Challenges and Solutions: Endodontic Strategies for Teeth with Open Apex and Necrotic Pulp

The clinical management of teeth with an open apex and necrotic pulp is a significant challenge in endodontic practice, especially in cases of immature teeth where root formation has been interrupted due to necrosis, often as a result of trauma or extremely deep caries. This scenario presents technical difficulties, such as the lack of a defined apical limit, controlling disinfection, and ensuring safe obturation—factors that complicate the long-term prognosis. This presentation aims to explore the most advanced therapeutic approaches for treating these conditions, with a special focus on apexification and regenerative therapies. It will discuss how traditional techniques, such as the use of calcium hydroxide, have been complemented and, in some cases, replaced by regenerative methods that leverage the biological potential of the periapical tissue and the incorporation of innovative biomaterials like calcium silicate-based cements. Clinical studies and successful cases will be presented, highlighting the benefits of pulp regeneration, including the formation of hard tissues, continuity of root development, and functional preservation of the tooth. Additionally, common challenges such as infection control, complication management, and criteria for selecting the most appropriate treatment based on the clinical case will be addressed. This session is aimed at dentists and specialists interested in expanding their knowledge of cutting-edge techniques that combine biological innovation and clinical precision to improve outcomes in teeth with open apices.