The judicious use of mineral trioxide aggregate putty for managing open apex: A report of two cases

Traumatic dental injuries during root development cause necrosis of pulp leading to incomplete root formation resulting in an open apex. Endodontic treatment of such cases comes with challenges during obturation due to loss of apical stop. The attempted report delineates the comprehensive management of two cases of nonvital immature permanent teeth via apexification performed under magnification with mineral trioxide aggregate (MTA) putty along with favorable follow-ups. The first case involved a 21-year-old male patient who presented with a discolored upper right central incisor (#11). The patient gave a history of trauma 12 years ago. The tooth gave a negative response to thermal and electrical pulp tests. Radiographic examination showed periapical radiolucency and wide open apex. A diagnosis of pulpal necrosis along with asymptomatic apical periodontitis was established. The tooth was managed via apexification with MTA putty under magnification. The second case was a 27-year-old female with pain in tooth #11, where investigations revealed Ellis class III fractures. The tooth was tender on percussion and negative to thermal tests while radiographic examination revealed periapical radiolucency with open nonblunderbuss root apex. A diagnosis of pulpal necrosis along with symptomatic apical periodontitis was formulated. The management included barrier formation with MTA putty. Thus, both teeth were managed using MTA putty via different techniques and highlight the role played by technological advancements and material formulations that guide us in achieving better healing outcomes. Moreover, this report highlights the importance of recording comprehensive dental history with clinical investigations when arriving at a diagnosis, rather than relying exclusively on radiographs.