Apexification Using MTA in Immature Permanent Anterior Teeth- A New Era in Pediatric Dentistry- Case Series

Abstract Apexification is a biologically guided technique aimed at forming mineralized tissue at the apex of an immature, non‑vital permanent tooth, overcoming the challenge posed by its open apex. Historically, calcium hydroxide was the material of choice, but its prolonged treatment time—often requiring 6 to 24 months or more—and its association with increased risk of cervical root fracture led clinicians to seek better alternatives. Mineral Trioxide Aggregate (MTA) emerged as a superior option due to its biocompatibility, excellent sealing properties, and capacity to stimulate periapical healing and hard‑tissue formation. Numerous clinical studies and systematic reviews have confirmed MTA’s efficacy and predictability, noting significantly faster apical barrier formation and lower fracture risk compared to calcium hydroxide. In this case series, adolescent patients with necrotic immature anterior teeth underwent apexification following a comprehensive disinfection protocol using triple antibiotic paste and sequential irrigation with sodium hypochlorite, chlorhexidine, and saline. A 4 mm MTA apical plug was placed—one case included a resorbable collagen barrier and use of the MAP system to maintain moisture control before MTA placement. Subsequent canal obturation was performed with bioceramic sealers to ensure a hermetic seal. Over follow‑up, all cases showed complete resolution of periapical pathology, absence of clinical symptoms, and successful apical closure radiographically. These outcomes reaffirm MTA’s clear advantages over calcium hydroxide—namely, reduced treatment duration, superior sealing, and enhanced structural integrity of the root. Thus, MTA apexification represents a predictable, efficient, and biologically favorable treatment for managing immature necrotic permanent teeth in pediatric dentistry, fully aligned with evidence‑based practice.