Intracanal Calcification Following Apexification: A Case Series

Apexification is a widely employed procedure for managing immature permanent teeth with necrotic pulps, utilizing calcium hydroxide (Ca(OH)₂) and iodoform combinations for canal disinfection and apical barrier formation. While these medicaments are effective, prolonged placement due to missed follow-up appointments may predispose to intracanal calcification, complicating subsequent canal negotiation and obturation. This case series reports three pediatric patients who presented with pain in mandibular permanent first molars exhibiting immature apices (Cvek’s stage 4) and periapical radiolucencies. All patients had previously undergone apexification with a Ca(OH)₂-iodoform medicament (Metapex, Meta Biomed Co. Ltd., Cheongju, Korea) but missed scheduled follow-up appointments, reporting after six to 10 months. At recall, clinical symptoms had subsided, and radiographs showed healing of the periapical lesions. However, during re-instrumentation, extensive intracanal calcifications and calcific barriers were observed in the apical third, obstructing complete canal negotiation and interfering with working length determination. This case series emphasizes the importance of strict follow-up compliance and cautious monitoring when employing long-term intracanal medicaments in pediatric endodontics.