
Dental Pulp Necrosis/therapy , Dentin, Secondary/chemically induced , Root Canal Obturation , Tooth Root/growth & development , Adult , Apicoectomy , Calcium Hydroxide , Child , Female , Gutta-Percha , Humans , Incisor/injuries , Male , Pulpotomy , Zinc Oxide-Eugenol CementABSTRACT
Five methods for the treatment of teeth with an incompletely formed apex (open apex) and a necrotic pulp are discussed. The methods discussed include the use of (1) a customized cone (blunt-end, rolled cone); (2) a short-fill technique; (3) periapical surgery (with or without a retrograde seal); (4) apexification (apical closure induction); and (5) one-visit apexification. The apexification techniques, which use various formulations of calcium hydroxide to induce closure, are stressed. Based on the review of the literature and clinical experience of the authors, it was concluded that successful treatment of an immature pulpless tooth can partly result from the antibacterial and calcification-inducing action of calcium hydroxide.
