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Trauma to an immature tooth can result in pulpal devitalization and arrested apexogenesis, resulting in open apices; this is most common in anterior teeth of the permanent dentition. The attainment of an apical seal in such cases is challenging. The management of an open apex in a central incisor in a 16-year-old male patient is described in this report. The satisfactory result achieved suggests that mineral trioxide aggregate (MTA) can be used successfully as a filling material in teeth with open apices.
Clinical Relevance: Preservation of anterior teeth following trauma is essential, especially in young patients. A good option is the use of mineral trioxide aggregate in the treatment of open apices.
Article
The treatment of immature permanent teeth with necrotic pulps and apical periodontitis poses significant challenges because of the large canal space, wide open apex and thin fragile root walls. A satisfactory apical barrier needs to be created to prevent egress of bacteria and their toxins from the root canal system into the periradicular tissues. The barrier also facilitates compaction of the root canal filling material without it encroaching on the periodontal tissues.
Calcium hydroxide has been successfully used to form an apical calcific barrier in a procedure known as apexification. High success rates in the range of 79−96% have been reported.1 Despite such success rates, however, calcium hydroxide has its limitations associated with the long treatment time needed. The formation of the apical calcific barrier generally takes, on average, 12.9 months.2 Patient compliance cannot be guaranteed. There is also an increased risk of loss of coronal seal and tooth fracture owing to prolonged dressing with calcium hydroxide.3 Additionally, the calcific barrier formed has been found to be porous and often containing small amounts of tissue.4
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