Endodontic Management of Immature Teeth

#D3/S2/W10
#Endo

Immature teeth

• open apex
• structurally compromised
• preserve pulp vitality
• casues of pulpal and periapical disease
  • trauma
  • caries

Historical

• vital pulp therapy 1920
• indirect pulp cap 1956
• apexification 1966

Management of deep caries

• indirect and direct pulp cap
• pulp status
  • exposure is carious or traumatic
  • classical studies
  • bacterial contamination
  • capping material
  • restorative material - microleakage

Calcium hydroxide

• intracanal medicament
  • hermann 1920 - first credited with its use in root canals
• pulp capping agent
  • glass and zander 1939
• traumatised teeth
  • granath 1959 - in traumatised teeth in open apex
  • frank 1966 - apexification
  • cvek and adreasen
  • 

Roles of Calcium hydroxide

• hard tissue formation
  • cause reparative dentine formation
• periapical tissues

Apexogenesis (Cvek pulpotomy)

• technique
  • isolate
  • diamond bur
  • effective cooling
  • level of amputation
  • rinse pulpal wound
  • suraface covered with calicium hydroxide
  • coronal seal
• 96% success after 31months

Apexification

• immature teeth with pulpal necrosis
• must be restorable
• surgery is not an alternative
• technique
  • isoalte
  • access
  • extirpate
  • working length
  • instrument
  • drey canal
  • calcium hydroxide (or MTA)
  • coronal seal
  • recall
  • hard tissue barrier
  • obturate
  • modified lateral condensation
    • master GP cone chemically softened
  • thermoplasticised GP
  • follow up