Precision at the apex: Apexification under magnification: A case report

Advanced materials and techniques are used to successfully manage the apexification of immature teeth with open apices. The use of mineral trioxide aggregate (MTA), bioceramic sealers, and sodium hypochlorite (NaOCl), combined with internal heating and ultrasonic activation, ensures that canals are cleaned, disinfected, and sealed properly. Magnification devices, such as dental operating microscopes (DOM), provide precise visualization for accurate material placement, while the micro apical placement system ensures void-free MTA delivery. This modern approach improves procedural outcomes, lowers iatrogenic errors, and increases long-term success in apexification, making it a dependable and predictable treatment option for immature teeth.

Apexification is a regenerative endodontic procedure that involves creating a calcified barrier at the apex of a nonvital tooth with an open apex. This technique is commonly used in immature teeth with necrotic pulps to ensure proper root canal sealing. Traditionally, calcium hydroxide was the preferred material, but advances have introduced bioceramic cements like MTA or Biodentine, which provide superior results with less treatment time. Apexification not only helps to maintain the tooth's structural integrity but also prevents further complications, making it an important procedure in such cases.

This case demonstrates the effectiveness of integrating advanced materials, precise irrigation protocols, and magnification tools in the apexification of immature teeth with open apices. The use of MTA created a stable apical barrier, while bioceramic sealers enhanced the seal and promoted long-term healing. NaOCl with internal heating, ultrasonic activation, and double-sided vented needles ensured thorough irrigation and disinfection, especially in complex canal anatomy.