Nonsurgical Management of Open Apex with a Large Cystic Lesion Using One-step Apexification Utilizing Platelet-rich Fibrin and Biodentine as an Apical Barrier: A Case Report

Teeth with open apices that lack an apical constriction present multiple difficulties during standard endodontic therapy, particularly in achieving a proper seal at the apex.Management becomes more complex when such teeth are associated with extensive periapical cyst-like lesions, which may lead to expansion or thinning of the surrounding cortical bone.While surgical intervention is often employed in managing these cases, a conservative approach that provides a comparable prognosis is always preferred when possible.Various approaches have been used to treat open-apices teeth, with or without periapical lesions, ranging from prolonged apexification using calcium hydroxide to the use of materials like mineral trioxide aggregate (MTA), Biodentine for apical barrier formation.The present case highlights the management of teeth with an immature apex and a large periapical radiolucency using growth factor and tricalcium silicate cements as a barrier to promote nonsurgical healing.Collectively, PRF and Biodentine formed an apical plug along with growth factors that proved to be a suitable substrate for apexification in a single step.Due to its ability to deposit hydroxyapatite crystals at the material-dentin interface, Biodentine has strong interfacial adhesion and sealing with dentin.