Asian Journal of Dental Sciences

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.