Managing The Open Apex - A Treatment Treatise

Dental injuries are common in childhood especially in the peaks relating to the first instance of toddler’s stage infant mobility, and later to increasing adventurous games and activities.Endodontic management of pulpless permanent tooth with a wide-open blunderbuss apex has long presented a challenge to dentistry. Although highly successful, apexification should be the treatment of last resort in a tooth with an incompletely formed root. Attention should be focused on the maintenance of vitality in these teeth so that as much root length and dentin formation as possible can occur in the root. Indirect pulp therapy, vital pulp capping and pulpotomy techniques have proved successful, aided by the tremendous blood supply present with the open apex. These procedures should be the treatment of choice if there is a possibility of success with any of them. When the tooth with an incompletely formed apex becomes pulpless or periapical disease has developed, apexification is the preferred treatment.