Endodontic treatment during root formation.

Various forms of endodontic treatment may be used in an attempt to maintain pulpal vitality during the period of root formation. In teeth with advanced caries but with no clinical evidence of pulpitis, indirect pulp capping with the retention of a small amount of softened dentine in the base of the cavity is preferable to further excavation and direct capping of a resulting exposure. Direct capping of pulpal exposures in traumatized incisors is confined to teeth in which the tissue loss is limited and the exposure is small and recent. Where there is more serious contamination of the pulp, whether by trauma or by caries, pulpotomy is indicated. In each of these three forms of treatment, calcium hydroxide is the dressing of choice. In incompletely formed teeth with necrotic pulps, the anatomy of the root canal poses problems which may not be entirely evident radiographically because of differential root development in the buccolingual and mesiodistal planes, whilst surgical treatment may result in excessive root shortening, besides being unacceptable to many patients. Treatment of these teeth is directed towards stimulating calcific closure of the apical foramen, preparatory to the insertion of a conventional root filling. Important factors in this form of treatment are the removal of necrotic tissue from the root canal, the preservation of vital tissue in the apical part of the root, and the use of a suitable agent as a root canal dressing. Calcium hydroxide is the agent of choice for this purpose.