Question

A 9-year-old boy has a midcrown fracture in a permanent maxillary central incisor. The fracture was sustained in an accident that occurred several months ago. The pulp is now necrotic. Radiographic examination reveals an incompletely formed root with an open apex. Treatment of choice is

A. formocresol pulpotomy.
B. root canal therapy.
C. calcium hydroxide pulpotomy.
D. apexification treatment with calcium hydroxide.
E. root canal therapy plus a retrograde amalgam.
F. none of the above. No treatment is indicated until root formation is complete.

Answer 1

Apexification with calcium hydroxide is the best treatment for a 9-year-old boy with a necrotic pulp and an incompletely formed root with an open apex, to allow for proper closure and foundation for future restorative work.

Step-by-step explanation:

The treatment of choice for a 9-year-old boy with a midcrown fracture in a permanent maxillary central incisor, where the pulp is now necrotic and the radiographic examination reveals an incompletely formed root with an open apex, is apexification treatment with calcium hydroxide. This method promotes the formation of apical closure to provide a solid foundation for future restorative work. Treatments like formocresol pulpotomy or root canal therapy plus a retrograde amalgam are not suitable in this case due to the open apex and immature root development. The goal of apexification is to disinfect the root canal system, remove necrotic tissue, and provide a conducive environment for the formation of a mineralized barrier at the root tip.

Answer 2

The appropriate treatment for a young patient with a necrotic pulp and open apex in a fractured permanent tooth is apexification treatment with calcium hydroxide to stimulate hard tissue formation and allow for root canal sealing.

Step-by-step explanation:

The treatment of choice for a 9-year-old boy with a midcrown fracture in a permanent maxillary central incisor with necrotic pulp and an incompletely formed root with an open apex is apexification treatment with calcium hydroxide. This procedure involves the removal of necrotic tissue followed by the placement of calcium hydroxide within the root canal space to stimulate the formation of a hard tissue barrier at the apex. This barrier will then allow for proper sealing of the root canal system. Apexification is a common procedure in pediatric endodontics when dealing with necrosis of a young permanent tooth with immature roots.