Normally, teeth have cone shaped roots and contain root canals that taper from the crown to the root end of the tooth. These root canals can usually be treated with conventional methods. However, there are some teeth with canals that do not close at the root end of the tooth resulting in an opening known as an "open apex." This most commonly occurs when the child/patient has suffered an injury or trauma to the tooth in the developmental stages of the tooth.

This situation is often found in teeth that are not fully developed or whose roots have been eroded away by a process known as resorption. An open apex complicates root canal therapy by making it difficult to seal the root canals with routine methods. Such teeth are treated by a procedure known as Apexification.

The goal of apexification is to form a hard barrier at the end of a root with an open apex. This allows the root canal to be sealed in a more normal manner. Although often successful, there are some instances when the root end barrier does not form or the resorption process continues. Situations such as these may require surgical treatment of the root end or the removal of the tooth may be necessary.

Course of Treatment

Apexification is started by removing the pulp and cleaning and shaping the root canals. A medication, MTA or Mineral Trioxide Aggregate is placed within the root canals of the tooth and sealed inside with a temporary filling material. The medication is replenished periodically. Since the number of visits and the extent of treatment required to achieve a root end barrier varies with the situation, the doctor will not initially be able to determine the total length of treatment time. However, the doctor will determine the specific intervals at which to replace the medication and this may vary from every 2-4 months.

When it is determined that a root end barrier has formed, the root canal therapy will be completed.