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Non-Vital Immature Teeth
Incomplete Root Development with Necrotic Pulp
When immature permanent incisors lose their vitality, incomplete root development poses the following challenges for the clinician:
- the root has thin dentine walls liable to fracture under physiological forces;
- a wide, open apex;
- wide root canal space which is time consuming and technically difficult to treat.
Endodontic procedures should aim to not only form a barrier at the apex against which the canal may be obturated but also strengthen the remaining root structure. Some 75% suffer root fracture within 5 years. Several options for treatment are available.
Apexification with Calcium Hydroxide
The aim of apexification is to create an apical hard tissue barrier against which a root canal filling can be placed, by using calcium hydroxide treatment (Fig. 31.1).
1. Local anaesthesia may or may not be required.
2. Place rubber dam and prepare traditional access cavity.
3. Extirpate necrotic tissue and chemo-mechanically prepare the canal 1 mm short of the radiographic apex, attempting to preserve as much root thickness as possible.
4. Spiral calcium hydroxide paste into the canal ensuring that the paste is well condensed and in contact with apical tissue.
5. Access cavity is restored with glass ionomer cement and the tooth restored with composite resin.
6. Review 3–6-monthly with radiographs and change/redress with calcium hydroxide if there is loss of the dressing in the canal.
7. The formation of a calcific bridge may take up to 18 months.
8. Once the bridge has formed the canal may be obturated using a warm vertical condensation technique with gutta percha or use of a thermoplasticised gutta percha delivery system.
Figure 31.1 Apexification. This immature tooth became necrotic (a) and required apexificatio/>
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