Management of teeth with necrotic pulps and open apices

Abstract

When the pulp of a tooth is irreversibly inflamed or necrotic and the apex is open, conventional root canal treatment is difficult to perform and the outcome is uncertain. Traditionally, the apexification procedure has consisted of multiple and long‐term applications of calcium hydroxide [Ca(OH)2] to create an apical barrier to aid the obturation. Recently, artificial apical barriers such as those made with mineral trioxide aggregate (MTA) have been used in teeth with necrotic pulps and open apices. More recently, procedures referred to as regenerative endodontics have received much attention as an option for these teeth. The purpose of this article is to provide a comprehensive literature review from May 1952–May 2011 regarding the management of teeth with necrotic pulps and open apices. This review covers the articles published in dental journals and book chapters regarding the definition, history, materials used, animal and human studies, mechanisms of action, prognosis, as well as advantages and disadvantages of apexification, apical plugs, and regenerative endodontics.

Pulp Revascularization- It’s your Future Whether you Know it or Not?

“…Complete obliteration of the canal is one possibility which can compromise the prognosis of future endodontic treatment, if required. In case, post and core is the final restorative treatment plan, revascularization is not the correct treatment option because the vital tissue in the apical two-thirds of the canal cannot be violated for post placement [22]. Moreover, the fibrin clot rationale behind revascularization is quite unreliable because the concentration and composition of cells trapped in the fibrin clot is unpredictable and tissue engineering is based on the delivery of effective concentration and composition of cells to restore function.…”

“…We used a double seal with MTA that has been demonstrated to have excellent sealing ability to a level below CEJ covered by bonded composite resin in the access opening [20]. The placement of MTA creates a hard barrier at its contact point with the blood clot and also provides signalling molecules for the growth of stem cells [21,22]. One question that comes to mind is the origin of new pulp tissue.…”

Use of mineral trioxide aggregate for retreatment of a tooth with large periapical lesion, wide-open apices and vertical root fracture

“…This is difficult in cases with large chronic periapical lesion and teeth with immature apex 2. In such cases, surgical treatment might be required for the complete elimination of infected tissues along with good apical retro-plugging 3…”

Alternativas clínicas para el tratamiento de dientes traumatizados con rizogénesis incompleta: una visión actualizada

“…Las opciones de tratamiento tradicionales incluyen apexifi cación con la utilización de medicación intraconducto (MIC) de hidróxido de calcio [Ca(OH) 2 ], o la colocación del agregado de trióxido mineral (MTA) o Biodentine (Septodont, Saint-Maur-desFossés, Francia) como barrera apical antes de obturar el sistema de conductos radiculares (4). Sin embargo, estas opciones de tratamiento requieren un pronóstico a largo plazo debido a las paredes de dentina delgadas, ápice no formado completamente y, en algunos casos, raíces cortas (5,6).…”