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Open or Blunderbuss Apex or divergent roots
The mechanical cleaning & shaping of teeth with blunderbuss canal apex are very difficult if not impossibly orthogratly due to 1- The thin fragile lateral dentinal walls that can fracture during mechanical filing.
2- The large volume of necrotic debris contained in a wide root canal is difficult to disinfect.3- Obturation of wide canal systems requires precise fabrication of a customized gutta percha cone
4- Moreover, many blunderbuss canals with flaring walls can not be obturated & sealed by orthograde methods & might require apical surgery & retrograde sealin of the canal
5- There is danger of splitting of the root during gutta percha condensation.Thus, Treatment of the immature non-vital anterior teeth with apical pathosis presents
Acute Mitral Regurgitation : Acute mitral regurgitation is an indication for early surgery. If patient is haemodynamically unstable, pre-operative intra aortic balloon pump
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