PDF: Treatment of the Immature Tooth with a Non–Vital Pulp and Apical Periodontitis


The immature root with a necrotic pulp and apical periodontitis presents multiple challenges to successful treatment.



1. The infected root canal space cannot be disinfected with the standard root canal protocol with the aggressive use of endodontic files.
2. Once the microbial phase of the treatment is complete, filling the root canal is difficult because the open apex provides no barrier for stopping the root filling material before impinging on the periodontal tissues.
3. Even when the challenges described earlier are overcome, the roots of these teeth are thin with a higher susceptibility to fracture.


These problems are overcome by using a disinfection protocol that does not include root canal instrumentation, stimulating the formation of a hard tissue barrier or providing an artificial apical barrier to allow for optimal filling of the canal, and reinforcing the weakened root against fracture during and after an apical stop is provided.

Martin Trope, DMD a,b,*
a University of Pennsylvania, Philadelphia, PA 19104, USA
b University of North Carolina School of Dentistry, Chapel Hill, NC 27599, USA
* 1601 Walnut Street, Suite 401, Philadelphia, PA 19102.
E-mail address: martintrope@gmail.com
Dent Clin N Am 54 (2010) 313–324
doi:10.1016/j.cden.2009.12.006
0011-8532/10/$ – see front matter ª 2010 Elsevier Inc. All rights reserved.






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