The use and predictable placement of Mineral Trioxide Aggregate in one-visit apexification cases

Endodontic treatment of the pulpless tooth with an immature root apex poses a special challenge for the clinician. The main difficulty encountered is the lack of an apical stop against which to compact an interim dressing of calcium hydroxide (Ca(OH)2), or the final obturation material. In these situations the unpredictability of the result, the difficulty in creating a leak-proof temporary restoration for the duration of treatment, and the difficulty in protecting the thin root from fracture may lead to complications when using traditional (Ca(OH)2-based) apexification techniques. Furthermore, given the increased mobility of today's society, lengthy treatment protocols are fraught with problems, and may not be followed through to completion. This may lead to ultimate failure of the case. Mineral Trioxide Aggregate (MTA) has recently been introduced for use in endodontics. Current literature supports its efficacy in a multitude of procedures including apexification. The focus of this paper is to propose a one-visit apexification protocol with MTA as an alternative to the traditional treatment practices with Ca(OH)2. One-visit apexification may shorten the treatment time between the patient's first appointment and the final restoration. The importance of this approach lies in the expedient cleaning and shaping of the root canal system, followed by its apical seal with a material that favours regeneration. Furthermore, the potential for fractures of immature teeth with thin roots is reduced, as a bonded core can be placed immediately within the root canal.