TEETH WITH AN OPEN APEX
When a tooth does not close at the end of root it is called an 'open apex', in other words, absence of sufficient root development to provide a conical taper to the root canal with thin dentinal walls which are less resistant to fractural stresses.
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CAUSES OF OPEN APEX
1 * Trauma to tooth during developing stage , children with class two div one incisors when fall leading to fracture of crowns of anterior teeth while roots are not fully developed, it stops further development of root result into open apex. https://doi.org/10.1515/ijamh-2018-0061 2 * Caries causes loss of vitality of tooth when root is not fully developed resulting in open apex , mostly in mandibular molars.
3 * Anomalies , eg dens in dente that is tooth within tooth, result into early inflammation, infection and open apex.
4 * Orthodontic forces , if heavy orthodontic forces are used , these can cause root resorption resulting into open apex.
TYPES OF OPEN APEX
2 : Non blunderbuss
BIUNDERBUSS Funnel shaped root apex, it means apical opening can be wider than the coronal root canal orifice. it appears when trauma to tooth hit during 1st two stages of root development when less than half of root has formed, it is a disastrous situation.
NON BLUNDERBUSS
The walls of root canal may be parallel to slightly convergent as canal exit the root apex, it is the situation when trauma occur during 2nd and 3rd stages of development
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PROBLEMS ASSOCIATED WITH NON VITAL TOOTH
1 - Roots are not developed ,walls very thin and fragile 2 - Apex is open, any material to fill up roots will extrude 3 - Periapical radiolucency are present and infection occurs again and again 4 - Due to less root length crown root ratio discrepancies can occur 5 - Fracture of crown may occur 6 - Chances of tooth discoloration increases
MANAGEMENT OF NONVITAL TOOTH WITH OPEN APEX
The aim of treatment is to save the tooth. there are two methods to manage such cases of trauma one is Apexification and the other is Revascularization
. In Apexification an artificial or a biological barrier is formed to close apex with the help o calcium hydroxide or MTA . It helps to eliminate sign and symptoms of infection and pain, prevent crown fracture and root resorption.
In Revascularization root begin to achieve width and length and gains its vitality again. In this procedure barrier is placed coronally at cementoenamel junction , it will regenerate growth of root till root apex close .It is a new concept of treatment modality known as Regenerative Endodonticshttps://www.sciencedirect.com
