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The open apex


There are various reasons why an open apex can be present and needs treatment, among others:

  • trauma of a teeth element during childhood while the apex has not yet been formed completely
  • inflammation reabsorption at the apex
  • the apex has been filed open
The recommended treatments are:
  • eliminating the microbes in the apical area
  • a good endodontic preliminary treatment
  • closing off the open apex

There are various methods to close off such an open apex:

Until recently the open apex was almost closed off as a standard procedure by means of a so-called ‘apexification’ with the help of Ca(OH)2. If then a dentine bridge had appeared, the canal filling was placed against it. This often was a long-lasting and time-consuming treatment, the favourable outcome was by far not always was certain.

The latest method with the best prognosis is the closing off with MTA (Pro Root).

This happens as follows:

In the first session, preparation and rinsing is done in the usual way. Then CA(OH)2 is placed in the root canal during at least a week.

In the second session the root canal is again carefully cleaned. It is extremely difficult to remove CA(OH)2 from the canal. The surgery microscope shows this well.


If it is a question of a big apical lucention which already was present for a long period, then there is much granulation tissue in the periapical area and there is no bone barrier.
The barrier can be made by placing calcium sulphate (BoneGen) in the periapical area. With the help of an MTA GunSystem calcium sulphate is put into the canal. With hand pluggers, adjusted on the length of the element in question, the calcium sulphate is condensed beyond the apex. Some minutes later it has become hard. The small remainders of calcium sulphate in the canal are removed, e.g. the way a canal is normally cleaned. A thick file wrapped with batting and then dampened, is another good method to clean the canal wall. It is also useful to clean with the aid of LN drills (thin round drills with a long shaft). They are adjusted at a length so much that one cannot drill beyond the apex. Then, with a light rasping movement the canal wall is cleaned at all sides. For all methods the surgery microscope is indispensable to assess the result. Now MTA (Pro Root) is produced, with which the apical part of the canal (plus minus 5 mm) is filled. A wet absorbent cotton wool is placed upon the MTA (Pro Root). The hardening time is at least four hours and that is why a third session is necessary.


The last x-ray photo is 1 year after treatment.

In the third session the absorbent cotton is removed and the rest of the canal is filled as usual.

From this page you can order in our web shop


  • Surgery microscope
  • Calcium sulfate (BoneGen)
  • MTA Pro Root
  • MTA GunSystem
  • LN drills
to last chapter: Tracing perforations/fausse routes
to next chapter: Filling the canals

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