Cystic change

A rare complication in the management of the non-vital immature permanent tooth is the development of a periapical cyst. An apparently routine treatment (Tig. 7.20) had proceeded extremely slowly and the apical radiolucency failed lo resolve. Comparison of serial radiographs suggested, in fact, that it had increased in size (Fig. 7.21), Although the barrier had formed it was incomplele and it was anticipated thai the sealer would be extruded into Lhe periapical tissues when the tooLh was rool filled. Arrangements were made, therefore. Lo carry out an apiceclomy and retrograde root lilting (Figs 7.22, 7.23).

Fig. 7.1 y Radiograph, of It (same patient as in Fig. 7..IS) after completidi) of rool tilling showing extrusion of small amounts of rool canal sealer through defects in the incomplete apical barrier.

NON-VITAL IMMATURE TEETH: LATE PRESENTATION

Fig, 7.20 Radiograph of 21 showing persistent periapical infection and bone loss despite calcium hydroxide therapy.

Fig. 7.21 Radiograph of 21 (same patient as Fig. 7,20) showing canal obturated with calcium hydroxide and debatable resolution of apical infection.

Fig. 7.23 Radiograph of 2 I (same patient as in figs 7.20-7.22) following apical surgery and a retrograde amalgam Idling,

Fig, 7.22 Radiograph of 21 (same patient as Figs 7.20, 7.21) at. the time of completion of the permanent roof' filling.

Fig. 7.23 Radiograph of 2 I (same patient as in figs 7.20-7.22) following apical surgery and a retrograde amalgam Idling,

FURTHER READING 93

FURTHER READING

Cvek, M. (1972). Treatment of non-vital permanent incisors with calcium hydroxide, I. Follow up of periapical repair and apical closure of immature roots, Odontologisk Revy, 23, 27-44.

Frank, A. L. (1966). Therapy for the divergent pulpless tooth by continued apical formation. Journal of the American Dental Association. 72, 87-90, Gutmann, J. L. and Heaton, J. F. (1981). Management of the open (immature) apex. 2.

Non-vital teeth. International Endodontology Journal 14, 173-7. Mackie, !. C„ Bentley, E. M.. and Worthington, H. V„ (1988). The closure of open apices in non-vital immature incisor teeth. British Dental Journal. (65, 169-73, Yates, j. (1988), Barrier formation time in non-vital teeth with open apices. International Endodontology Journal. 21, 313-19.

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