Re-Treatment of Maxillary Central Incisor and Apexification Using MTA Apical Plug: A Case Report

Abstract

Management of immature permanent teeth with open apices and persistent periapical pathosis remains challenging, particularly when previous endodontic treatment has failed. This case report describes the non-surgical retreatment and apexification of a maxillary left central incisor using a mineral trioxide aggregate (MTA) apical plug. A 21-year-old woman presented with intermittent pain and swelling in the maxillary anterior region. The patient had sustained a traumatic dental injury to tooth #21 approximately 10 years earlier and had previously undergone root canal treatment. Clinical examination revealed tenderness to percussion and apical palpation, discolouration, and no response to pulp sensibility testing. The pre-operative periapical radiograph showed inadequate obturation, an open apex, widening of the periodontal ligament space, loss of the lamina dura, and a periapical radiolucency measuring approximately 2 mm × 4 mm. Non-surgical retreatment was performed under magnification. The previous root canal filling was removed, an intracanal medicament was placed, and the canal was disinfected using sodium hypochlorite irrigation with ultrasonic activation. A 3 mm mineral trioxide aggregate apical plug was placed, followed by thermoplasticised obturation with a bioceramic sealer and definitive coronal restoration with a crown. At the 24-month follow-up, the patient was asymptomatic, and the follow-up radiograph showed periapical healing and a stable apical barrier. This case highlights the favourable clinical outcome of MTA apexification in an immature tooth with an open apex and persistent periapical pathosis.