10- endo in teeth with open apex

What is rhizogenesis?

Formation of roofts

What are 3 different terms used to refer to endo procedures for teeth that have not yet completed root development?

Immature teeth with incomplete rhizogenesis

Immature/incomplete/open apex

Young foramen

In cases of immature roots, what a]do the canals look like?

Truncated shape- base turned apically

Very wide

Foramen has large diameter

What does the open foramen fail to provide?

Anatomical stop- hard to confine the treatment, imposible to seal in 3D shape

What does conservative treatment aid in?

Preserving vitality of pulp and hertwig epithelial sheath

Allows root formation to continue

What is the Hertwigs pod?

Extension of cervical loop or edge of enamel

Made up of internal and external epithelia

What does the hertwigs sheath do?

Induces differentiation of odontoblasts- produce root dentin, through the differential growth of its genetic border determines shape and number of roots

On an x ray what is it possible to confuse with a periapical lesion?

Dental sac- embryonic structure that is the origin of the periodontal tissues, surrounds apex of developing teeth

What makes the differential diagnosis of am immature apex possible?

Age

Dimensions of pulp cavity- wider in immature

Compare affected tooth to counterpart

Why must you be careful when choosing endo treatment in young teeeth?

If assess root development stage wrong- leads to failure

What is the classification of endo in teeth with open apex?

Living pulp no incomplete rhizogenesis

Necrotic teeth and incomplete rhizogenesis

Regenerative endo

When the pulp vitality is diagnosed and we need endo…

Do conservative treatment- can allow root formation to continue

But if small pulp exposure during cavity prep- direct pulp capping

Extensive pulp exposure- pulpotomy

What are the advantages of apexogenesis- formation of apical end of root?

Root length and shape

Apical formation

Thickness of root canal walls

What would lead to a risk of tooth anchorage

Short length with age and perio problems, hard to use intracanal posts

What will proper apical formation ensure?

Can create appropriate apical stops if need radical RCTin future

Facilitates prep and filling procedures

What dos proper thickness of duct walls ensure?

Living pulp and dentin deposition on canal walls

Increases mechanical resistance of treated tooth

If thin- creates vertical fracture

In teeth with the loss of dental pulp…

No normal root development

Treatment can induce apexification but dentin won’t form in pulp cavity, canal remains wide, shorter root, higher risk of root fracture

What is used to induce apexification in teeth with incomplete rhizogenesis and periapical lesions and any disadvantages?)

Calcium hydroxide- long treatment so frequent visits, increased risk of fracture- thinner walls in cervical and middle root, may close apical foramen with immature apex

What is better than using caoh?

Mta plug- single visit

What has been used to stop caoh from changing tooth morphology?

Regenerative endo treatment or of dentin pulp complex

What does regenerative endo treatment consist of?

Disinfect root canal by irrigation with nacloh

Antibiotic paste applied, file used to incise periapical tissue- creates bleeding

Sterile cotton balls stop bleeding at cervical level

MTA protects clot after homeostasis

X ray every 6 months