Apexification Using Mineral Trioxide Aggregate and Modified Internal Matrix: A Case Report

Abstract

When pulpal necrosis occurs in immature teeth, one of the treatment alternatives is the creation of an artificial apical barrier through the placement of an apical plug. However, controlling the mineral trioxide aggregate (MTA) during placement has proven difficult. Several studies evaluated the use of resorbable barriers to act as an internal matrix to prevent accidental extrusion of MTA. The aim of this case report was to document the effectiveness of Surgicel as a modified internal matrix for proper placement of MTA during management of immature teeth with necrotic pulp using the apical plug technique. A 12-year-old female patient reported with the chief complaint of a badly mutilated lower right second premolar. The tooth suffered enamel hypoplasia and had a defective coronal structure. It was asymptomatic except for slight tenderness to percussion. Based on the clinical and radiographic findings, a diagnosis of pulpal necrosis with symptomatic apical periodontitis was made. The 3- and 6-month followup showed radiographic evidence of continued root and hard tissue formation. Based on these findings, we infer that Surgicel can be used as a modified internal matrix to prevent extrusion of the MTA into the periapical area and allow for proper MTA placement. Keywords: Apexification; Apical plug; Mineral trioxide aggregate; Calcium hydroxide; Surgicel; Modified internal matrix