A Modified Obturation Strategy Using the Piston Technique With a Calcium Silicate-Based Sealer in the Management of...

Endodontic management of immature permanent teeth with pulp necrosis is challenging due to open apices and thin root walls. This case report describes an alternative obturation strategy-the piston technique-in which a calcium silicate-based sealer serves as the primary apical sealing material, while thermoplasticized gutta-percha acts mainly as a pressure-transmitting medium to facilitate its apical displacement. A 14-year-old patient presented with tenderness to percussion of an immature mandibular second molar with an open apex and periapical radiolucency. A diagnosis of pulp necrosis with symptomatic apical periodontitis was established. Treatment was performed in two visits. After chemo-mechanical debridement, calcium hydroxide was placed as an intracanal medicament. At the second visit, obturation was achieved using the piston technique, in which calcium silicate-based sealer is combined with thermoplasticized gutta-percha, allowing apical sealing without the need for an artificial apical barrier. The tooth was subsequently restored. At follow-up, the patient was asymptomatic, and radiographic evaluation showed evidence of an adequate apical seal and periapical healing. The combination of a calcium silicate-based sealer and thermoplasticized gutta-percha, as used in the piston technique, may represent a clinically feasible obturation strategy in selected cases for immature necrotic posterior teeth when regenerative procedures are not indicated.