Apexification as a Clinical Strategy for the Management of an Immature Non-Vital Tooth with Buccal Bone Loss: A Case Report

Abstract

Endodontic treatment of immature non-vital teeth poses a considerable challenge. Its goals should include the control of intracanal infection and the promotion of continuous root development. This case report describes an apexification as an alternative strategy for the maintenance of a tooth with incomplete root formation. An 11-year-old female presented with a history of pain and discomfort on the left side of the mandibular region. Intraoral examination revealed the presence of a draining sinus tract located in the buccal mucosa, next to tooth 35, for which a cold test was negative. Periapical radiographs revealed a single-rooted tooth with incomplete root formation and a periapical lesion. A diagnosis of periapical abscess with fistula was made, and a root canal treatment in conjunction with apexification was planned. Cone Beam Computed Tomography (CBCT) imaging was performed which revealed resorption on the buccal side of the root and the destruction of the buccal cortical bone. After six appointments, the intraoral sinus tract had healed, no purulent discharge was observed, and the root apex was closed. The root canal was filled, and the tooth was restored. The three years follow-up examination showed adequate bone repair and the absence of periapical lesion. Apexification shows favourable results for the management of immature non-vital teeth.

Keywords

• calcium hydroxide
• open apex
• root canal therapy