Use of Calcium Silicate-Based Materials in the Management of Open Apices: A Case Report

Trauma in immature teeth can lead to open apices, posing challenges for treatment. Calcium hydroxide (Ca(OH)₂), the traditional option, has limitations such as lengthy treatment times and risks of fracture. Mineral trioxide aggregate (MTA) has emerged as a superior alternative, offering excellent sealing and biocompatibility. This paper describes managing an immature central incisor in a 19-year-old male with necrotic pulp using an MTA apical plug, with a 24-month follow-up. The presented case outlines the difficulties encountered in treating an immature tooth with an acute apical abscess due to prior trauma. Challenges such as a wide apex, periradicular infection, and thin root walls complicated treatment decisions. Nevertheless, prioritizing the preservation of the tooth's function and aesthetics, the decision was made to utilize MTA apical plugs. MTA, known for its superior properties, including sealing ability, antibacterial efficacy, and biocompatibility, emerged as the treatment of choice. The case underscores the importance of MTA in endodontic practice, particularly in cases with open apices and periapical inflammation. Techniques such as proper MTA placement and adjunctive therapies like Ca(OH)₂ dressing contribute to successful outcomes. Comparative studies highlight the effectiveness of MTA and Biodentine in apical sealing, with both materials demonstrating comparable performance. However, the technique used for apical plug formation influences microleakage, emphasizing the importance of precise placement methods. Overall, the case report contributes to the understanding of MTA's role in managing challenging endodontic cases, underscoring its efficacy in promoting periapical healing and preserving tooth structure and function. The MTA barrier as a treatment for apexification does not require multiple appointments, and the barrier formation does not need an external factor to develop, as in the case of Ca(OH)₂ apexification, as well as in pulp regeneration.