A Short Case Study: Pulp Must Be Vital With an Open Apex

Rico D. Short, DMD


Apexogenesis is a procedure that encourages the root to continue development as the pulp is healed. Soft tissue is covered with medication to encourage growth. The tip of the root (apex) will continue to close as the child gets older. In turn, the walls of the root canal will thicken. If the pulp heals, no additional treatment will be necessary. The more mature the root becomes, the better the chance to save the tooth.

This case featured a 6-year-old who had a large cavity into the pulp on tooth No. 19 (Figure 1). Apexogenesis was performed with white MTA (Figure 2). Recalls at 6 months, 1.5 years, and 2.5 years were performed (Figures 3 to 5). The last recall showed complete closure of the apex, increased root length, and increased root thickening.

Figure 1. There was deep decay on tooth No. 19 with an open or immature apicies. Figure 2. Apexogenesis was performed with MTA with a cotton pellet, and Cavit was placed.
Figure 3. At the 6-month recall, the patient has a stainless steel crown and the apicies are starting to close. Figure 4. At the 1.5-year recall, the apex was closing.
Figure 5. At the 2.5-year recall, the apex was closed.

I have explained my particular technique in a previous article. The only difference is that in this case, I used Bioceramic Root Repair Material (Brassler) on the anterior and bicuspid teeth due to staining from mineral trioxide aggregate, or MTA (Dentsply).

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Dr. Short attended the Medical College of Georgia (MCG) School of Dentistry to attain a Doctor of Dental Medicine degree in 1999. In 2002, he earned his postdoctorate degree in endodontics from Nova Southeastern University and became a Diplomate of the American Board of Endodontics in 2009. Dr. Short is an expert consultant in endodontics to the Georgia Board of Dentistry and assistant clinical professor at the Dental College of Georgia in Augusta. Dr. Short also has published articles in several magazines and peer-reviewed journals including Dentistry Today, Inside Dentistry, Rolling Out Magazine, Upscale Magazine, and the Journal of Endodontics. He has lectured throughout the United States and the Caribbean. Dr. Short is endorsed by the American Association of Endodontists speakers bureau, and his private practice, Apex Endodontics PC, is located in Smryna, Ga. Dr. Short also has authored a book, Getting to the Root of Your Problem: 365 Days of Inspirational Thinking.

Additional Short Case Studies

The Necrotic No. 2 Tooth

A Root Canal Trifecta

What to Do When the Pin Drops In