Indirect Single-Step Apexification Utilizing a Carrier-Supported Custom-Fit Biomaterial: A Novel Technique Using...

Management of teeth with open apices remains technically challenging because conventional apexification techniques may be associated with prolonged treatment, multiple clinical visits, difficulty in controlling apical barrier placement, and the risk of extrusion of biomaterial beyond the apical foramen. This technical report involves capturing the three-dimensional internal morphology of the prepared root canal using a light-body silicone impression, reproducing the canal configuration in heavy-body putty, fabricating a mineral trioxide aggregate (MTA) or Biodentine plug within the negative replica, and incorporating a twisted stainless-steel ligature wire to facilitate retrieval and controlled intracanal placement. The technique was clinically applied to two teeth with open apices and periapical lesions. Biodentine was used in a 32-year-old woman with an open apex in the maxillary left central incisor, whereas MTA was used in a 45-year-old man with an open apex in the mandibular right first premolar. Both cases showed favorable clinical and radiographic outcomes during 24 months of follow-up. The Periapical Index score improved from 4 to 1 in both cases, and no apical extrusion of the biomaterial was observed. The described technique suggests the feasibility of indirect fabrication and controlled placement of a custom-fit apical biomaterial plug. Further laboratory and clinical studies are required to evaluate its dimensional accuracy, sealing ability, mechanical behavior, biological response, and long-term clinical performance.