Management of Open APEX in Maxillary Central Insicivus With Mineral Trioxide Aggregate

The maxillary anterior teeth in both children and adults are often traumatized. As a result, the tooth become necrosis before the development and root growth is complete, thus causing the root canal is not fully formed and open apex. In teeth with open apex, the absence of normal apical constriction of the root canal complicates the management of root filling materials. Management of open apex can be done using mineral trioxide aggregate (MTA). MTA has been proposed as an ideal filler as it can create an apical plug at the end of the root-canal system, so it can preventing the extrusion of filling material. Purpose: The aim of this case report is to show the use of MTA to form an apical plug in open apex followed by complete root canal obturation using thermoplasticized gutta-percha. Case: A 20 year-old male patient came to Clinic of Conservative Dentistry of Airlangga University with the complaint of fractured maxillary right central incisor. The patient reported that the trauma occurred about 7 years ago and no treatment had been performed. Clinical examination revealed crown fracture exposing pulp of maxillary right central incisor. The tooth failed to respond for vitality test. The radiographic examination revealed the presence of periapical lesion and the apex is open. Case management: The treatment was access opening, determined working length with apex locator and working length obtained 20mm, preparation root canal and irrigation, dressing with calcium hydroxide. The next visit, application of MTA and then obturation with thermoplasticized technique and continued with the final restoration Conclusion: Apexification using MTA can reduce treatment time by forming an apical plug in the open apex, obturation can be done immediately and after six-month follow up, there was reduction in sze of periapical lesion radiographically