Abstract
BackgroundThis paper analyzed the distribution of treatments for permanent teeth with necrotic pulps and open apices according to the stage of root development.Material and MethodsDental records from all root canal procedures performed in permanent teeth with necrotic pulps and open apices over a period of 14 years by residents of the Speciality of Endodontics, University of Guadalajara, Mexico, were analized.ResultsRecords from 206 treatments were mainly divided into the following 3 different stages according to criteria described by Cvek: stage IV (n = 79, 38.3%), stage V (n = 66, 32%) and stage III (n = 53, 25.7%). Few cases involved the initial stages of root development (stages I and II) (n = 8, 3.8%). Such teeth were submitted to four different treatments: MTA apical barrier (n = 69), Ca(OH)2 replacements (n = 34), gutta-percha (n = 67) and a plug of Ca(OH)2/gutta-percha (n = 36). The teeth with intermediate root development (Cvek stage III) showed a predilection for the MTA apical barrier and Ca(OH)2 replacement techniques (P ≤ 0.001). Furthermore, the stage of root development did not influence the apical extent of the root filling.ConclusionsThe finding of permanent teeth with necrotic pulp and open apices is not exclusive to young patients with an open apex. Moreover, teeth with fragile, irregular and divergent apical morphologies, such as Cvek’s stages´ I and II, were not common and may be considered to be unusual findings. The diverse endodontic procedures were reliable regardless of the stage of root development. Key words:Incomplete root formation, Open apex, Epidemiological studies, Root development.
Highlights
The endodontic treatment of permanent teeth with open apices and necrotic pulp is considered one of the most complex challenges for clinicians
The assessment of dental maturity is a typical strategy employed by some dental specialities [8,9], but few studies have examined the stage of root development in relation to the frequency of teeth with open apices and necrotic pulp [10,11,12]
Considering that endodontic procedure selection most likely depends on the maturity of the affected root, the goal of this study was to analyze the distribution of treatments in pemanent teeth with necrotic pulps and open apices according to the stage of root development in a Mexican sub-population
Summary
The endodontic treatment of permanent teeth with open apices and necrotic pulp is considered one of the most complex challenges for clinicians These teeth are associated with young people who develop early cavities, have a morphological anomaly or have suffered a dental trauma that prematurely halts root development [1]. Adults with completely formed roots can develop an open apex due to certain pathological (e.g., external inflammatory root resorption) [2,3] or iatrogenic (over-instrumentation) [4] factors, that modify mature apical lumen diameter Such teeth show thin radicular walls with increased susceptibility to fracture, and the wide lumen of the apical foramen makes it difficult to maintain the filling material inside the root canal system and impossible for proper mechanical cleaning to avoid excessive root weakness [5,6,7]. The diverse endodontic procedures were reliable regardless of the stage of root development
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