Modified apexification with MTA and non-vital bleaching as a comprehensive case management of a necrotic immature...

Apexification for immature permanent teeth with necrotic pulp aims to close the root end without causing canal wall thickening or continuous root lengthening. Traditionally done using calcium hydroxide (CH), recently bioactive materials such as Mineral Trioxide Aggregate (MTA) have become a popular alternative due to its superior sealing abilities. While Regenerative endodontic Procedures (REP) offer potential for root development, their outcome remains unpredictable. This case report presents a modified apexification technique using MTA to facilitate continued root end development while incorporating non-vital bleaching to address aesthetic concerns.

An 11-year-old male patient presented with an immature permanent maxillary central incisor (#11) exhibiting pulpal necrosis with symptomatic apical periodontitis following trauma. The tooth had an open apex (Cvek Stage 4), hence, two treatment options, apexification using MTA or REPs, were considered. Due to the unpredictability of REPs and the potential need for a post and core, a modified MTA apexification technique was selected. This involved placing Mineral Trioxide Aggregate (MTA) with a resorbable collagen matrix to prevent extrusion into periapical tissues. Thereafter, nonvital bleaching was performed to enhance esthetics.

The modified apexification technique promoted successful root end closure of the tooth. Nonvital bleaching successfully improved the esthetic, achieving a significant color change. Radiographic evaluation at 3 months, 6 months, and 12 months showed signs of root end closure with no symptoms or complications.

Incorporating non-vital bleaching provided significant esthetic improvement, making this approach a comprehensive treatment modality for necrotic Immature teeth with discoloration. Further research is recommended to assess the long-term efficacy and outcomes of this technique in clinical practice.