A large number of different apical configurations can
result if an immature tooth with an open apex is
traumatized. Continued root development, apical
doming, in-growth of bone, and aberrant root formation
have all been reported. Repair appears to be more
related to the creation of an environment conducive to
repair rather than the type of medicament used.
The diagnosis of pulp necrosis and infection in an
immature tooth is often difficult. Radiographic changes
may be difficult to see. The clinician often has to rely
on an assessment of other signs and symptoms, such as
the presence of acute or chronic pain, tenderness to
percussion, increased mobility, discolouration of the
crown, or the presence of a draining sinus tract.
Radiographic comparison of the root formation of the
tooth in question with its contra-lateral tooth is helpful
to establish if root development is continuing at the
normal rate for that patient. Calcific changes indicate
that the pulp is vital, or at least it maintained vitality
for some time after the injury. External inflammatory
resorption indicates that the pulp is necrotic and
infected, and in need of urgent treatment. Apical
remodeling after luxation injuries may indicate that
revascularization of the pulp is occurring, or that it has
occurred. In general, erring on the side of caution
through observation and review is desirable, but great
care should be taken when doing this if the tooth was
avulsed or intruded, and also when patient compliance
with recall examinations is questionable.
A number of studies have suggested that long-term
dressing of root canals with calcium hydroxide may
weaken the dentine, thus early restoration of
immature non-vital teeth with MTA has been suggested
as an alternative treatment protocol.