Management of an open apex in a necrotic tooth.
A fourteen year old recently developed symptoms and swelling associated with tooth #18. The pain persisted for several weeks and the patient was referred to our office for treatment. Clinically, the tooth tested consistent with a pulpal necrosis. Slight swelling was evident in the muco-buccal fold and the tooth was hypersensitive to percussion and simulated biting. Our radiograph revealed a definitive lucency along the root apices and an underdeveloped distal root apex. In order to best treat this tooth I completed the instrumentation and opted to place CAOH to the terminus for 12 weeks, changing the medication every month. At our final visit, I rinsed out the CAOH with EDTA and confirmed working lengths with an apex locator and paper points. Considering the open distal root apex, I placed MTA orthograde to the terminus using the MAP system. MTA is the best way to seal an open apex. Once the placement of the MTA was confirmed clinically, I could then backfill with Gutta Percha. Our final radiograph reveals nice healing at the three month mark. Our patient plans to return in six months for an additional recall. I hope to see complete healing at that point!