Open apex management

Modern management of the open apex: Materials, techniques, and clinical challenges

Overview

In this video, we're looking at the evolving approaches to managing teeth with open apices, moving beyond traditional calcium hydroxide dressing techniques. The discussion highlights the challenges of such cases, especially in young patients, and introduces modern bioceramic materials like MTA and putty-based materials. The focus is on achieving a good apical seal, controlling the obturation, and preserving tooth structure for long-term success.

Key topics covered

• The challenges associated with managing open apices, including controlling obturation, achieving a good seal, and the thinness of dentinal walls in immature teeth
• A review of various materials used for open apex management, from traditional ProRoot MTA to newer bioceramics like Endosequence/TotalFill and Well-Root putty, discussing their properties and handling
• The importance of cleaning and disinfection protocols, emphasising sodium hypochlorite and EDTA, along with activation techniques (e.g. EndoActivator, Eddy, XP-Endo Shaper) to disrupt biofilm in these wider canals
• Techniques for placing apical barrier materials, including the use of pluggers and the concept of a "sandwich technique" with gutta-percha coronal to the bioceramic plug
• Considerations for the coronal restoration following open apex treatment, including the use of low-viscosity bulk-fill composites or dual-cure composites to reinforce the tooth and reduce fracture risk

Clinical relevance

This video provides clinicians with a contemporary understanding of how to manage open apex cases, moving beyond older, potentially less predictable methods. The discussion on material selection, precise placement techniques for apical barriers, and the importance of the final restoration offers practical insights that can directly improve treatment outcomes and long-term tooth survival for these challenging clinical situations.

Learning outcomes

After watching this, dentists should be better able to:

• Understand the limitations of traditional open apex treatments and the advantages of modern bioceramic approaches
• Select appropriate bioceramic materials (e.g., MTA, putties) for creating an apical barrier in open apex cases
• Implement effective cleaning, shaping, and obturation techniques tailored to the unique anatomy of immature teeth with open apices
• Appreciate the importance of the coronal restoration in reinforcing teeth after open apex treatment and make informed choices about restorative materials