Background: Endodontic therapy of a tooth with open apex and necrotic pulp presents multiple challenges during treatment. Microbial elimination from chronic lesions makes treatment all the more difficult. Apexification and pulp revascularization are the treatment options available. Apexification with calcium hydroxide has certain disadvantages and mineral trioxide aggregate (MTA) may be considered as a promising alternative.
Case description: This case report describes the management of a symptomatic maxillary left central incisor with immature apex and a chronic periapical lesion. Sodium hypochlorite of 3% and EDTA were used as irrigants for microbial elimination. Repeated intracanal dressings with calcium hydroxide were given for better periapical healing. MTA was used for apical barrier formation. After confirming the hard set of MTA, obturation was done with thermoplasticized gutta-percha and access cavity sealed with composite resin restoration.
Conclusion: In this case, MTA helped to form an apical barrier in the immature necrotic maxillary central incisor and showed a good clinical and radiographic success. The use of irrigants and calcium hydroxide as an intracanal medicament promoted the periapical healing of the chronic apical periodontitis.
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