Strategies to manage permanent non-vital teeth with open apices: a clinical update.

If dental pulp injury occurs prior to complete root formation and apical closure, normal root development is halted. This condition produces several complications. Firstly, the apical diameter of the canal is often larger than the coronal diameter, so debridement is difficult. Secondly, the lack of an apical stop makes the obturation in all dimensions virtually impossible. And finally, the thin walls of the root canal are prone to fracture, so that surgical treatment is generally not a viable option. There are a number protocols to manage non-vital open-apex teeth such as apexification, apical barrier technique (one-visit apexification), orthograde root filling using MTA, triple antibiotic paste, and tissue engineering concept. The aim of this paper is to review these treatment protocols.