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treatments of teeth with open apical foramen study | Fig. 2: Time history of the extractions (N = 19). 300 250 200 150 100 50 0 0 s h t n o m 5 10 15 20 n = extractions Fig. 2 Introduction Endodontic treatment of teeth with incomplete root growth poses a special challenge. In young pa- tients, the necessity for endodontic treatment results from an accident or profound caries. Aside from dam- age control, this treatment aims at promoting tooth maturation including narrowing respectively closure of the apical foramen (apexification) and possibly root extension (apexogenesis). According to Zeldow (1967) the following treat- ment options are commonly used: · For vital teeth: Pulpotomy (VitA) with subsequent conservative root canal treatment (RT) · For non-vital teeth: – either RT or – RT in connection with apicoectomy/retrograde root canal filling or – inducing of bleeding with root canal filling in the coronal root part only. Krakow et al. (1977) disapprove of a VitA inevita- bly following root canal filling. Joschko (2012) points out that the often diverging roots of immature teeth exclude a dense root canal filling, and that open api- cal foramen promotes overfilling. Some authors, like Kvinnsland et al. (2010) and Rafter (2005), state that the dental papilla may simulate an apical periodonti- tis in the area of the open apical foramen. Various methods favouring maturation of the im- mature teeth are described. Surgical interventions turned out to be less promising (Kreter 1959, Khoury 1992). Herforth (1981) obtained a very high healing rate of apical periodontitis with Jodoform deposits, however the success rate regarding stimulation of hard tissue induction only amounted to 3 % versus 83 % with calcium hydroxide (Ca(OH)2). Hermann (1920, 1930) introduced calcium hydroxide as ma- terial with osteogenic potential. Frank (1966) was the first to use it as medical dressing in teeth with incomplete root growth. These dressings should be replaced approx. every three months for a time period of six through 18 months. Cvek (1972) and Feiglin (1985), however, do favour a replacement of the dressing only in case of pathology. The long treat- ment duration—and thus loss of patient compli- ance—as well as a decrease of fracture resistance (Cvek 1972, Andreasen, Fabrik and Munksgaard 2002, Andreasen, Munksgaard and Bakland 2006, Trope 2006) are regarded as adverse features of the calcium hydroxide method. As formaldehyde also features an osteogenic po- tential (Orban 1935), tests with formocresol versus calcium hydroxide were made as well. Within a pul- potomy study, Spedding et al. (1965) judged formo- cresol as being more appropriate for apexification. Latest literature prefers mineral trioxide aggregate (MTA) over calcium hydroxide (Andreasen et al. 2006, Schwartz et al. 2008, Schäfer 2003, 2004). Shabahang et al. (1999) as well as ElMeligy et al. (2006) made a comparison between mineral trioxide aggregate and calcium hydroxide ending up in favour of MTA. In a prospective study, Simon et al. (2007) report on 43 one-stage MTA treatments, which were followed up after a control period of at least 12 months (up to 36): 65 % of apical lesions were completely healed and an apical barrier could be observed in 11 cases (26 %). 78.7% were free from apical periodontitis, whereas apexification took place in only 64 out of 75 cases (85.3 %). The time period for control of apical development was clearly longer, though, amounting to 70 months. roots 3 2017 07