The immature root with a necrotic pulp and apical periodontitis presents multiple challenges to successful treatment.
1. The infected root canal space cannot be disinfected with the standard root canal protocol with the aggressive use of endodontic files.
2. Once the microbial phase of the treatment is complete, filling the root canal is difficult because the open apex provides no barrier for stopping the root filling material before impinging on the periodontal tissues.
3. Even when the challenges described earlier are overcome, the roots of these teeth are thin with a higher susceptibility to fracture.
These problems are overcome by using a disinfection protocol that does not include root canal instrumentation, stimulating the formation of a hard tissue barrier or providing an artificial apical barrier to allow for optimal filling of the canal, and reinforcing the weakened root against fracture during and after an apical stop is provided.
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Disinfection of the Canal
Because in most cases nonvital teeth are infected, the first phase of treatment is to disinfect the root canal system to ensure periapical healing.
° Martin Trope, DMD