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Pulpal and periapical pathosis in an immature anterior tooth following traumatic injury is a frequent occurrence, and management of open apices in such cases poses a constant challenge to endodontists. Treatment of immature pulpless teeth with long-term calcium hydroxide may consequently weaken the dentin and increase the fracture susceptibility. This case report demonstrates a six-month follow-up result of an open apex and a periapical lesion involving maxillary right central incisor 11 with the Biodentine obturation that was previously subjected to triple antibiotic paste as an intra-canal medicament for three weeks.
The satisfactory healing rate of tooth 11 with the reduction in the size of periapical radiolucency at the end of the six-month follow-up in this current article is highly considerable. Keywords: triple antibiotic paste, open apex, obturation, immature permanent teeth, biodentine. Dental traumatic injuries are most common in children, occurring between the age groups of 8 and 12 years.
These injuries might lead to pulpal necrosis, which would cease the root formation, thereby resulting in an immature root apex [ 1 ]. Due to the open apices and weaker dentinal walls, the efficient management both from the restorative and endodontic perspective becomes quite cumbersome, which would often predispose to root fractures especially at the cervical region [ 2 ].
The apexification procedure is a viable choice of management in the case of immature permanent teeth with open apices. Though various materials have been suggested for apexification procedures, calcium hydroxide has been extensively used for apical barrier formation [ 3 ]. Several studies done in this regard have shown that apexification can form a hard tissue apical barrier, but the teeth might be more prone to cervical fracture due to thin dentin walls at the cementoenamel junction CEJ [ 4 ].
