Single-visit MTA apexification: A progressive approach for immature teeth with Ellis Class IV fractures- case report

Trauma to developing teeth can disrupt root formation, leading to an open apex and complicating endodontic treatment. Apexification is essential in managing immature non-vital teeth to induce a calcified apical barrier for effective obturation. Traditionally, calcium hydroxide has been the material of choice, but it presents challenges such as extended treatment time and risk of root fractures. Mineral trioxide aggregate (MTA) has emerged as a reliable alternative, offering faster treatment with fewer complications. A 12-year-old male presented with a history of trauma to the maxillary central incisors (teeth 11 and 21), resulting in Ellis Class IV fractures. The trauma occurred six months prior during a fall. Clinical examination revealed pulpal necrosis, and radiographs confirmed incomplete root formation with open apices. The patient underwent root canal therapy, including pulpal debridement and one-visit apexification with MTA to induce an apical barrier. The MTA was compacted at the apical ends of the canals to provide immediate sealing. Root canal obturation was successfully completed, and radiographic follow-up demonstrated satisfactory apical sealing. The patient experienced no post-operative complications, and long-term follow-up will be conducted to monitor root maturation and tooth stability. MTA provides an efficient, biocompatible alternative to calcium hydroxide in apexification, offering faster treatment and reduced risk of root fracture. One-visit apexification with MTA can be considered a viable treatment for non-vital immature permanent teeth with open apices.