Management of teeth with blunderbuss canals and its esthetic rehabilitation

The most important factor in endodontics is proper debridement of the canal, to obturate it effectively and three dimensionally as possible.[1] This leads to proper apical seal with a “fluid-tight” obturation which prevents bacterial ingress and ensures favorable outcome.[2] However, having a proper apical seal becomes difficult in patients with open apices. Obturation becomes a challenge due to the large open apex, diverging walls, thin dentinal walls that are susceptible to fracture, and associated frequent periapical lesion.[1] The most common teeth with open apex are maxillary anterior. This is due to its position in the jaw which is more prone to trauma and less due to caries.[3] There are two types of open apex:[1] 1. Non-blunderbuss type. 2. Blunderbuss type. Non-blunderbuss type: Walls are parallel or slightly convergent as the canal exits the root. Apex can be broad (cylinder shape) or slightly tapered (convergent). Blunderbuss type: Walls of the canal are divergent, flaring, especially in buccolingual direction. Mostly, apex is funnel shaped, wider than the coronal aspect. “Blunderbuss” is referred to as the 18th century weapon which has a short and wide barrel. It derives its origin from the Dutch word “DONDERBUS” which means “thunder gun.” Causes of open apices are as follows:[1]