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Keywords

open apex, pulp regeneration, apexification

Abstract

Aim: To describe different endodontic techniques for managing immature necrotic teeth. Managing immature necrotic teeth has always posed challenges because of the unpredictable nature of treating roots with wide open apices that lack an apical stop. Traditionally, treatment involved placement of long-term calcium hydroxide, which was often tedious and required multiple visits. Compliance was frequently an issue, especially since many patients in this category are children and as a result, many teeth were lost due to infection or fracture. Recently, with the introduction of more biocompatible materials, a shorter treatment approach has been advocated using calcium silicate materials, such as MTA, which can be placed at the apex to provide a suitable seal. However, this technique remains challenging when encountering a blunderbuss apex, where placing the material without pushing it past the apex can be extremely difficult. More recently, pulp regeneration has emerged as a viable alternative to apexification for managing blunderbuss apices. This case series explores various techniques and methods for managing an open apex.

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