Delayed MTA apical plug in immature open apex - A case report

Abstract

Aim: To present a case in which clinical and radiographic signs of healing were obtained after apical plugging of an immature open apex with MTA. Summary: A discolored tooth (9) was subjected to radiographic examination revealing an open apex and a periapical radioluscency. The canal was cleaned using intracanal instruments and 5.25% of NaOCl irrigation. To obtain canal disinfection, a slurry of calcium hydroxide mixed with sterile saline was temporized in the canal. The patient was asked to return after two weeks for the MTA apical plug placement. The patient returned after three months, during which interval she had got the calcium hydroxide dressing repeated four times from a local dentist. The tooth was opened, instrumented and irrigated. At this time, a definite apical stop was felt by an endodontic instrument. Around 3mm of MTA plug was compacted apically and allowed to set. Thereafter, the remainder of canal system was filled with thermoplasticised gutta- percha. A corono-radicular composite restoration sealed the access after non vital bleaching. A six-month follow up demonstrated clinically asymptomatic and adequately functional tooth, with radiographic signs of healing. Key Learning point: The positive clinical resolution of this case is encouraging for the use of white MTA as an apical plug, in immature teeth with open apex.